ABIM IM BOARD ITE EXAM / ACTUAL ABIM
INTERNAL MEDICINE CERTIFICATION
2026/2027 ACTUAL TEST BANK PRACTICE
QUESTIONS AND STUDY GUIDE ACCURATE
EXAM COMPLETE APPROVED QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH
DETAILED RATIONALES (RELIABLE ANSWERS)
LATEST UPDATED VERSION 2026 EDITION |
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1. A 68-year-old man with chronic heart failure with reduced ejection
fraction (HFrEF) on optimal medical therapy including
sacubitril/valsartan, beta-blocker, and spironolactone continues to have
NYHA class III symptoms. Left ventricular ejection fraction is 30%.
There is no significant coronary disease. Which intervention has been
shown to reduce mortality in this population?
A. Implantable cardioverter-defibrillator (ICD) alone
B. Cardiac resynchronization therapy with defibrillator (CRT-D)
C. Left ventricular assist device (LVAD) as destination therapy
D. Heart transplantation listing
Correct Answer: B
Rationale: In patients with HFrEF, wide QRS (≥150 ms) and left bundle
branch block (LBBB), CRT-D reduces mortality and hospitalizations.
ICD alone does not improve symptoms or mortality in this specific
,population. LVAD and transplantation are reserved for advanced disease
with refractory symptoms.
2. A 62-year-old man presents with exertional chest pain relieved by
rest. ECG shows ST depression in leads V4-V6. What is the most
appropriate next step in management?
A. Coronary angiography
B. Start nitrates, beta-blocker, and aspirin
C. Schedule a stress echocardiogram
D. Immediate thrombolysis
Correct Answer: B
Rationale: Stable angina is characterized by predictable exertional chest
pain relieved by rest or nitroglycerin. Initial management includes
antianginal therapy (nitrates, beta-blockers), risk factor modification,
and aspirin. Coronary angiography is indicated only if symptoms persist
despite optimal medical therapy.
3. A 55-year-old woman with type 2 diabetes presents with painful
burning in her feet. Examination shows decreased vibration sense. What
is the most appropriate first-line treatment?
A. Gabapentin
B. Amitriptyline
C. Duloxetine
D. Capsaicin cream
,Correct Answer: C
Rationale: Diabetic peripheral neuropathy is best managed with
duloxetine or pregabalin as first-line agents. Duloxetine, an SNRI,
provides both analgesic and antidepressant benefits. Tricyclics like
amitriptyline are effective but have more side effects in older adults.
4. A 48-year-old man with a history of chronic alcohol use presents with
confusion, ataxia, and ophthalmoplegia. What is the most likely
diagnosis?
A. Hepatic encephalopathy
B. Wernicke encephalopathy
C. Korsakoff psychosis
D. Alcohol withdrawal
Correct Answer: B
Rationale: The triad of confusion, ataxia, and ophthalmoplegia is classic
for Wernicke encephalopathy, due to thiamine deficiency. IV thiamine
should be administered before glucose to prevent worsening
neurological injury.
6. A 65-year-old man presents with progressive exertional dyspnea. On
exam, he has bibasilar crackles and an S3 gallop. Echocardiogram shows
an ejection fraction of 35%. Which of the following is the most
appropriate first-line therapy?
A. Hydrochlorothiazide
B. Digoxin
, C. ACE inhibitor
D. Beta-blocker
Correct Answer: C. ACE inhibitor
Rationale: In patients with heart failure with reduced ejection fraction
(HFrEF), ACE inhibitors reduce mortality and morbidity and are a key
component of guideline-directed medical therapy. Diuretics primarily
relieve congestion, while digoxin may improve symptoms but does not
reduce mortality. Beta-blockers are also important for long-term
management once the patient is clinically stable.
7. A 58-year-old man with hypertension presents with sudden tearing
chest pain radiating to the back. Blood pressure is 190/110 mmHg in the
right arm and 160/90 mmHg in the left arm. Chest radiograph shows a
widened mediastinum. What is the most appropriate initial treatment?
A. IV esmolol
B. IV nitroglycerin alone
C. Oral aspirin
D. Immediate thrombolysis
Correct Answer: A. IV esmolol
Rationale: Acute aortic dissection requires rapid reduction of aortic wall
stress. IV beta-blockade with agents such as esmolol is initiated first to
reduce heart rate and contractility.
8. A 72-year-old woman presents with fatigue and constipation.
Laboratory studies show calcium 11.8 mg/dL and suppressed
parathyroid hormone (PTH). Chest imaging reveals a lung mass. What is
the most likely cause of her hypercalcemia?
INTERNAL MEDICINE CERTIFICATION
2026/2027 ACTUAL TEST BANK PRACTICE
QUESTIONS AND STUDY GUIDE ACCURATE
EXAM COMPLETE APPROVED QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH
DETAILED RATIONALES (RELIABLE ANSWERS)
LATEST UPDATED VERSION 2026 EDITION |
GUARANTEED PASS A+ | INSTANT DOWNLOAD
PDF JUST RELEASED
1. A 68-year-old man with chronic heart failure with reduced ejection
fraction (HFrEF) on optimal medical therapy including
sacubitril/valsartan, beta-blocker, and spironolactone continues to have
NYHA class III symptoms. Left ventricular ejection fraction is 30%.
There is no significant coronary disease. Which intervention has been
shown to reduce mortality in this population?
A. Implantable cardioverter-defibrillator (ICD) alone
B. Cardiac resynchronization therapy with defibrillator (CRT-D)
C. Left ventricular assist device (LVAD) as destination therapy
D. Heart transplantation listing
Correct Answer: B
Rationale: In patients with HFrEF, wide QRS (≥150 ms) and left bundle
branch block (LBBB), CRT-D reduces mortality and hospitalizations.
ICD alone does not improve symptoms or mortality in this specific
,population. LVAD and transplantation are reserved for advanced disease
with refractory symptoms.
2. A 62-year-old man presents with exertional chest pain relieved by
rest. ECG shows ST depression in leads V4-V6. What is the most
appropriate next step in management?
A. Coronary angiography
B. Start nitrates, beta-blocker, and aspirin
C. Schedule a stress echocardiogram
D. Immediate thrombolysis
Correct Answer: B
Rationale: Stable angina is characterized by predictable exertional chest
pain relieved by rest or nitroglycerin. Initial management includes
antianginal therapy (nitrates, beta-blockers), risk factor modification,
and aspirin. Coronary angiography is indicated only if symptoms persist
despite optimal medical therapy.
3. A 55-year-old woman with type 2 diabetes presents with painful
burning in her feet. Examination shows decreased vibration sense. What
is the most appropriate first-line treatment?
A. Gabapentin
B. Amitriptyline
C. Duloxetine
D. Capsaicin cream
,Correct Answer: C
Rationale: Diabetic peripheral neuropathy is best managed with
duloxetine or pregabalin as first-line agents. Duloxetine, an SNRI,
provides both analgesic and antidepressant benefits. Tricyclics like
amitriptyline are effective but have more side effects in older adults.
4. A 48-year-old man with a history of chronic alcohol use presents with
confusion, ataxia, and ophthalmoplegia. What is the most likely
diagnosis?
A. Hepatic encephalopathy
B. Wernicke encephalopathy
C. Korsakoff psychosis
D. Alcohol withdrawal
Correct Answer: B
Rationale: The triad of confusion, ataxia, and ophthalmoplegia is classic
for Wernicke encephalopathy, due to thiamine deficiency. IV thiamine
should be administered before glucose to prevent worsening
neurological injury.
6. A 65-year-old man presents with progressive exertional dyspnea. On
exam, he has bibasilar crackles and an S3 gallop. Echocardiogram shows
an ejection fraction of 35%. Which of the following is the most
appropriate first-line therapy?
A. Hydrochlorothiazide
B. Digoxin
, C. ACE inhibitor
D. Beta-blocker
Correct Answer: C. ACE inhibitor
Rationale: In patients with heart failure with reduced ejection fraction
(HFrEF), ACE inhibitors reduce mortality and morbidity and are a key
component of guideline-directed medical therapy. Diuretics primarily
relieve congestion, while digoxin may improve symptoms but does not
reduce mortality. Beta-blockers are also important for long-term
management once the patient is clinically stable.
7. A 58-year-old man with hypertension presents with sudden tearing
chest pain radiating to the back. Blood pressure is 190/110 mmHg in the
right arm and 160/90 mmHg in the left arm. Chest radiograph shows a
widened mediastinum. What is the most appropriate initial treatment?
A. IV esmolol
B. IV nitroglycerin alone
C. Oral aspirin
D. Immediate thrombolysis
Correct Answer: A. IV esmolol
Rationale: Acute aortic dissection requires rapid reduction of aortic wall
stress. IV beta-blockade with agents such as esmolol is initiated first to
reduce heart rate and contractility.
8. A 72-year-old woman presents with fatigue and constipation.
Laboratory studies show calcium 11.8 mg/dL and suppressed
parathyroid hormone (PTH). Chest imaging reveals a lung mass. What is
the most likely cause of her hypercalcemia?
