ABIM Internal Medicine Boards / ITE – Actual
Practice Questions with Answers ABIM Internal
Medicine certification/MOC and IM-ITE
preparation LATEST UPDATED
VERSION
Coverage
Cardiovascular (~20 Q): ACS, heart failure, arrhythmias, valvular disease,
syncope, hypertension, lipids
Pulmonary / Critical Care (~20 Q): COPD, asthma, pneumonia, PE, ILD,
lung cancer, pleural disease, sepsis
Gastroenterology (~15 Q): GERD/Barrett’s, PUD/bleed, IBD, liver disease,
pancreatitis, biliary disease, GI cancers
Nephrology (~12 Q): AKI, CKD, electrolytes, glomerular diseases, stones,
dialysis basics
Infectious Disease (~15 Q): CAP, UTI/pyelo, skin/soft tissue,
meningitis/encephalitis, TB, HIV/OIs, endocarditis
Endocrinology / Metabolism (~12 Q): Diabetes, thyroid, adrenal, pituitary,
calcium/bone, metabolic emergencies
Hematology / Oncology (~15 Q): Anemias, hemoglobinopathies,
coagulopathy, leukemias, lymphomas, myeloma, MPNs, solid tumors
Rheumatology / Immunology (~12 Q): RA, SLE, vasculitides,
spondyloarthropathies, gout, myositis, scleroderma, GCA/PMR
Neurology (~12 Q): Stroke/TIA, seizures, headaches, movement disorders,
dementia, neuromuscular, MS/GBS
General Internal Medicine / Geriatrics / Women’s Health / Ethics (~17 Q):
Preventive care, screening, geriatric syndromes, pregnancy complications,
palliative care, ethics
Q1
,A 62-year-old man with hypertension and hyperlipidemia presents with 30 minutes of
crushing substernal chest pain radiating to the left arm. ECG shows 2-mm ST elevation in
leads II, III, and aVF. Which of the following is the most appropriate immediate reperfusion
strategy if PCI is available within 90 minutes?
A. Fibrinolytic therapy
B. Primary percutaneous coronary intervention (PCI)
C. Coronary artery bypass grafting (CABG)
D. Medical therapy alone
Correct answer: B
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI if it can be
performed within 90 minutes of first medical contact. Fibrinolysis is reserved for settings
where timely PCI is unavailable.
Q2
A 58-year-old woman presents with progressive dyspnea on exertion and orthopnea.
Echocardiogram shows LV ejection fraction of 25% and global hypokinesis. Which
medication has been shown to reduce mortality in patients with heart failure with reduced
ejection fraction (HFrEF)?
A. Furosemide
B. Digoxin
C. Carvedilol
D. Ivabradine
Correct answer: C
,Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in
HFrEF. Diuretics improve symptoms but not mortality; digoxin reduces hospitalizations but
not mortality.
Q3
A 67-year-old man with a history of MI presents with palpitations and lightheadedness. ECG
shows wide-complex tachycardia at 180 bpm, BP 70/40 mmHg. What is the most
appropriate immediate management?
A. Adenosine 6 mg IV
B. Synchronized cardioversion
C. Amiodarone 150 mg IV
D. Vagal maneuvers
Correct answer: B
Rationale: Unstable wide-complex tachycardia with hypotension requires immediate
synchronized cardioversion. Antiarrhythmics or adenosine are not appropriate first steps in
an unstable patient.
Q4
A 45-year-old woman has a blood pressure of 162/102 mmHg on three separate visits. She
has no symptoms and no secondary causes are suspected. Which of the following is the
most appropriate initial pharmacologic therapy?
A. Clonidine
B. Hydrochlorothiazide
, C. Hydralazine
D. Minoxidil
Correct answer: B
Rationale: Thiazide diuretics, ACE inhibitors, ARBs, or CCBs are appropriate first-line
agents for uncomplicated hypertension. Clonidine, hydralazine, and minoxidil are not
first-line.
Q5
A 70-year-old man with stable angina has an LDL cholesterol of 135 mg/dL. According to
current guidelines, which of the following is the most appropriate intensity of statin therapy?
A. No statin therapy
B. Low-intensity statin
C. Moderate- to high-intensity statin
D. Statin only if LDL >190 mg/dL
Correct answer: C
Rationale: Patients with clinical ASCVD (including stable angina) should receive at least
moderate- to high-intensity statin therapy regardless of baseline LDL.
Q6
A 55-year-old man presents with sudden onset severe “tearing” chest pain radiating to the
back. BP is 190/110 mmHg in the right arm and 150/90 mmHg in the left arm. CT
angiogram confirms aortic dissection. What is the most appropriate initial medical therapy?
Practice Questions with Answers ABIM Internal
Medicine certification/MOC and IM-ITE
preparation LATEST UPDATED
VERSION
Coverage
Cardiovascular (~20 Q): ACS, heart failure, arrhythmias, valvular disease,
syncope, hypertension, lipids
Pulmonary / Critical Care (~20 Q): COPD, asthma, pneumonia, PE, ILD,
lung cancer, pleural disease, sepsis
Gastroenterology (~15 Q): GERD/Barrett’s, PUD/bleed, IBD, liver disease,
pancreatitis, biliary disease, GI cancers
Nephrology (~12 Q): AKI, CKD, electrolytes, glomerular diseases, stones,
dialysis basics
Infectious Disease (~15 Q): CAP, UTI/pyelo, skin/soft tissue,
meningitis/encephalitis, TB, HIV/OIs, endocarditis
Endocrinology / Metabolism (~12 Q): Diabetes, thyroid, adrenal, pituitary,
calcium/bone, metabolic emergencies
Hematology / Oncology (~15 Q): Anemias, hemoglobinopathies,
coagulopathy, leukemias, lymphomas, myeloma, MPNs, solid tumors
Rheumatology / Immunology (~12 Q): RA, SLE, vasculitides,
spondyloarthropathies, gout, myositis, scleroderma, GCA/PMR
Neurology (~12 Q): Stroke/TIA, seizures, headaches, movement disorders,
dementia, neuromuscular, MS/GBS
General Internal Medicine / Geriatrics / Women’s Health / Ethics (~17 Q):
Preventive care, screening, geriatric syndromes, pregnancy complications,
palliative care, ethics
Q1
,A 62-year-old man with hypertension and hyperlipidemia presents with 30 minutes of
crushing substernal chest pain radiating to the left arm. ECG shows 2-mm ST elevation in
leads II, III, and aVF. Which of the following is the most appropriate immediate reperfusion
strategy if PCI is available within 90 minutes?
A. Fibrinolytic therapy
B. Primary percutaneous coronary intervention (PCI)
C. Coronary artery bypass grafting (CABG)
D. Medical therapy alone
Correct answer: B
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI if it can be
performed within 90 minutes of first medical contact. Fibrinolysis is reserved for settings
where timely PCI is unavailable.
Q2
A 58-year-old woman presents with progressive dyspnea on exertion and orthopnea.
Echocardiogram shows LV ejection fraction of 25% and global hypokinesis. Which
medication has been shown to reduce mortality in patients with heart failure with reduced
ejection fraction (HFrEF)?
A. Furosemide
B. Digoxin
C. Carvedilol
D. Ivabradine
Correct answer: C
,Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in
HFrEF. Diuretics improve symptoms but not mortality; digoxin reduces hospitalizations but
not mortality.
Q3
A 67-year-old man with a history of MI presents with palpitations and lightheadedness. ECG
shows wide-complex tachycardia at 180 bpm, BP 70/40 mmHg. What is the most
appropriate immediate management?
A. Adenosine 6 mg IV
B. Synchronized cardioversion
C. Amiodarone 150 mg IV
D. Vagal maneuvers
Correct answer: B
Rationale: Unstable wide-complex tachycardia with hypotension requires immediate
synchronized cardioversion. Antiarrhythmics or adenosine are not appropriate first steps in
an unstable patient.
Q4
A 45-year-old woman has a blood pressure of 162/102 mmHg on three separate visits. She
has no symptoms and no secondary causes are suspected. Which of the following is the
most appropriate initial pharmacologic therapy?
A. Clonidine
B. Hydrochlorothiazide
, C. Hydralazine
D. Minoxidil
Correct answer: B
Rationale: Thiazide diuretics, ACE inhibitors, ARBs, or CCBs are appropriate first-line
agents for uncomplicated hypertension. Clonidine, hydralazine, and minoxidil are not
first-line.
Q5
A 70-year-old man with stable angina has an LDL cholesterol of 135 mg/dL. According to
current guidelines, which of the following is the most appropriate intensity of statin therapy?
A. No statin therapy
B. Low-intensity statin
C. Moderate- to high-intensity statin
D. Statin only if LDL >190 mg/dL
Correct answer: C
Rationale: Patients with clinical ASCVD (including stable angina) should receive at least
moderate- to high-intensity statin therapy regardless of baseline LDL.
Q6
A 55-year-old man presents with sudden onset severe “tearing” chest pain radiating to the
back. BP is 190/110 mmHg in the right arm and 150/90 mmHg in the left arm. CT
angiogram confirms aortic dissection. What is the most appropriate initial medical therapy?
