AMERICAN BOARD OF INTERNAL
MEDICINE (ABIM) CERTIFICATION
EXAMINATION QUESTION AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
INSTANT DOWNLOAD PDF
1. A 65-year-old man with hypertension and diabetes presents with crushing
substernal chest pain radiating to the left arm for 45 minutes. ECG shows ST
elevation in leads II, III, and aVF. The most appropriate immediate
management is:
A. Intravenous beta-blocker only
B. Oral aspirin and observation
C. Thrombolytic therapy after 24 hours
D. Primary percutaneous coronary intervention
Correct Answer: D. Primary percutaneous coronary intervention
Rationale: ST-elevation myocardial infarction (STEMI) requires immediate
reperfusion, with PCI preferred when available within guideline-recommended
timeframes.
2. A patient with chronic atrial fibrillation has a CHA₂DS₂-VASc score of 3. The
recommended long-term therapy is:
A. Aspirin alone
B. No anticoagulation
, C. Oral anticoagulation
D. Dual antiplatelet therapy
Correct Answer: C. Oral anticoagulation
Rationale: A CHA₂DS₂-VASc score ≥2 in men indicates a high risk of stroke and
warrants anticoagulation.
3. Which condition is most commonly associated with secondary
hypertension?
A. Essential hypertension
B. Renal artery stenosis
C. Anxiety disorder
D. High sodium diet
Correct Answer: B. Renal artery stenosis
Rationale: Renovascular disease is a classic cause of secondary hypertension,
especially in older adults or those with refractory hypertension.
4. A 45-year-old woman presents with fatigue, pruritus, and elevated alkaline
phosphatase. Antimitochondrial antibodies are positive. Diagnosis is:
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Primary biliary cholangitis
D. Viral hepatitis
Correct Answer: C. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is characterized by antimitochondrial
antibodies and cholestatic liver enzyme elevation.
5. Which acid–base disorder is seen in severe diarrhea?
A. Metabolic alkalosis
B. Respiratory acidosis
, C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C. Metabolic acidosis
Rationale: Loss of bicarbonate-rich intestinal fluids leads to non–anion gap
metabolic acidosis.
6. A patient with long-standing GERD develops progressive dysphagia.
Endoscopy shows columnar epithelium replacing squamous epithelium.
This is:
A. Esophageal carcinoma
B. Barrett esophagus
C. Achalasia
D. Esophagitis
Correct Answer: B. Barrett esophagus
Rationale: Barrett esophagus involves intestinal metaplasia and increases the
risk of esophageal adenocarcinoma.
7. A 30-year-old man presents with acute onset dyspnea and pleuritic chest
pain after a long flight. Best initial diagnostic test:
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. Ventilation-perfusion scan
Correct Answer: C. CT pulmonary angiography
Rationale: In patients with high suspicion for pulmonary embolism, CT
pulmonary angiography is the diagnostic test of choice.
8. Which finding is most characteristic of nephrotic syndrome?
A. Hematuria
, B. Hypertension
C. Proteinuria >3.5 g/day
D. Elevated creatinine only
Correct Answer: C. Proteinuria >3.5 g/day
Rationale: Massive proteinuria is the hallmark of nephrotic syndrome.
9. A diabetic patient presents with confusion, abdominal pain, and Kussmaul
respirations. The most likely diagnosis is:
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B. Diabetic ketoacidosis
Rationale: DKA presents with metabolic acidosis, ketones, dehydration, and
deep rapid breathing.
10.Which organism is most commonly responsible for community-acquired
pneumonia in adults?
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Correct Answer: C. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most common cause of
community-acquired pneumonia.
11.A patient with rheumatoid arthritis develops splenomegaly and
neutropenia. This condition is called:
A. Still disease
MEDICINE (ABIM) CERTIFICATION
EXAMINATION QUESTION AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
INSTANT DOWNLOAD PDF
1. A 65-year-old man with hypertension and diabetes presents with crushing
substernal chest pain radiating to the left arm for 45 minutes. ECG shows ST
elevation in leads II, III, and aVF. The most appropriate immediate
management is:
A. Intravenous beta-blocker only
B. Oral aspirin and observation
C. Thrombolytic therapy after 24 hours
D. Primary percutaneous coronary intervention
Correct Answer: D. Primary percutaneous coronary intervention
Rationale: ST-elevation myocardial infarction (STEMI) requires immediate
reperfusion, with PCI preferred when available within guideline-recommended
timeframes.
2. A patient with chronic atrial fibrillation has a CHA₂DS₂-VASc score of 3. The
recommended long-term therapy is:
A. Aspirin alone
B. No anticoagulation
, C. Oral anticoagulation
D. Dual antiplatelet therapy
Correct Answer: C. Oral anticoagulation
Rationale: A CHA₂DS₂-VASc score ≥2 in men indicates a high risk of stroke and
warrants anticoagulation.
3. Which condition is most commonly associated with secondary
hypertension?
A. Essential hypertension
B. Renal artery stenosis
C. Anxiety disorder
D. High sodium diet
Correct Answer: B. Renal artery stenosis
Rationale: Renovascular disease is a classic cause of secondary hypertension,
especially in older adults or those with refractory hypertension.
4. A 45-year-old woman presents with fatigue, pruritus, and elevated alkaline
phosphatase. Antimitochondrial antibodies are positive. Diagnosis is:
A. Primary sclerosing cholangitis
B. Autoimmune hepatitis
C. Primary biliary cholangitis
D. Viral hepatitis
Correct Answer: C. Primary biliary cholangitis
Rationale: Primary biliary cholangitis is characterized by antimitochondrial
antibodies and cholestatic liver enzyme elevation.
5. Which acid–base disorder is seen in severe diarrhea?
A. Metabolic alkalosis
B. Respiratory acidosis
, C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C. Metabolic acidosis
Rationale: Loss of bicarbonate-rich intestinal fluids leads to non–anion gap
metabolic acidosis.
6. A patient with long-standing GERD develops progressive dysphagia.
Endoscopy shows columnar epithelium replacing squamous epithelium.
This is:
A. Esophageal carcinoma
B. Barrett esophagus
C. Achalasia
D. Esophagitis
Correct Answer: B. Barrett esophagus
Rationale: Barrett esophagus involves intestinal metaplasia and increases the
risk of esophageal adenocarcinoma.
7. A 30-year-old man presents with acute onset dyspnea and pleuritic chest
pain after a long flight. Best initial diagnostic test:
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. Ventilation-perfusion scan
Correct Answer: C. CT pulmonary angiography
Rationale: In patients with high suspicion for pulmonary embolism, CT
pulmonary angiography is the diagnostic test of choice.
8. Which finding is most characteristic of nephrotic syndrome?
A. Hematuria
, B. Hypertension
C. Proteinuria >3.5 g/day
D. Elevated creatinine only
Correct Answer: C. Proteinuria >3.5 g/day
Rationale: Massive proteinuria is the hallmark of nephrotic syndrome.
9. A diabetic patient presents with confusion, abdominal pain, and Kussmaul
respirations. The most likely diagnosis is:
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B. Diabetic ketoacidosis
Rationale: DKA presents with metabolic acidosis, ketones, dehydration, and
deep rapid breathing.
10.Which organism is most commonly responsible for community-acquired
pneumonia in adults?
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Correct Answer: C. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most common cause of
community-acquired pneumonia.
11.A patient with rheumatoid arthritis develops splenomegaly and
neutropenia. This condition is called:
A. Still disease
