ABIM INTERNAL MEDICINE BOARDS & ITE ACTUAL
EXAM 2026-2027 COMPLETE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED ANSWERS) NEWEST ABIM INTERNAL
MEDICINE BOARDS & ITE EDITION 2026 ALREADY
GRADED A+ |INSTANT DOWNLOAD PDF
A 67-year-old man with hypertension and hyperlipidemia develops substernal chest
pressure while climbing stairs. The discomfort resolves after 5 minutes of rest.
ECG at rest is normal. Which of the following is the most appropriate initial
diagnostic test?
A. Coronary CT angiography
B. Exercise treadmill ECG
C. Transthoracic echocardiography
D. Urgent coronary angiography
E. 24-hour ambulatory ECG monitoring
ANSWER: A. Coronary CT angiography
,Coronary CT angiography is an appropriate initial noninvasive test for many
patients with stable chest pain and an intermediate probability of obstructive
coronary disease, particularly when anatomic clarification is desirable. Exercise
ECG alone is less accurate and is generally preferred only in selected patients with
an interpretable ECG and adequate exercise capacity. Echocardiography evaluates
ventricular structure and function but does not directly exclude coronary disease.
Urgent angiography is reserved for high-risk or unstable presentations. Ambulatory
ECG monitoring evaluates intermittent arrhythmias rather than exertional
ischemia.
A 72-year-old woman presents with acute dyspnea, orthopnea, and bilateral
crackles. Blood pressure is 174/96 mm Hg, oxygen saturation is 86%, and chest
radiograph shows pulmonary edema. Which intervention should be performed
immediately?
A. Intravenous normal saline
B. Intravenous loop diuretic and noninvasive positive-pressure ventilation
C. Oral beta blocker
D. Intravenous digoxin
E. Fluid restriction alone
ANSWER: B. Intravenous loop diuretic and noninvasive positive-pressure
ventilation
This patient has acute cardiogenic pulmonary edema with significant hypoxemia
and hypertension. Noninvasive positive-pressure ventilation rapidly improves
oxygenation and reduces preload and afterload. Intravenous loop diuretics treat
volume overload. Normal saline would worsen pulmonary edema. A beta blocker
,should not be newly initiated during acute decompensation. Digoxin has no role as
immediate therapy for pulmonary edema. Fluid restriction alone is insufficient.
A 59-year-old man presents with an inferior STEMI. He receives aspirin and
undergoes successful PCI. Three days later, he develops a new harsh systolic
murmur and sudden pulmonary edema. Which complication is most likely?
A. Papillary muscle rupture
B. Dressler syndrome
C. Ventricular aneurysm
D. Pericarditis
E. Left ventricular free-wall rupture
ANSWER: A. Papillary muscle rupture
Papillary muscle rupture typically occurs 2–7 days after myocardial infarction and
causes acute severe mitral regurgitation, pulmonary edema, and a new holosystolic
murmur. Inferior infarctions are particularly associated with posteromedial
papillary muscle rupture because it usually has a single blood supply. Dressler
syndrome occurs weeks later. Ventricular aneurysm develops later and causes
persistent ST elevation. Free-wall rupture causes hemopericardium and tamponade.
A 74-year-old woman has atrial fibrillation and hypertension. Her ventricular rate
is 128/min. She is hemodynamically stable. Which medication is most appropriate
for acute rate control?
A. Adenosine
, B. Metoprolol
C. Amiodarone in every case
D. Flecainide
E. Lidocaine
ANSWER: B. Metoprolol
In a hemodynamically stable patient with atrial fibrillation and rapid ventricular
response, a beta blocker such as metoprolol is an effective acute rate-control agent.
Adenosine transiently blocks AV-node conduction but does not terminate typical
atrial fibrillation. Flecainide is used for rhythm control in selected patients without
significant structural heart disease, not routine acute rate control. Lidocaine is
primarily used for ventricular arrhythmias. Amiodarone can be used in selected
circumstances but is not the routine first-line rate-control drug in a stable patient.
A 68-year-old man with systolic heart failure has an ejection fraction of 30%.
Which medication combination has established mortality benefit in chronic
HFrEF?
A. Furosemide and digoxin
B. Sacubitril/valsartan, evidence-based beta blocker, and mineralocorticoid
receptor antagonist
C. Diltiazem and hydrochlorothiazide
D. Nifedipine and digoxin
E. Hydrochlorothiazide alone
EXAM 2026-2027 COMPLETE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED ANSWERS) NEWEST ABIM INTERNAL
MEDICINE BOARDS & ITE EDITION 2026 ALREADY
GRADED A+ |INSTANT DOWNLOAD PDF
A 67-year-old man with hypertension and hyperlipidemia develops substernal chest
pressure while climbing stairs. The discomfort resolves after 5 minutes of rest.
ECG at rest is normal. Which of the following is the most appropriate initial
diagnostic test?
A. Coronary CT angiography
B. Exercise treadmill ECG
C. Transthoracic echocardiography
D. Urgent coronary angiography
E. 24-hour ambulatory ECG monitoring
ANSWER: A. Coronary CT angiography
,Coronary CT angiography is an appropriate initial noninvasive test for many
patients with stable chest pain and an intermediate probability of obstructive
coronary disease, particularly when anatomic clarification is desirable. Exercise
ECG alone is less accurate and is generally preferred only in selected patients with
an interpretable ECG and adequate exercise capacity. Echocardiography evaluates
ventricular structure and function but does not directly exclude coronary disease.
Urgent angiography is reserved for high-risk or unstable presentations. Ambulatory
ECG monitoring evaluates intermittent arrhythmias rather than exertional
ischemia.
A 72-year-old woman presents with acute dyspnea, orthopnea, and bilateral
crackles. Blood pressure is 174/96 mm Hg, oxygen saturation is 86%, and chest
radiograph shows pulmonary edema. Which intervention should be performed
immediately?
A. Intravenous normal saline
B. Intravenous loop diuretic and noninvasive positive-pressure ventilation
C. Oral beta blocker
D. Intravenous digoxin
E. Fluid restriction alone
ANSWER: B. Intravenous loop diuretic and noninvasive positive-pressure
ventilation
This patient has acute cardiogenic pulmonary edema with significant hypoxemia
and hypertension. Noninvasive positive-pressure ventilation rapidly improves
oxygenation and reduces preload and afterload. Intravenous loop diuretics treat
volume overload. Normal saline would worsen pulmonary edema. A beta blocker
,should not be newly initiated during acute decompensation. Digoxin has no role as
immediate therapy for pulmonary edema. Fluid restriction alone is insufficient.
A 59-year-old man presents with an inferior STEMI. He receives aspirin and
undergoes successful PCI. Three days later, he develops a new harsh systolic
murmur and sudden pulmonary edema. Which complication is most likely?
A. Papillary muscle rupture
B. Dressler syndrome
C. Ventricular aneurysm
D. Pericarditis
E. Left ventricular free-wall rupture
ANSWER: A. Papillary muscle rupture
Papillary muscle rupture typically occurs 2–7 days after myocardial infarction and
causes acute severe mitral regurgitation, pulmonary edema, and a new holosystolic
murmur. Inferior infarctions are particularly associated with posteromedial
papillary muscle rupture because it usually has a single blood supply. Dressler
syndrome occurs weeks later. Ventricular aneurysm develops later and causes
persistent ST elevation. Free-wall rupture causes hemopericardium and tamponade.
A 74-year-old woman has atrial fibrillation and hypertension. Her ventricular rate
is 128/min. She is hemodynamically stable. Which medication is most appropriate
for acute rate control?
A. Adenosine
, B. Metoprolol
C. Amiodarone in every case
D. Flecainide
E. Lidocaine
ANSWER: B. Metoprolol
In a hemodynamically stable patient with atrial fibrillation and rapid ventricular
response, a beta blocker such as metoprolol is an effective acute rate-control agent.
Adenosine transiently blocks AV-node conduction but does not terminate typical
atrial fibrillation. Flecainide is used for rhythm control in selected patients without
significant structural heart disease, not routine acute rate control. Lidocaine is
primarily used for ventricular arrhythmias. Amiodarone can be used in selected
circumstances but is not the routine first-line rate-control drug in a stable patient.
A 68-year-old man with systolic heart failure has an ejection fraction of 30%.
Which medication combination has established mortality benefit in chronic
HFrEF?
A. Furosemide and digoxin
B. Sacubitril/valsartan, evidence-based beta blocker, and mineralocorticoid
receptor antagonist
C. Diltiazem and hydrochlorothiazide
D. Nifedipine and digoxin
E. Hydrochlorothiazide alone
