ABIM IM BOARDS ITE EXAM NEWEST 2026 ACTUAL
EXAM TEST BANK| ABIM IM BOARDS ITE EXAM PREP
WITH COMPLETE 350 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!)
1. A 62-year-old man with hypertension and diabetes presents
with substernal chest pressure radiating to the jaw, occurring at
rest and lasting 15 minutes. ECG shows ST depression in V4–V6.
Troponin is elevated. What is the most appropriate next step?
A. Exercise stress test
B. Aspirin, clopidogrel, heparin, and urgent catheterization
C. Outpatient cardiology referral
D. Nitroglycerin and discharge with aspirin
Answer: B
Rationale: This patient has non-ST elevation myocardial infarction
(NSTEMI) based on symptoms, ECG changes, and elevated
troponin. High-risk features (diabetes, ongoing symptoms)
warrant urgent invasive strategy (within 24 hours) with dual
antiplatelet therapy (DAPT) and anticoagulation.
2. A 55-year-old man reports palpitations. ECG shows
irregularly irregular rhythm with no P waves and ventricular rate
1
,140 bpm. What is the most appropriate acute management if he
is hemodynamically stable?
A. Immediate synchronized cardioversion
B. Rate control with metoprolol or diltiazem
C. Aspirin 325 mg
D. Amiodarone 150 mg IV push
Answer: B
Rationale: Atrial fibrillation with rapid ventricular response in a
stable patient is managed with rate control (beta-blocker or
nondihydropyridine calcium channel blocker). Cardioversion is for
unstable patients or after appropriate anticoagulation.
3. A 70-year-old woman has a blood pressure of 150/90
mmHg. She has diabetes and chronic kidney disease (eGFR 40
mL/min). What is the target blood pressure for this patient per
recent guidelines?
A. <120/80 mmHg
B. <130/80 mmHg
C. <140/90 mmHg
D. <150/90 mmHg
Answer: B
Rationale: ACC/AHA guidelines recommend BP target <130/80
mmHg for patients with diabetes, CKD, or established
2
,cardiovascular disease. SPRINT trial supports intensive control but
excludes diabetes.
4. A patient with heart failure with reduced ejection fraction
(HFrEF, LVEF 30%) is on carvedilol, lisinopril, and furosemide.
Which medication has been shown to reduce mortality and should
be added?
A. Digoxin
B. Spironolactone
C. Hydralazine/isosorbide dinitrate
D. Diltiazem
Answer: B
Rationale: Mineralocorticoid receptor antagonists (spironolactone,
eplerenone) reduce mortality in HFrEF (NYHA II–IV). Add after
ACE inhibitor/ARB and beta-blocker. Digoxin reduces
hospitalizations but not mortality.
5. A 48-year-old man has a new murmur. On auscultation, there
is a mid-systolic click followed by a late systolic murmur at the
apex. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
3
, D. Mitral regurgitation from papillary muscle rupture
Answer: B
Rationale: Mid-systolic click + late systolic murmur is classic for
mitral valve prolapse. The click occurs when chordae snap taut
during systole; murmur from regurgitation.
6. A patient with chest pain has ECG showing ST elevation in
leads V1–V4. Cardiac catheterization shows 90% proximal LAD
stenosis. What is the most appropriate next step?
A. Medical management with aspirin and statin
B. PCI with drug-eluting stent
C. CABG
D. Thrombolytics
Answer: B
Rationale: STEMI (ST elevation in V1–V4 = anterior MI) requires
emergent reperfusion. PCI is preferred if door-to-balloon time
<90 minutes. Thrombolytics if PCI not available.
7. A 72-year-old man with hypertension reports lightheadedness
when standing. BP supine 140/80, HR 72; standing BP 100/60,
HR 80. Which medication is most likely contributing?
A. Metoprolol
B. Lisinopril
4
EXAM TEST BANK| ABIM IM BOARDS ITE EXAM PREP
WITH COMPLETE 350 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!)
1. A 62-year-old man with hypertension and diabetes presents
with substernal chest pressure radiating to the jaw, occurring at
rest and lasting 15 minutes. ECG shows ST depression in V4–V6.
Troponin is elevated. What is the most appropriate next step?
A. Exercise stress test
B. Aspirin, clopidogrel, heparin, and urgent catheterization
C. Outpatient cardiology referral
D. Nitroglycerin and discharge with aspirin
Answer: B
Rationale: This patient has non-ST elevation myocardial infarction
(NSTEMI) based on symptoms, ECG changes, and elevated
troponin. High-risk features (diabetes, ongoing symptoms)
warrant urgent invasive strategy (within 24 hours) with dual
antiplatelet therapy (DAPT) and anticoagulation.
2. A 55-year-old man reports palpitations. ECG shows
irregularly irregular rhythm with no P waves and ventricular rate
1
,140 bpm. What is the most appropriate acute management if he
is hemodynamically stable?
A. Immediate synchronized cardioversion
B. Rate control with metoprolol or diltiazem
C. Aspirin 325 mg
D. Amiodarone 150 mg IV push
Answer: B
Rationale: Atrial fibrillation with rapid ventricular response in a
stable patient is managed with rate control (beta-blocker or
nondihydropyridine calcium channel blocker). Cardioversion is for
unstable patients or after appropriate anticoagulation.
3. A 70-year-old woman has a blood pressure of 150/90
mmHg. She has diabetes and chronic kidney disease (eGFR 40
mL/min). What is the target blood pressure for this patient per
recent guidelines?
A. <120/80 mmHg
B. <130/80 mmHg
C. <140/90 mmHg
D. <150/90 mmHg
Answer: B
Rationale: ACC/AHA guidelines recommend BP target <130/80
mmHg for patients with diabetes, CKD, or established
2
,cardiovascular disease. SPRINT trial supports intensive control but
excludes diabetes.
4. A patient with heart failure with reduced ejection fraction
(HFrEF, LVEF 30%) is on carvedilol, lisinopril, and furosemide.
Which medication has been shown to reduce mortality and should
be added?
A. Digoxin
B. Spironolactone
C. Hydralazine/isosorbide dinitrate
D. Diltiazem
Answer: B
Rationale: Mineralocorticoid receptor antagonists (spironolactone,
eplerenone) reduce mortality in HFrEF (NYHA II–IV). Add after
ACE inhibitor/ARB and beta-blocker. Digoxin reduces
hospitalizations but not mortality.
5. A 48-year-old man has a new murmur. On auscultation, there
is a mid-systolic click followed by a late systolic murmur at the
apex. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
3
, D. Mitral regurgitation from papillary muscle rupture
Answer: B
Rationale: Mid-systolic click + late systolic murmur is classic for
mitral valve prolapse. The click occurs when chordae snap taut
during systole; murmur from regurgitation.
6. A patient with chest pain has ECG showing ST elevation in
leads V1–V4. Cardiac catheterization shows 90% proximal LAD
stenosis. What is the most appropriate next step?
A. Medical management with aspirin and statin
B. PCI with drug-eluting stent
C. CABG
D. Thrombolytics
Answer: B
Rationale: STEMI (ST elevation in V1–V4 = anterior MI) requires
emergent reperfusion. PCI is preferred if door-to-balloon time
<90 minutes. Thrombolytics if PCI not available.
7. A 72-year-old man with hypertension reports lightheadedness
when standing. BP supine 140/80, HR 72; standing BP 100/60,
HR 80. Which medication is most likely contributing?
A. Metoprolol
B. Lisinopril
4
