ABIM Internal Medicine-style practice
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 65-year-old man with a history of hypertension presents with sudden onset chest
pain radiating to his back. Blood pressure is 180/100 mmHg, pulse 110 bpm. Which is
the most appropriate next step in management?
A) Start nitroglycerin infusion
B) Emergent ECG and troponin
C) Immediate CT angiography of chest
D) Administer aspirin
Answer: C
Rationale: Sudden, severe chest pain radiating to the back in a hypertensive patient raises
concern for acute aortic dissection. CT angiography is the imaging modality of choice for
diagnosis. Blood pressure control is important, but imaging comes first for confirmation.
2. A 72-year-old woman presents with fatigue, pallor, and a hemoglobin of 8 g/dL. MCV
is 72 fL. Which is the most likely cause?
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Anemia of chronic disease
D) Folate deficiency
Answer: B
Rationale: Microcytic anemia (MCV <80 fL) in an elderly patient is most commonly due to
iron deficiency, often secondary to chronic blood loss, e.g., gastrointestinal bleeding.
, 3. A 55-year-old man presents with fever, cough, and pleuritic chest pain. Chest X-ray
shows a lobar consolidation. Which is the most likely organism?
A) Mycoplasma pneumoniae
B) Streptococcus pneumoniae
C) Legionella pneumophila
D) Haemophilus influenzae
Answer: B
Rationale: Acute onset of fever, productive cough, and lobar consolidation is classic for
Streptococcus pneumoniae pneumonia.
4. Which medication is first-line for rate control in a patient with atrial fibrillation and
preserved left ventricular function?
A) Digoxin
B) Amiodarone
C) Metoprolol
D) Verapamil
Answer: C
Rationale: Beta-blockers are first-line for rate control in AF with preserved systolic
function.
5. A 48-year-old man with diabetes presents with polyuria, polydipsia, and fasting
glucose of 320 mg/dL. Which is the most appropriate next step?
A) Start insulin immediately
B) Prescribe metformin
C) Check hemoglobin A1c
D) Schedule an oral glucose tolerance test
Answer: A
Rationale: Severe hyperglycemia with symptomatic presentation warrants immediate
insulin therapy.
6. A 60-year-old man has progressive shortness of breath. Chest X-ray shows bilateral
hilar lymphadenopathy. Which is the most likely diagnosis?
A) Sarcoidosis
B) Tuberculosis
C) Pulmonary edema
D) Pneumoconiosis
Answer: A
Rationale: Bilateral hilar lymphadenopathy, particularly in a middle-aged adult, is classic
for sarcoidosis.
, 7. A patient with chronic kidney disease has hyperphosphatemia. Which is the most
appropriate therapy?
A) Calcium carbonate
B) Furosemide
C) Sodium bicarbonate
D) Vitamin D
Answer: A
Rationale: Calcium-based phosphate binders like calcium carbonate are used to treat
hyperphosphatemia in CKD.
8. A 40-year-old woman presents with proximal muscle weakness and a heliotrope rash.
Which is the most likely diagnosis?
A) Polymyalgia rheumatica
B) Dermatomyositis
C) Myasthenia gravis
D) Guillain-Barre syndrome
Answer: B
Rationale: Heliotrope rash with proximal muscle weakness is characteristic of
dermatomyositis.
9. Which drug is most effective for secondary prevention after myocardial infarction?
A) Nifedipine
B) Aspirin
C) Furosemide
D) Amiodarone
Answer: B
Rationale: Aspirin reduces recurrent cardiovascular events and is first-line for secondary
prevention post-MI.
10. A 70-year-old man with chronic alcohol use presents with confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine (B1)
C) Vitamin B6
D) Folate
Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine deficiency, commonly seen in
chronic alcoholics.
11. Which of the following is the most common cause of community-acquired
pneumonia in adults?
Exam With Actual 120 Questions &
Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 65-year-old man with a history of hypertension presents with sudden onset chest
pain radiating to his back. Blood pressure is 180/100 mmHg, pulse 110 bpm. Which is
the most appropriate next step in management?
A) Start nitroglycerin infusion
B) Emergent ECG and troponin
C) Immediate CT angiography of chest
D) Administer aspirin
Answer: C
Rationale: Sudden, severe chest pain radiating to the back in a hypertensive patient raises
concern for acute aortic dissection. CT angiography is the imaging modality of choice for
diagnosis. Blood pressure control is important, but imaging comes first for confirmation.
2. A 72-year-old woman presents with fatigue, pallor, and a hemoglobin of 8 g/dL. MCV
is 72 fL. Which is the most likely cause?
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Anemia of chronic disease
D) Folate deficiency
Answer: B
Rationale: Microcytic anemia (MCV <80 fL) in an elderly patient is most commonly due to
iron deficiency, often secondary to chronic blood loss, e.g., gastrointestinal bleeding.
, 3. A 55-year-old man presents with fever, cough, and pleuritic chest pain. Chest X-ray
shows a lobar consolidation. Which is the most likely organism?
A) Mycoplasma pneumoniae
B) Streptococcus pneumoniae
C) Legionella pneumophila
D) Haemophilus influenzae
Answer: B
Rationale: Acute onset of fever, productive cough, and lobar consolidation is classic for
Streptococcus pneumoniae pneumonia.
4. Which medication is first-line for rate control in a patient with atrial fibrillation and
preserved left ventricular function?
A) Digoxin
B) Amiodarone
C) Metoprolol
D) Verapamil
Answer: C
Rationale: Beta-blockers are first-line for rate control in AF with preserved systolic
function.
5. A 48-year-old man with diabetes presents with polyuria, polydipsia, and fasting
glucose of 320 mg/dL. Which is the most appropriate next step?
A) Start insulin immediately
B) Prescribe metformin
C) Check hemoglobin A1c
D) Schedule an oral glucose tolerance test
Answer: A
Rationale: Severe hyperglycemia with symptomatic presentation warrants immediate
insulin therapy.
6. A 60-year-old man has progressive shortness of breath. Chest X-ray shows bilateral
hilar lymphadenopathy. Which is the most likely diagnosis?
A) Sarcoidosis
B) Tuberculosis
C) Pulmonary edema
D) Pneumoconiosis
Answer: A
Rationale: Bilateral hilar lymphadenopathy, particularly in a middle-aged adult, is classic
for sarcoidosis.
, 7. A patient with chronic kidney disease has hyperphosphatemia. Which is the most
appropriate therapy?
A) Calcium carbonate
B) Furosemide
C) Sodium bicarbonate
D) Vitamin D
Answer: A
Rationale: Calcium-based phosphate binders like calcium carbonate are used to treat
hyperphosphatemia in CKD.
8. A 40-year-old woman presents with proximal muscle weakness and a heliotrope rash.
Which is the most likely diagnosis?
A) Polymyalgia rheumatica
B) Dermatomyositis
C) Myasthenia gravis
D) Guillain-Barre syndrome
Answer: B
Rationale: Heliotrope rash with proximal muscle weakness is characteristic of
dermatomyositis.
9. Which drug is most effective for secondary prevention after myocardial infarction?
A) Nifedipine
B) Aspirin
C) Furosemide
D) Amiodarone
Answer: B
Rationale: Aspirin reduces recurrent cardiovascular events and is first-line for secondary
prevention post-MI.
10. A 70-year-old man with chronic alcohol use presents with confusion,
ophthalmoplegia, and ataxia. Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine (B1)
C) Vitamin B6
D) Folate
Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine deficiency, commonly seen in
chronic alcoholics.
11. Which of the following is the most common cause of community-acquired
pneumonia in adults?
