ABIM Internal Medicine Boards & ITE
Exam QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED.pdf
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1-20)
Question 1
A 55-year-old man with a history of hypertension presents with chest pain at rest
associated with transient ST-segment elevation on ECG. What is the most likely
diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) NSTEMI
Answer: C
Rationale: Prinzmetal's (variant) angina is characterized by chest pain at rest with
transient ST-segment elevation due to coronary artery vasospasm. Unlike stable angina, it
is not associated with exertion. Unstable angina typically presents with ST depression or T-
wave inversion. NSTEMI is diagnosed with elevated troponins .
,Question 2
Which ECG finding is most specific for acute pericarditis?
A) ST-segment elevation in all leads
B) PR-segment depression
C) Diffuse ST-segment elevation with PR-segment depression
D) Pathologic Q waves
Answer: C
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation (concave
upward) with PR-segment depression across multiple leads. PR-segment depression is
highly specific for pericarditis and distinguishes it from myocardial infarction, which shows
regional ST elevation with reciprocal changes .
Question 3
A 68-year-old man with severe asymptomatic aortic stenosis is being managed
conservatively. Which medication class is relatively contraindicated in this patient?
A) ACE inhibitors
B) Beta-blockers
C) Calcium channel blockers
D) Nitrates
Answer: D
Rationale: Nitrates are relatively contraindicated in severe aortic stenosis because they
reduce preload and can cause profound hypotension. Patients with severe aortic stenosis
are preload-dependent to maintain cardiac output. ACE inhibitors, beta-blockers, and
calcium channel blockers can be used cautiously, but excessive afterload reduction should
be avoided .
,Question 4
A 45-year-old man presents with palpitations and diaphoresis. ECG shows a regular,
narrow-complex tachycardia at 180 bpm. The patient is hemodynamically stable. What is
the most appropriate initial management?
A) Adenosine 6 mg IV push
B) Synchronized cardioversion
C) Amiodarone 150 mg IV
D) Vagal maneuvers
Answer: D
Rationale: For hemodynamically stable, regular narrow-complex tachycardia, vagal
maneuvers (Valsalva, carotid sinus massage) are the first-line intervention. Adenosine is
given if vagal maneuvers fail. Synchronized cardioversion is for unstable patients .
Question 5
A 72-year-old woman with heart failure with reduced ejection fraction (HFrEF) is being
optimized on GDMT. Which of the following medications has been shown to provide the
greatest mortality benefit in HFrEF?
A) Digoxin
B) Furosemide
C) Sacubitril/Valsartan
D) Spironolactone
Answer: C
, Rationale: Sacubitril/valsartan (ARNI) has been shown to provide significant mortality and
hospitalization reduction in HFrEF, with benefits over enalapril. Beta-blockers (carvedilol,
metoprolol succinate, bisoprolol) and aldosterone antagonists also show mortality benefit.
Digoxin reduces hospitalization but not mortality. Furosemide provides symptom relief .
Question 6
A 60-year-old male with hypertension and diabetes presents with sudden-onset, severe
"tearing" chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right
arm and 140/80 mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Acute aortic dissection presents with sudden, severe, tearing chest pain
radiating to the back. Blood pressure differential between arms suggests aortic
involvement. Chest X-ray may show widened mediastinum. CT angiography is diagnostic .
Question 7
A 55-year-old woman with hypertension and hyperlipidemia is noted to have a systolic
ejection murmur at the right upper sternal border that radiates to the carotids. Which
finding would suggest aortic stenosis rather than aortic sclerosis?
A) Murmur intensity of 2/6
B) Decreased carotid upstroke (pulsus parvus et tardus)
Exam QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED.pdf
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1-20)
Question 1
A 55-year-old man with a history of hypertension presents with chest pain at rest
associated with transient ST-segment elevation on ECG. What is the most likely
diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) NSTEMI
Answer: C
Rationale: Prinzmetal's (variant) angina is characterized by chest pain at rest with
transient ST-segment elevation due to coronary artery vasospasm. Unlike stable angina, it
is not associated with exertion. Unstable angina typically presents with ST depression or T-
wave inversion. NSTEMI is diagnosed with elevated troponins .
,Question 2
Which ECG finding is most specific for acute pericarditis?
A) ST-segment elevation in all leads
B) PR-segment depression
C) Diffuse ST-segment elevation with PR-segment depression
D) Pathologic Q waves
Answer: C
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation (concave
upward) with PR-segment depression across multiple leads. PR-segment depression is
highly specific for pericarditis and distinguishes it from myocardial infarction, which shows
regional ST elevation with reciprocal changes .
Question 3
A 68-year-old man with severe asymptomatic aortic stenosis is being managed
conservatively. Which medication class is relatively contraindicated in this patient?
A) ACE inhibitors
B) Beta-blockers
C) Calcium channel blockers
D) Nitrates
Answer: D
Rationale: Nitrates are relatively contraindicated in severe aortic stenosis because they
reduce preload and can cause profound hypotension. Patients with severe aortic stenosis
are preload-dependent to maintain cardiac output. ACE inhibitors, beta-blockers, and
calcium channel blockers can be used cautiously, but excessive afterload reduction should
be avoided .
,Question 4
A 45-year-old man presents with palpitations and diaphoresis. ECG shows a regular,
narrow-complex tachycardia at 180 bpm. The patient is hemodynamically stable. What is
the most appropriate initial management?
A) Adenosine 6 mg IV push
B) Synchronized cardioversion
C) Amiodarone 150 mg IV
D) Vagal maneuvers
Answer: D
Rationale: For hemodynamically stable, regular narrow-complex tachycardia, vagal
maneuvers (Valsalva, carotid sinus massage) are the first-line intervention. Adenosine is
given if vagal maneuvers fail. Synchronized cardioversion is for unstable patients .
Question 5
A 72-year-old woman with heart failure with reduced ejection fraction (HFrEF) is being
optimized on GDMT. Which of the following medications has been shown to provide the
greatest mortality benefit in HFrEF?
A) Digoxin
B) Furosemide
C) Sacubitril/Valsartan
D) Spironolactone
Answer: C
, Rationale: Sacubitril/valsartan (ARNI) has been shown to provide significant mortality and
hospitalization reduction in HFrEF, with benefits over enalapril. Beta-blockers (carvedilol,
metoprolol succinate, bisoprolol) and aldosterone antagonists also show mortality benefit.
Digoxin reduces hospitalization but not mortality. Furosemide provides symptom relief .
Question 6
A 60-year-old male with hypertension and diabetes presents with sudden-onset, severe
"tearing" chest pain radiating to the back. Blood pressure is 180/100 mmHg in the right
arm and 140/80 mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Acute aortic dissection presents with sudden, severe, tearing chest pain
radiating to the back. Blood pressure differential between arms suggests aortic
involvement. Chest X-ray may show widened mediastinum. CT angiography is diagnostic .
Question 7
A 55-year-old woman with hypertension and hyperlipidemia is noted to have a systolic
ejection murmur at the right upper sternal border that radiates to the carotids. Which
finding would suggest aortic stenosis rather than aortic sclerosis?
A) Murmur intensity of 2/6
B) Decreased carotid upstroke (pulsus parvus et tardus)
