ABIM Internal Medicine ITE Exam 200 Original Multiple-Choice
Practice Questions with Answers and Rationales – Complete
Board Review Covering Cardiology, Pulmonology, GI, Nephro,
Endo, Heme/Onc, ID, Rheum, Neuro, Geriatrics, and General
Internal Medicine
Coverage:
The questions are distributed across the major content areas outlined in the ABIM
Internal Medicine blueprint and commonly tested on ITE exams, including:
Cardiovascular Medicine
Pulmonary and Critical Care Medicine
Gastroenterology and Hepatology
Hematology, Oncology, and Infectious Disease
Endocrinology, Diabetes, and Metabolism
Nephrology and Hypertension
Rheumatology, Allergy, and Immunology
Neurology, Geriatrics, and General Internal Medicine
SECTION 1 | Cardiovascular Medicine | Q1–Q25
Q1. A 62-year-old man with hypertension and dyslipidemia presents with crushing
substernal chest pain radiating to his left arm. Which initial diagnostic test is most
,appropriate to evaluate for acute myocardial infarction?
A. Exercise stress echocardiography
B. Resting 12-lead electrocardiogram
C. Cardiac CT angiography
D. Cardiac MRI with gadolinium
E. Coronary angiography
Correct Answer: B
Rationale: A resting ECG is the first test to assess for ischemia or infarction.abim+1
Q2. A 55-year-old woman with type 2 diabetes and hypertension reports progressive
dyspnea on exertion and orthopnea. Which medication is most likely to improve survival in
heart failure with reduced ejection fraction?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Isosorbide mononitrate
E. Amlodipine
Correct Answer: B
Rationale: ACE inhibitors improve survival in HFrEF and are guideline-directed
therapy.abim+1
Q3. A 70-year-old man with prior myocardial infarction presents with palpitations and
lightheadedness. Which rhythm is most concerning for sudden cardiac death risk?
A. Sinus tachycardia
B. Atrial fibrillation
C. Sustained monomorphic ventricular tachycardia
,D. First-degree AV block
E. Premature atrial complexes
Correct Answer: C
Rationale: Sustained VT in structural heart disease is high risk for sudden death.abim+1
Q4. A 48-year-old woman has new-onset severe hypertension, hypokalemia, and metabolic
alkalosis. Which endocrine disorder is the most likely cause of her secondary hypertension?
A. Pheochromocytoma
B. Primary hyperaldosteronism
C. Cushing syndrome
D. Hyperthyroidism
E. Acromegaly
Correct Answer: B
Rationale: Hyperaldosteronism classically causes hypertension with hypokalemia and
metabolic alkalosis.abim+1
Q5. A 65-year-old man with coronary artery disease develops sudden severe tearing chest
pain radiating to the back. Which imaging study is most appropriate to confirm suspected
aortic dissection?
A. Transthoracic echocardiogram
B. Chest radiograph
C. CT angiography of the chest
D. Cardiac catheterization
E. V/Q scan
Correct Answer: C
Rationale: CT angiography is a rapid, accurate test for diagnosing aortic dissection.abim+1
, Q6. A 58-year-old man presents with exertional chest pain relieved by rest and sublingual
nitroglycerin. Which medication is most appropriate for long-term symptom control of stable
angina?
A. Immediate-release nifedipine
B. Metoprolol succinate
C. Ranolazine alone
D. Clonidine
E. Hydralazine
Correct Answer: B
Rationale: Beta-blockers are first-line therapy for symptom control in stable angina.abim+1
Q7. A 72-year-old woman with a history of heart failure presents with rapidly worsening
dyspnea and bilateral crackles. Which initial therapy is most appropriate for acute
decompensated heart failure?
A. Intravenous furosemide
B. Oral spironolactone
C. Intravenous metoprolol
D. Oral digoxin
E. Sublingual nitroglycerin only
Correct Answer: A
Rationale: IV loop diuretics are first-line for volume overload in acute HF.abim+1
Q8. A 45-year-old man with no prior cardiac history has syncope and a systolic murmur that
increases with standing. Which diagnosis is most likely?
A. Aortic stenosis
B. Hypertrophic obstructive cardiomyopathy
C. Mitral regurgitation
Practice Questions with Answers and Rationales – Complete
Board Review Covering Cardiology, Pulmonology, GI, Nephro,
Endo, Heme/Onc, ID, Rheum, Neuro, Geriatrics, and General
Internal Medicine
Coverage:
The questions are distributed across the major content areas outlined in the ABIM
Internal Medicine blueprint and commonly tested on ITE exams, including:
Cardiovascular Medicine
Pulmonary and Critical Care Medicine
Gastroenterology and Hepatology
Hematology, Oncology, and Infectious Disease
Endocrinology, Diabetes, and Metabolism
Nephrology and Hypertension
Rheumatology, Allergy, and Immunology
Neurology, Geriatrics, and General Internal Medicine
SECTION 1 | Cardiovascular Medicine | Q1–Q25
Q1. A 62-year-old man with hypertension and dyslipidemia presents with crushing
substernal chest pain radiating to his left arm. Which initial diagnostic test is most
,appropriate to evaluate for acute myocardial infarction?
A. Exercise stress echocardiography
B. Resting 12-lead electrocardiogram
C. Cardiac CT angiography
D. Cardiac MRI with gadolinium
E. Coronary angiography
Correct Answer: B
Rationale: A resting ECG is the first test to assess for ischemia or infarction.abim+1
Q2. A 55-year-old woman with type 2 diabetes and hypertension reports progressive
dyspnea on exertion and orthopnea. Which medication is most likely to improve survival in
heart failure with reduced ejection fraction?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Isosorbide mononitrate
E. Amlodipine
Correct Answer: B
Rationale: ACE inhibitors improve survival in HFrEF and are guideline-directed
therapy.abim+1
Q3. A 70-year-old man with prior myocardial infarction presents with palpitations and
lightheadedness. Which rhythm is most concerning for sudden cardiac death risk?
A. Sinus tachycardia
B. Atrial fibrillation
C. Sustained monomorphic ventricular tachycardia
,D. First-degree AV block
E. Premature atrial complexes
Correct Answer: C
Rationale: Sustained VT in structural heart disease is high risk for sudden death.abim+1
Q4. A 48-year-old woman has new-onset severe hypertension, hypokalemia, and metabolic
alkalosis. Which endocrine disorder is the most likely cause of her secondary hypertension?
A. Pheochromocytoma
B. Primary hyperaldosteronism
C. Cushing syndrome
D. Hyperthyroidism
E. Acromegaly
Correct Answer: B
Rationale: Hyperaldosteronism classically causes hypertension with hypokalemia and
metabolic alkalosis.abim+1
Q5. A 65-year-old man with coronary artery disease develops sudden severe tearing chest
pain radiating to the back. Which imaging study is most appropriate to confirm suspected
aortic dissection?
A. Transthoracic echocardiogram
B. Chest radiograph
C. CT angiography of the chest
D. Cardiac catheterization
E. V/Q scan
Correct Answer: C
Rationale: CT angiography is a rapid, accurate test for diagnosing aortic dissection.abim+1
, Q6. A 58-year-old man presents with exertional chest pain relieved by rest and sublingual
nitroglycerin. Which medication is most appropriate for long-term symptom control of stable
angina?
A. Immediate-release nifedipine
B. Metoprolol succinate
C. Ranolazine alone
D. Clonidine
E. Hydralazine
Correct Answer: B
Rationale: Beta-blockers are first-line therapy for symptom control in stable angina.abim+1
Q7. A 72-year-old woman with a history of heart failure presents with rapidly worsening
dyspnea and bilateral crackles. Which initial therapy is most appropriate for acute
decompensated heart failure?
A. Intravenous furosemide
B. Oral spironolactone
C. Intravenous metoprolol
D. Oral digoxin
E. Sublingual nitroglycerin only
Correct Answer: A
Rationale: IV loop diuretics are first-line for volume overload in acute HF.abim+1
Q8. A 45-year-old man with no prior cardiac history has syncope and a systolic murmur that
increases with standing. Which diagnosis is most likely?
A. Aortic stenosis
B. Hypertrophic obstructive cardiomyopathy
C. Mitral regurgitation
