ABIM INTERNAL MEDICINE EXAM – ACTUAL 250 REAL
QUESTIONS & VERIFIED ANSWERS | INTERNAL MEDICINE
BOARD PREP (GRADED A+)
Overview
This resource provides a comprehensive 250-question ABIM Internal Medicine practice
exam Every question is in multiple-choice format with clear italicized explanations, covering
all blueprint domains:
Cardiology
Pulmonology
Infectious Disease
Endocrinology
Gastroenterology
Hematology/Oncology
Rheumatology
Neurology
Dermatology
Psychiatry
Geriatrics
Ethics & Patient Safety
Cardiovascular Disease
1. 65-year-old man with HFrEF (EF 30%) on metoprolol and lisinopril. Which additional
therapy improves survival?
A. Digoxin
B. Furosemide
C. Spironolactone
D. Ivabradine Answer: C Spironolactone, a mineralocorticoid receptor antagonist,
reduces mortality in HFrEF patients when added to ACE inhibitors and
beta-blockers.
, 2. NSTEMI patient post-PCI with drug-eluting stent. Duration of dual antiplatelet
therapy?
A. 1 month
B. 3 months
C. 6 months
D. 12 months Answer: D Guidelines recommend at least 12 months of dual
antiplatelet therapy (aspirin + P2Y12 inhibitor) after drug-eluting stent placement in
ACS.
3. 55-year-old with syncope, ECG shows prolonged QTc. Which drug most likely
responsible?
A. Amiodarone
B. Ciprofloxacin
C. Digoxin
D. Metoprolol Answer: B Fluoroquinolones like ciprofloxacin can prolong QT interval
and predispose to torsades de pointes.
4. 70-year-old with severe aortic stenosis, symptomatic. Best management?
A. Medical therapy
B. Balloon valvuloplasty
C. Surgical valve replacement
D. Watchful waiting Answer: C Definitive treatment for symptomatic severe aortic
stenosis is valve replacement (surgical or TAVR).
5. Patient with AF, CHA₂DS₂-VASc = 3. Best management?
A. Aspirin
B. Warfarin
C. DOAC
D. No therapy Answer: C Oral anticoagulation with a DOAC is preferred for stroke
prevention in AF with CHA₂DS₂-VASc ≥2.
Pulmonary Disease
,6. COPD patient with FEV1 45% predicted, FEV1/FVC 0.55. GOLD stage?
A. I
B. II
C. III
D. IV Answer: C FEV1 30–49% predicted corresponds to GOLD stage III (severe).
7. Asthma patient with daily symptoms, nighttime awakenings twice per week, FEV1
70%. Severity?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent Answer: C Daily symptoms and FEV1 60–80% predicted
indicate moderate persistent asthma.
8. 60-year-old smoker with hemoptysis. Best initial diagnostic test?
A. Chest X-ray
B. CT chest
C. Sputum cytology
D. Bronchoscopy Answer: B CT chest is the most sensitive initial test for lung
cancer evaluation in a smoker with hemoptysis.
9. Patient with pleural effusion, exudative by Light’s criteria. Most likely cause?
A. CHF
B. Cirrhosis
C. Pneumonia
D. Nephrotic syndrome Answer: C Exudative effusions are commonly due to
infection, malignancy, or inflammatory conditions; pneumonia is classic.
10. Sarcoidosis hallmark finding?
A. Caseating granulomas
B. Non-caseating granulomas
, C. Necrosis
D. Fibrosis only Answer: B Sarcoidosis is characterized by non-caseating
granulomas in affected tissues.
Infectious Disease
11. HIV patient, CD4 40, bilateral interstitial infiltrates. Diagnosis?
A. PCP
B. CMV
C. TB
D. Bacterial pneumonia Answer: A PCP pneumonia presents with hypoxia and
diffuse interstitial infiltrates in patients with CD4 <200.
12. HIV patient with odynophagia, endoscopy shows white plaques. Cause?
A. HSV
B. CMV
C. Candida
D. EBV Answer: C Candida esophagitis is the most common cause of odynophagia
in HIV patients with low CD4 counts.
13. Traveler from India with fever, hepatosplenomegaly, pancytopenia. Diagnosis?
A. Malaria
B. Leishmaniasis
C. Typhoid
D. Dengue Answer: B Visceral leishmaniasis (kala-azar) presents with fever,
hepatosplenomegaly, and pancytopenia.
14. Patient with prosthetic valve, fever, positive blood cultures. Best empiric therapy?
A. Vancomycin + cefepime
B. Ampicillin alone
C. Ciprofloxacin
QUESTIONS & VERIFIED ANSWERS | INTERNAL MEDICINE
BOARD PREP (GRADED A+)
Overview
This resource provides a comprehensive 250-question ABIM Internal Medicine practice
exam Every question is in multiple-choice format with clear italicized explanations, covering
all blueprint domains:
Cardiology
Pulmonology
Infectious Disease
Endocrinology
Gastroenterology
Hematology/Oncology
Rheumatology
Neurology
Dermatology
Psychiatry
Geriatrics
Ethics & Patient Safety
Cardiovascular Disease
1. 65-year-old man with HFrEF (EF 30%) on metoprolol and lisinopril. Which additional
therapy improves survival?
A. Digoxin
B. Furosemide
C. Spironolactone
D. Ivabradine Answer: C Spironolactone, a mineralocorticoid receptor antagonist,
reduces mortality in HFrEF patients when added to ACE inhibitors and
beta-blockers.
, 2. NSTEMI patient post-PCI with drug-eluting stent. Duration of dual antiplatelet
therapy?
A. 1 month
B. 3 months
C. 6 months
D. 12 months Answer: D Guidelines recommend at least 12 months of dual
antiplatelet therapy (aspirin + P2Y12 inhibitor) after drug-eluting stent placement in
ACS.
3. 55-year-old with syncope, ECG shows prolonged QTc. Which drug most likely
responsible?
A. Amiodarone
B. Ciprofloxacin
C. Digoxin
D. Metoprolol Answer: B Fluoroquinolones like ciprofloxacin can prolong QT interval
and predispose to torsades de pointes.
4. 70-year-old with severe aortic stenosis, symptomatic. Best management?
A. Medical therapy
B. Balloon valvuloplasty
C. Surgical valve replacement
D. Watchful waiting Answer: C Definitive treatment for symptomatic severe aortic
stenosis is valve replacement (surgical or TAVR).
5. Patient with AF, CHA₂DS₂-VASc = 3. Best management?
A. Aspirin
B. Warfarin
C. DOAC
D. No therapy Answer: C Oral anticoagulation with a DOAC is preferred for stroke
prevention in AF with CHA₂DS₂-VASc ≥2.
Pulmonary Disease
,6. COPD patient with FEV1 45% predicted, FEV1/FVC 0.55. GOLD stage?
A. I
B. II
C. III
D. IV Answer: C FEV1 30–49% predicted corresponds to GOLD stage III (severe).
7. Asthma patient with daily symptoms, nighttime awakenings twice per week, FEV1
70%. Severity?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent Answer: C Daily symptoms and FEV1 60–80% predicted
indicate moderate persistent asthma.
8. 60-year-old smoker with hemoptysis. Best initial diagnostic test?
A. Chest X-ray
B. CT chest
C. Sputum cytology
D. Bronchoscopy Answer: B CT chest is the most sensitive initial test for lung
cancer evaluation in a smoker with hemoptysis.
9. Patient with pleural effusion, exudative by Light’s criteria. Most likely cause?
A. CHF
B. Cirrhosis
C. Pneumonia
D. Nephrotic syndrome Answer: C Exudative effusions are commonly due to
infection, malignancy, or inflammatory conditions; pneumonia is classic.
10. Sarcoidosis hallmark finding?
A. Caseating granulomas
B. Non-caseating granulomas
, C. Necrosis
D. Fibrosis only Answer: B Sarcoidosis is characterized by non-caseating
granulomas in affected tissues.
Infectious Disease
11. HIV patient, CD4 40, bilateral interstitial infiltrates. Diagnosis?
A. PCP
B. CMV
C. TB
D. Bacterial pneumonia Answer: A PCP pneumonia presents with hypoxia and
diffuse interstitial infiltrates in patients with CD4 <200.
12. HIV patient with odynophagia, endoscopy shows white plaques. Cause?
A. HSV
B. CMV
C. Candida
D. EBV Answer: C Candida esophagitis is the most common cause of odynophagia
in HIV patients with low CD4 counts.
13. Traveler from India with fever, hepatosplenomegaly, pancytopenia. Diagnosis?
A. Malaria
B. Leishmaniasis
C. Typhoid
D. Dengue Answer: B Visceral leishmaniasis (kala-azar) presents with fever,
hepatosplenomegaly, and pancytopenia.
14. Patient with prosthetic valve, fever, positive blood cultures. Best empiric therapy?
A. Vancomycin + cefepime
B. Ampicillin alone
C. Ciprofloxacin
