ABIM Internal Medicine ITE Test Bank – Complete
Practice Questions with Verified Answers &
Explanations – Updated 2025/2026 In-Training
Exam Prep
1. A 67-year-old man presents with worsening dyspnea on exertion. His exam
reveals a prolonged expiratory phase and wheezing. What is the most likely
diagnosis?
(A) Heart failure
(B) Chronic obstructive pulmonary disease (COPD)
(C) Asthma
(D) Pulmonary fibrosis
Rationale: The patient's age, symptoms of dyspnea, prolonged expiratory phase,
and wheezing are classic signs of COPD, characterized by airflow limitation and
chronic inflammation.
2. Which of the following is a common side effect of thiazide diuretics?
(A) Hyperkalemia
(B) Hypokalemia
(C) Hyperglycemia
(D) Hyponatremia
Rationale: Thiazide diuretics frequently cause hypokalemia due to increased
potassium excretion in the urine, which can lead to muscle weakness and
arrhythmias.
3. A 55-year-old woman presents with fatigue and pallor. Laboratory tests
reveal a hemoglobin level of 8 g/dL and iron studies show low serum ferritin
and low serum iron. What is the most likely diagnosis?
(A) Anemia of chronic disease
(B) Iron deficiency anemia
(C) Aplastic anemia
(D) Hemolytic anemia
Rationale: The combination of low serum ferritin and low serum iron indicates
iron deficiency anemia, which is characterized by decreased iron stores and
impaired hemoglobin synthesis.
4. In a patient with diabetes, what is the most appropriate target for HbA1c to
reduce the risk of complications?
(A) < 6.0%
(B) < 7.0%
, (C) < 8.0%
(D) < 9.0%
Rationale: An HbA1c target of less than 7.0% is generally recommended to
reduce the risk of microvascular and macrovascular complications in patients
with diabetes.
5. A 62-year-old male with a history of smoking presents with a new cough and
hemoptysis. A chest X-ray shows a mass in the right lung. What is the next
best step in management?
(A) Observation
(B) CT scan of the chest
(C) Bronchoscopy
(D) Biopsy
Rationale: A CT scan of the chest is warranted to further evaluate the lung mass,
including its size, characteristics, and potential lymphadenopathy, before
deciding on a biopsy.
6. What is the most common cause of secondary hypertension in adults?
(A) Primary hyperaldosteronism
(B) Renal disease
(C) Cushing's syndrome
(D) Pheochromocytoma
Rationale: Renal disease, particularly chronic kidney disease, is the most
common cause of secondary hypertension due to fluid overload and activation
of the renin-angiotensin-aldosterone system.
7. A 70-year-old woman is found to have a blood pressure of 160/90 mmHg
during a routine visit. She has no other medical history. What is the most
appropriate initial treatment?
(A) Beta-blocker
(B) Diuretic
(C) Thiazide diuretic
(D) ACE inhibitor
Rationale: A thiazide diuretic is recommended as first-line therapy for
uncomplicated hypertension in older adults, especially if they are not at high risk
for other cardiovascular diseases.
8. What is the mechanism of action of metformin in the management of type 2
diabetes?
(A) Increases insulin secretion
, (B) Decreases hepatic glucose production
(C) Enhances peripheral glucose uptake
(D) Increases intestinal glucose absorption
Rationale: Metformin primarily works by decreasing hepatic glucose production
and improving insulin sensitivity, making it the first-line medication for type 2
diabetes.
9. A patient presents with a 3-week history of fever, night sweats, and weight
loss. A chest X-ray reveals cavitary lesions in the upper lobes. What is the
most likely diagnosis?
(A) Lung cancer
(B) Tuberculosis
(C) Fungal infection
(D) Sarcoidosis
Rationale: The symptoms and radiographic findings are highly suggestive of
pulmonary tuberculosis, especially in the setting of cavitary lesions.
10. Which of the following findings is most consistent with a diagnosis of heart
failure with preserved ejection fraction (HFpEF)?
(A) Reduced ejection fraction
(B) Left ventricular hypertrophy
(C) S3 gallop
(D) Pulmonary congestion
Rationale: HFpEF is often associated with left ventricular hypertrophy and
diastolic dysfunction, while the ejection fraction remains preserved.
11. A 45-year-old woman presents with a butterfly rash on her face, joint pain,
and fatigue. What is the most likely diagnosis?
(A) Psoriasis
(B) Systemic lupus erythematosus (SLE)
(C) Dermatomyositis
(D) Sjögren's syndrome
Rationale: The butterfly rash and systemic symptoms are classic features of
systemic lupus erythematosus, an autoimmune disease.
12. What is the first-line treatment for chronic stable angina?
(A) Beta-blockers
(B) Calcium channel blockers
(C) Nitrates
(D) Statins
, Rationale: Nitrates are effective for immediate relief of anginal symptoms, while
beta-blockers are also considered a first-line treatment for long-term
management.
13. In a patient with acute pancreatitis, what is the most important initial
management step?
(A) Antibiotics
(B) Fluid resuscitation
(C) Surgery
(D) Pain management
Rationale: Fluid resuscitation is crucial in the initial management of acute
pancreatitis to prevent complications such as shock and organ failure.
14. A 30-year-old woman presents with amenorrhea and weight loss. Laboratory
findings reveal elevated TSH and low free T4. What is the most likely
diagnosis?
(A) Primary hyperthyroidism
(B) Primary hypothyroidism
(C) Secondary hypothyroidism
(D) Thyroiditis
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism,
which can result in menstrual irregularities such as amenorrhea.
15. What is the most appropriate screening method for colorectal cancer in
average-risk adults?
(A) Flexible sigmoidoscopy every 5 years
(B) Colonoscopy every 10 years
(C) Fecal occult blood test annually
(D) CT colonography every 5 years
Rationale: Colonoscopy every 10 years is the recommended screening method
for colorectal cancer for average-risk adults starting at age 45.
16. A 70-year-old male presents with confusion and has a history of dementia.
His family reports he has not been eating well. What electrolyte abnormality
should you suspect?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypercalcemia
(D) Hypomagnesemia
Practice Questions with Verified Answers &
Explanations – Updated 2025/2026 In-Training
Exam Prep
1. A 67-year-old man presents with worsening dyspnea on exertion. His exam
reveals a prolonged expiratory phase and wheezing. What is the most likely
diagnosis?
(A) Heart failure
(B) Chronic obstructive pulmonary disease (COPD)
(C) Asthma
(D) Pulmonary fibrosis
Rationale: The patient's age, symptoms of dyspnea, prolonged expiratory phase,
and wheezing are classic signs of COPD, characterized by airflow limitation and
chronic inflammation.
2. Which of the following is a common side effect of thiazide diuretics?
(A) Hyperkalemia
(B) Hypokalemia
(C) Hyperglycemia
(D) Hyponatremia
Rationale: Thiazide diuretics frequently cause hypokalemia due to increased
potassium excretion in the urine, which can lead to muscle weakness and
arrhythmias.
3. A 55-year-old woman presents with fatigue and pallor. Laboratory tests
reveal a hemoglobin level of 8 g/dL and iron studies show low serum ferritin
and low serum iron. What is the most likely diagnosis?
(A) Anemia of chronic disease
(B) Iron deficiency anemia
(C) Aplastic anemia
(D) Hemolytic anemia
Rationale: The combination of low serum ferritin and low serum iron indicates
iron deficiency anemia, which is characterized by decreased iron stores and
impaired hemoglobin synthesis.
4. In a patient with diabetes, what is the most appropriate target for HbA1c to
reduce the risk of complications?
(A) < 6.0%
(B) < 7.0%
, (C) < 8.0%
(D) < 9.0%
Rationale: An HbA1c target of less than 7.0% is generally recommended to
reduce the risk of microvascular and macrovascular complications in patients
with diabetes.
5. A 62-year-old male with a history of smoking presents with a new cough and
hemoptysis. A chest X-ray shows a mass in the right lung. What is the next
best step in management?
(A) Observation
(B) CT scan of the chest
(C) Bronchoscopy
(D) Biopsy
Rationale: A CT scan of the chest is warranted to further evaluate the lung mass,
including its size, characteristics, and potential lymphadenopathy, before
deciding on a biopsy.
6. What is the most common cause of secondary hypertension in adults?
(A) Primary hyperaldosteronism
(B) Renal disease
(C) Cushing's syndrome
(D) Pheochromocytoma
Rationale: Renal disease, particularly chronic kidney disease, is the most
common cause of secondary hypertension due to fluid overload and activation
of the renin-angiotensin-aldosterone system.
7. A 70-year-old woman is found to have a blood pressure of 160/90 mmHg
during a routine visit. She has no other medical history. What is the most
appropriate initial treatment?
(A) Beta-blocker
(B) Diuretic
(C) Thiazide diuretic
(D) ACE inhibitor
Rationale: A thiazide diuretic is recommended as first-line therapy for
uncomplicated hypertension in older adults, especially if they are not at high risk
for other cardiovascular diseases.
8. What is the mechanism of action of metformin in the management of type 2
diabetes?
(A) Increases insulin secretion
, (B) Decreases hepatic glucose production
(C) Enhances peripheral glucose uptake
(D) Increases intestinal glucose absorption
Rationale: Metformin primarily works by decreasing hepatic glucose production
and improving insulin sensitivity, making it the first-line medication for type 2
diabetes.
9. A patient presents with a 3-week history of fever, night sweats, and weight
loss. A chest X-ray reveals cavitary lesions in the upper lobes. What is the
most likely diagnosis?
(A) Lung cancer
(B) Tuberculosis
(C) Fungal infection
(D) Sarcoidosis
Rationale: The symptoms and radiographic findings are highly suggestive of
pulmonary tuberculosis, especially in the setting of cavitary lesions.
10. Which of the following findings is most consistent with a diagnosis of heart
failure with preserved ejection fraction (HFpEF)?
(A) Reduced ejection fraction
(B) Left ventricular hypertrophy
(C) S3 gallop
(D) Pulmonary congestion
Rationale: HFpEF is often associated with left ventricular hypertrophy and
diastolic dysfunction, while the ejection fraction remains preserved.
11. A 45-year-old woman presents with a butterfly rash on her face, joint pain,
and fatigue. What is the most likely diagnosis?
(A) Psoriasis
(B) Systemic lupus erythematosus (SLE)
(C) Dermatomyositis
(D) Sjögren's syndrome
Rationale: The butterfly rash and systemic symptoms are classic features of
systemic lupus erythematosus, an autoimmune disease.
12. What is the first-line treatment for chronic stable angina?
(A) Beta-blockers
(B) Calcium channel blockers
(C) Nitrates
(D) Statins
, Rationale: Nitrates are effective for immediate relief of anginal symptoms, while
beta-blockers are also considered a first-line treatment for long-term
management.
13. In a patient with acute pancreatitis, what is the most important initial
management step?
(A) Antibiotics
(B) Fluid resuscitation
(C) Surgery
(D) Pain management
Rationale: Fluid resuscitation is crucial in the initial management of acute
pancreatitis to prevent complications such as shock and organ failure.
14. A 30-year-old woman presents with amenorrhea and weight loss. Laboratory
findings reveal elevated TSH and low free T4. What is the most likely
diagnosis?
(A) Primary hyperthyroidism
(B) Primary hypothyroidism
(C) Secondary hypothyroidism
(D) Thyroiditis
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism,
which can result in menstrual irregularities such as amenorrhea.
15. What is the most appropriate screening method for colorectal cancer in
average-risk adults?
(A) Flexible sigmoidoscopy every 5 years
(B) Colonoscopy every 10 years
(C) Fecal occult blood test annually
(D) CT colonography every 5 years
Rationale: Colonoscopy every 10 years is the recommended screening method
for colorectal cancer for average-risk adults starting at age 45.
16. A 70-year-old male presents with confusion and has a history of dementia.
His family reports he has not been eating well. What electrolyte abnormality
should you suspect?
(A) Hyperkalemia
(B) Hyponatremia
(C) Hypercalcemia
(D) Hypomagnesemia
