ABIM Practice Test Questions and Answers

Start your preparation with these ABIM Practice Exam Questions and Answers, designed to help physicians and residents pass the American Board of Internal Medicine certification with confidence. This comprehensive exam prep resource includes 850 carefully structured multiple-choice questions, detailed explanations, and a downloadable, printable PDF you can study anytime.

Whether you are preparing for the ABIM certification exam for the first time or planning a retake, this complete preparation set is built to strengthen clinical judgment, reinforce high-yield concepts, and improve exam performance quickly. Each question mirrors real exam complexity and focuses on modern internal medicine topics tested in current certification cycles.

This resource delivers structured, exam-focused preparation without the confusion of scattered online materials. You get a focused, efficient study experience designed for busy professionals who want results. Download instantly and begin structured preparation today with a complete internal medicine practice solution trusted by serious candidates preparing for board success.

“Not all ABIM practice tests improve your score — this one is built to train how you think, not just what you know.”

Why This ABIM Practice Exam Actually Improves Your Score

Most ABIM practice resources focus on giving you more questions. The problem is — more questions alone do not guarantee a higher score.

What truly makes the difference is how you think through clinical scenarios, how quickly you identify patterns, and how effectively you learn from mistakes. This ABIM Internal Medicine practice test is designed with that exact goal in mind.

Instead of passive question solving, each set is structured to train your clinical reasoning — the same skill the actual ABIM exam evaluates. Every question forces you to interpret patient presentations, connect symptoms with underlying pathology, and choose the most appropriate next step in management.

You are not just memorizing facts. You are building decision-making speed.

How This Helps You Perform Better on Exam Day

• Exam-Level Question Framing
  Questions are written to reflect real ABIM scenarios, including multi-layered clinical cases that require careful analysis rather than surface-level recall.
• Concept-Based Answer Explanations
  Each explanation focuses on why the correct answer works and why the other options fail, helping you eliminate traps and improve accuracy over time.
• Pattern Recognition Training
  Repeated exposure to high-yield conditions helps you recognize disease patterns faster — a key factor in timed exam performance.
• Focused Weak Area Improvement
  As you move through the questions, you naturally identify gaps in your knowledge, allowing you to refine your study strategy without wasting time on already-mastered topics.

Built to Simulate the Real ABIM Experience

The ABIM exam is not just about knowledge — it is about applying that knowledge under pressure.

This practice set prepares you for that environment by exposing you to:

• Clinical vignettes similar in length and complexity to the actual exam
• Single-best-answer questions that test judgment, not guesswork
• Mixed-topic questions that reflect real exam unpredictability

By the time you complete this practice test, you are not walking into the exam unprepared — you are walking in with familiarity.

Who Should Use This ABIM Practice Questions?

This comprehensive preparation pack is ideal for:

• Physicians preparing for ABIM certification
• Internal medicine residents nearing board exams
• International medical graduates pursuing U.S. certification
• Retest candidates aiming to improve scores
• Busy clinicians needing structured revision
• Medical professionals wanting realistic exam practice
• Anyone seeking a downloadable PDF study resource
• Candidates who prefer clinically focused question-based learning

If your goal is to pass confidently and avoid last-minute cramming, this structured question bank offers a focused path to exam readiness.

What Is the ABIM Exam?

The American Board of Internal Medicine certification examination evaluates a physician’s ability to apply clinical knowledge in real patient care scenarios. It tests diagnostic reasoning, treatment decisions, preventive medicine, and evidence-based practice across all major internal medicine specialties.

This exam is not simply a memory test. It measures how effectively candidates can interpret clinical data, choose appropriate investigations, and manage complex conditions. Topics include cardiology, endocrinology, infectious disease, nephrology, pulmonology, gastroenterology, hematology, oncology, and preventive care.

A well-structured ABIM Practice Assessment helps candidates become familiar with exam patterns, improve clinical reasoning, and build the confidence needed for success. Consistent practice with realistic questions remains one of the most effective ways to prepare for this demanding professional examination.

What You Will Learn From This ABIM Exam Practice Questions

This comprehensive Internal Medicine Board Practice Exam Preparation resource is designed to sharpen clinical accuracy and strengthen exam performance through realistic scenarios and structured explanations.

With this study pack, you will:

• Practice real-style internal medicine questions
• Strengthen diagnostic reasoning skills
• Improve clinical decision-making speed
• Understand management guidelines clearly
• Identify weak knowledge areas quickly
• Build exam-day confidence
• Improve accuracy under timed conditions
• Reinforce high-yield internal medicine topics
• Develop structured clinical thinking
• Prepare for modern board-style questions

Each explanation is written to reinforce concepts rather than simply provide correct answers, ensuring deeper understanding and long-term retention.

What’s Included in This ABIM Practice Exam?

Your complete exam prep package includes everything needed for structured, high-yield preparation:

• ✔ 850 high-quality internal medicine questions
• ✔ Multiple-choice format aligned with real board style
• ✔ Detailed answer explanations for every question
• ✔ Clinically relevant scenarios and case-based learning
• ✔ Instant downloadable PDF format
• ✔ Covers all major internal medicine subjects
• ✔ Updated according to current clinical standards
• ✔ Designed for efficient revision and mastery
• ✔ Suitable for independent or group study

This resource is structured to simulate real exam thinking and ensure candidates are prepared for a wide range of clinical topics tested on the ABIM certification exam.

Why Choose This Over Free and Premium ABIM Practice Exam?

Many free ABIM resources lack structure, contain outdated material, or fail to reflect real board-level complexity. Practicing random questions without clear explanations rarely leads to meaningful score improvement.

At the same time, some premium platforms offer large question banks and advanced tools, but they can often feel overwhelming, time-consuming, or unnecessarily complex — especially when your goal is focused preparation.

This ABIM practice test is built to bridge that gap.

It provides a structured, exam-focused approach without distractions, helping you stay aligned with what actually matters for passing the exam.

Why Candidates Prefer This Approach

• Structured Like the Real ABIM Exam
  Questions are organized to reflect actual exam patterns, helping you build familiarity and confidence.
• Clinically Relevant and Up-to-Date
  Content is designed around real-world internal medicine concepts, not outdated or purely theoretical material.
• Focused on High-Yield Learning
  Instead of overwhelming you with excessive volume, this set prioritizes topics that matter most for exam success.
• Clear, Practical Explanations
  Every answer is written for understanding, making it easier to retain concepts and apply them under exam conditions.
• Efficient for Revision and Time-Limited Study
  Ideal for candidates who want to revise quickly without sacrificing depth or quality.
• Simple, Distraction-Free Format
  No unnecessary tools or complicated interfaces — just straightforward preparation that keeps you focused.
• Comprehensive Without Being Overwhelming
  Covers essential areas of the ABIM exam while maintaining a manageable and structured learning flow.
• Instant Access, No Delays
  Start practicing immediately without waiting or navigating complex systems.

A More Practical Way to Prepare

Instead of switching between multiple platforms or getting lost in oversized question banks, this resource gives you a clear, organized path to follow.

It’s designed for candidates who want to study with purpose — focusing on understanding, accuracy, and exam readiness rather than just completing more questions.

Realistic Preparation for Modern Board Exams

Preparing for internal medicine certification requires more than reviewing textbooks. Candidates must apply knowledge in clinical scenarios, interpret data quickly, and select appropriate management plans under pressure.

This ABIM Mock Exam style question collection reflects the complexity of real certification exams. Each scenario is built to challenge clinical reasoning while reinforcing evidence-based practice. By working through structured explanations, candidates improve both knowledge and confidence.

Regular practice with realistic exam-level questions helps:

• Reduce exam anxiety
• Improve time management
• Increase accuracy
• Strengthen clinical judgment
• Enhance retention of key concepts

A complete ABIM Sample Test approach ensures you are not surprised by question style or difficulty on exam day.

Topic Coverage in This ABIM Practice Test

This preparation pack covers the full spectrum of internal medicine topics commonly tested in certification exams, including:

• Cardiology and vascular medicine
• Pulmonology and critical care
• Gastroenterology and hepatology
• Endocrinology and metabolism
• Nephrology and electrolyte disorders
• Infectious diseases
• Hematology and oncology
• Rheumatology and immunology
• Neurology basics
• Preventive medicine and screening

The goal is to ensure balanced preparation across all high-yield areas rather than focusing on only a few topics.

Study Smarter and Pass Faster

Success in internal medicine certification comes from consistent, focused practice with high-quality questions. Reading alone is not enough. Active problem-solving strengthens recall, improves decision-making, and builds confidence.

This structured ABIM Exam Questions collection allows candidates to study efficiently without wasting time on scattered or outdated materials. You can review explanations, revisit challenging topics, and track improvement as you progress.

The downloadable format allows flexible study:

• Review on mobile or tablet
• Print for offline practice
• Use for daily revision sessions
• Study during clinical breaks
• Prepare anywhere, anytime

Consistent practice using a structured question set remains one of the most reliable ways to achieve board exam success.

30-Day ABIM Study Plan for Structured Preparation

Preparing for the ABIM exam in the final month requires consistent revision, realistic question practice, and focused review of high-yield internal medicine topics. Many residents and physicians use a structured 30-day approach to strengthen weak areas, improve clinical reasoning, and build confidence before exam day while managing clinical duties.

Suggested 30-day preparation approach:

• Review core internal medicine subjects including cardiology, pulmonology, gastroenterology, and infectious disease during the first phase of preparation

• Complete 30–50 board-style practice questions daily to reinforce concepts and identify weaker areas

• Carefully review explanations for incorrect answers to strengthen clinical reasoning and decision-making

• Focus on commonly tested management guidelines, diagnostic approaches, and next-step clinical decisions

• Gradually increase mixed-topic practice sets to improve speed and accuracy under timed conditions

• Use weekends or lighter schedules for longer revision sessions and cumulative topic review

• Revisit previously incorrect questions and high-yield notes during the final two weeks

• Prioritize consistency over long study hours to avoid burnout and maintain retention

• In the last few days before the exam, focus on light review, key concepts, and confidence building

Consistent question-based revision throughout the final month helps many ABIM candidates improve recall, strengthen clinical judgment, and approach the exam with greater confidence and clarity.

Start Preparing Today

Serious candidates know that structured preparation leads to better results. A complete, organized question bank with detailed explanations can make the difference between uncertainty and confidence on exam day.

Download your complete practice resource today and begin focused preparation with a comprehensive internal medicine study tool designed for real results.

ABIM Free Sample Questions and Answers

Question 1

A 64-year-old man with long-standing hypertension presents with exertional chest pain relieved by rest. ECG is normal at rest. What is the best initial diagnostic test?
A. Coronary angiography
B. Stress echocardiography
C. CT coronary angiogram
D. Troponin measurement

Correct Answer: B. Stress echocardiography

Explanation:
In patients with stable exertional chest pain and intermediate pretest probability for coronary artery disease, noninvasive stress testing is the appropriate first diagnostic step. Stress echocardiography provides functional assessment of myocardial ischemia and can detect wall motion abnormalities during exercise or pharmacologic stress. Coronary angiography is reserved for high-risk or positive stress test patients. Troponin is useful for acute coronary syndrome, not stable angina. CT angiography is useful but generally secondary to functional testing in many ABIM scenarios unless anatomy needs direct evaluation.

Question 2

A 72-year-old woman with atrial fibrillation and hypertension presents for stroke prevention. CHA₂DS₂-VASc score is 4. What is the best management?
A. Aspirin alone
B. Warfarin or DOAC anticoagulation
C. No therapy
D. Dual antiplatelet therapy

Correct Answer: B. Warfarin or DOAC anticoagulation

Explanation:
A CHA₂DS₂-VASc score ≥2 in women indicates high stroke risk and requires systemic anticoagulation unless contraindicated. Direct oral anticoagulants (DOACs) are preferred over warfarin for non-valvular atrial fibrillation due to lower intracranial bleeding risk and fewer monitoring requirements. Aspirin alone is inadequate for stroke prevention in atrial fibrillation. Dual antiplatelet therapy does not replace anticoagulation and carries bleeding risk without equivalent stroke protection. ABIM emphasizes risk stratification and anticoagulation as standard care.

Question 3

A patient with COPD presents with worsening dyspnea and purulent sputum. Oxygen saturation is 89%. What is first-line treatment?
A. Oral steroids and bronchodilators
B. Immediate intubation
C. Diuretics
D. Beta blockers

Correct Answer: A. Oral steroids and bronchodilators

Explanation:
Acute COPD exacerbations are typically managed with short-acting bronchodilators and systemic corticosteroids to reduce inflammation and improve airflow. Antibiotics are added if purulent sputum or infection signs are present. Oxygen therapy should be carefully titrated to avoid CO₂ retention but maintain saturation 88–92%. Intubation is reserved for respiratory failure or altered mental status. Diuretics are for heart failure, and beta blockers may worsen bronchospasm in acute COPD exacerbations.

Question 4

A 55-year-old diabetic patient has persistent albuminuria. Blood pressure is 138/86 mmHg. Which medication should be started?
A. Thiazide diuretic
B. ACE inhibitor
C. Calcium channel blocker
D. Beta blocker

Correct Answer: B. ACE inhibitor

Explanation:
ACE inhibitors are first-line therapy for diabetic patients with albuminuria because they reduce intraglomerular pressure and slow progression of diabetic nephropathy. Even with relatively controlled blood pressure, RAAS blockade is recommended for renal protection. Thiazides and calcium channel blockers lower BP but lack the same renal protective effects. Beta blockers are not first-line for nephropathy unless other cardiac indications exist. ABIM commonly tests renoprotective benefits of ACE inhibitors and ARBs in diabetes.

Question 5

A hospitalized patient develops sudden unilateral leg swelling and pain. Ultrasound confirms DVT. What is initial management?
A. Aspirin
B. Immediate anticoagulation
C. Compression only
D. Bed rest without treatment

Correct Answer: B. Immediate anticoagulation

Explanation:
Confirmed deep vein thrombosis requires prompt anticoagulation to prevent clot propagation and pulmonary embolism. DOACs or heparin followed by oral anticoagulation are standard. Aspirin is insufficient for treatment. Compression stockings may help symptoms but do not treat the clot. Bed rest alone increases risk of embolization. ABIM emphasizes rapid initiation of anticoagulation once diagnosis is confirmed unless contraindications such as active bleeding exist.

Question 6

A 48-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is elevated and free T4 is low. Diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism
C. Subclinical hypothyroidism
D. Pituitary adenoma

Correct Answer: B. Primary hypothyroidism

Explanation:
Elevated TSH with low free T4 indicates primary hypothyroidism due to thyroid gland failure. In subclinical hypothyroidism, TSH is elevated but free T4 remains normal. Hyperthyroidism shows low TSH and high T4. Pituitary adenoma causing secondary hypothyroidism would produce low or normal TSH with low T4. ABIM commonly tests interpretation of thyroid function tests and differentiating primary from central thyroid disorders.

Question 7

A 60-year-old smoker presents with hemoptysis and weight loss. CT shows lung mass. Next step?
A. Start chemotherapy immediately
B. Bronchoscopy with biopsy
C. Repeat CT in 6 months
D. Antibiotics

Correct Answer: B. Bronchoscopy with biopsy

Explanation:
A suspected lung cancer requires tissue diagnosis before initiating therapy. Bronchoscopy with biopsy allows histologic confirmation and staging. Starting chemotherapy without diagnosis is inappropriate. Waiting 6 months delays care. Antibiotics are not indicated without infection evidence. ABIM questions frequently emphasize obtaining tissue diagnosis prior to oncologic treatment and staging lung masses appropriately.

Question 8

A patient with cirrhosis presents with confusion and asterixis. Most likely diagnosis?
A. Stroke
B. Hepatic encephalopathy
C. Meningitis
D. Hypoglycemia

Correct Answer: B. Hepatic encephalopathy

Explanation:
Cirrhosis with confusion and asterixis strongly suggests hepatic encephalopathy due to accumulation of ammonia and neurotoxins. Treatment includes lactulose and rifaximin. Stroke presents with focal deficits rather than global confusion with asterixis. Meningitis involves fever and neck stiffness. Hypoglycemia must be ruled out but typically presents with diaphoresis and altered consciousness. ABIM emphasizes recognizing classic hepatic encephalopathy features and treatment.

Question 9

Which screening is recommended for average-risk adults starting at age 45?
A. Lung cancer CT
B. Colon cancer screening
C. PSA for all men
D. Routine cardiac stress test

Correct Answer: B. Colon cancer screening

Explanation:
Guidelines recommend colorectal cancer screening beginning at age 45 for average-risk adults using colonoscopy, FIT testing, or other approved methods. Lung cancer screening applies only to heavy smokers aged 50–80. PSA testing is individualized, not universal. Routine stress testing in asymptomatic adults is not recommended. ABIM frequently tests preventive screening recommendations based on age and risk factors.

Question 10

A patient with acute pancreatitis should initially receive:
A. Immediate surgery
B. Aggressive IV fluids
C. High-fat diet
D. Antibiotics for all cases

Correct Answer: B. Aggressive IV fluids

Explanation:
Early aggressive IV fluid resuscitation with isotonic crystalloids is the cornerstone of acute pancreatitis management. It maintains pancreatic perfusion and prevents complications. Surgery is reserved for complications like necrosis or gallstones with obstruction. Antibiotics are not routine unless infection is suspected. Patients are initially kept NPO then gradually resume diet. ABIM frequently tests early management priorities in pancreatitis.

Question 11

A patient has HbA1c of 9.5% despite metformin. Next step?
A. Stop metformin
B. Add second agent (GLP-1 or SGLT2 inhibitor)
C. Diet only
D. No change

Correct Answer: B. Add second agent

Explanation:
If HbA1c remains above target (>7%) despite metformin, guidelines recommend adding a second agent such as a GLP-1 receptor agonist or SGLT2 inhibitor, especially in patients with cardiovascular risk. Metformin should be continued unless contraindicated. Lifestyle changes alone are insufficient at this level. ABIM frequently tests stepwise diabetes escalation and cardioprotective agents.

Question 12

Which murmur increases with Valsalva maneuver?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Pulmonic stenosis

Correct Answer: C. Hypertrophic cardiomyopathy

Explanation:
Valsalva decreases preload and ventricular volume. In hypertrophic cardiomyopathy, reduced ventricular size worsens outflow obstruction, increasing murmur intensity. Most other murmurs, including aortic stenosis and mitral regurgitation, decrease with Valsalva due to reduced flow. This classic exam finding is frequently tested on ABIM and helps differentiate HCM from other systolic murmurs.

Question 13

A patient with CKD has potassium 6.2 mEq/L and peaked T waves. First step?
A. Kayexalate only
B. IV calcium gluconate
C. Dialysis immediately
D. Sodium restriction

Correct Answer: B. IV calcium gluconate

Explanation:
Severe hyperkalemia with ECG changes requires immediate cardiac membrane stabilization with IV calcium gluconate. This does not lower potassium but prevents arrhythmias. Insulin, beta agonists, and diuretics reduce potassium afterward. Dialysis may be needed but stabilization comes first. Kayexalate acts slowly. ABIM emphasizes recognizing life-threatening hyperkalemia and urgent stabilization.

Question 14

Best initial test for suspected pulmonary embolism in stable patient?
A. D-dimer (low risk)
B. Immediate surgery
C. MRI
D. Chest X-ray only

Correct Answer: A. D-dimer

Explanation:
In low-risk patients with suspected PE, D-dimer testing helps rule out disease due to high sensitivity. If elevated or patient is moderate/high risk, CT pulmonary angiography is indicated. Imaging immediately is unnecessary in low-risk cases. MRI and chest X-ray are not primary diagnostic tools. ABIM frequently tests PE diagnostic algorithms and risk stratification.

Question 15

A patient with GERD has alarm symptoms (weight loss, dysphagia). Next step?
A. Start PPI only
B. Upper endoscopy
C. Antacids
D. Observation

Correct Answer: B. Upper endoscopy

Explanation:
Alarm symptoms such as dysphagia, weight loss, anemia, or GI bleeding require endoscopic evaluation to rule out malignancy or severe esophagitis. Empiric PPI therapy alone is insufficient in this setting. ABIM often tests recognition of alarm features requiring urgent endoscopy in GERD patients.

Question 16

First-line treatment for anaphylaxis?
A. Antihistamines
B. Epinephrine IM
C. Steroids only
D. Oxygen only

Correct Answer: B. Epinephrine IM

Explanation:
Intramuscular epinephrine is the first and most critical treatment for anaphylaxis because it reverses airway edema, bronchospasm, and hypotension rapidly. Antihistamines and steroids are adjuncts but should never delay epinephrine. Oxygen and IV fluids support stabilization. ABIM strongly emphasizes early epinephrine administration as life-saving.

Question 17

A patient with iron deficiency anemia should undergo:
A. Iron only
B. Colonoscopy and evaluation for bleeding
C. No testing
D. Vitamin B12 therapy

Correct Answer: B. Colonoscopy and evaluation

Explanation:
Iron deficiency anemia in adults, especially men and postmenopausal women, requires evaluation for occult GI bleeding or malignancy. Colonoscopy and upper endoscopy are typically performed. Treating with iron alone without identifying cause risks missing cancer. ABIM emphasizes investigating underlying etiology of iron deficiency anemia.

Question 18

Which vaccine is recommended annually for adults?
A. Hepatitis B
B. Influenza
C. MMR
D. Varicella

Correct Answer: B. Influenza

Explanation:
Annual influenza vaccination is recommended for all adults unless contraindicated. It reduces morbidity and mortality, especially in elderly and chronic disease patients. Hepatitis B and MMR are given based on risk or immunity status. ABIM frequently tests adult immunization schedules.

Question 19

A diabetic patient with chest pain and ST elevation should receive:
A. Observation
B. Immediate reperfusion therapy
C. Aspirin only
D. Discharge

Correct Answer: B. Immediate reperfusion therapy

Explanation:
ST-elevation myocardial infarction requires urgent reperfusion via PCI or thrombolytics if PCI unavailable. Delays increase myocardial damage and mortality. Aspirin is given but not sufficient alone. Observation or discharge is inappropriate. ABIM emphasizes rapid recognition and management of STEMI.

Question 20

Best initial therapy for gout flare?
A. Allopurinol initiation
B. NSAIDs
C. Stop all meds
D. Surgery

Correct Answer: B. NSAIDs

Explanation:
Acute gout flares are treated with NSAIDs, colchicine, or corticosteroids. Urate-lowering therapy like allopurinol is not started during acute flare unless already on it. NSAIDs reduce inflammation and pain rapidly. ABIM commonly tests distinction between acute flare treatment and long-term urate control.

Question 21

A patient with severe hypertension and papilledema has:
A. Hypertensive urgency
B. Hypertensive emergency
C. Anxiety
D. Migraine

Correct Answer: B. Hypertensive emergency

Explanation:
Hypertensive emergency involves severe BP elevation with target organ damage such as papilledema, encephalopathy, renal failure, or MI. Requires IV antihypertensives and ICU monitoring. Urgency lacks organ damage. ABIM frequently tests recognition and management of hypertensive crises.

Question 22

Most common cause of community-acquired pneumonia?
A. Pseudomonas
B. Streptococcus pneumoniae
C. TB
D. Fungal infection

Correct Answer: B. Streptococcus pneumoniae

Explanation:
Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia worldwide. Treatment typically includes beta-lactam plus macrolide or respiratory fluoroquinolone depending on severity. ABIM frequently tests common pathogens and empiric therapy.

Question 23

A patient with obesity and daytime sleepiness likely has:
A. Asthma
B. Obstructive sleep apnea
C. COPD
D. GERD

Correct Answer: B. Obstructive sleep apnea

Explanation:
Obesity, loud snoring, and daytime somnolence suggest obstructive sleep apnea. Diagnosis is confirmed with sleep study. Untreated OSA increases cardiovascular risk. ABIM often tests recognition and complications of sleep apnea.

Question 24

Initial treatment for hyperthyroidism symptoms?
A. Levothyroxine
B. Beta blockers
C. Insulin
D. Steroids only

Correct Answer: B. Beta blockers

Explanation:
Beta blockers rapidly control adrenergic symptoms such as palpitations and tremor in hyperthyroidism. Definitive treatment includes antithyroid drugs, radioactive iodine, or surgery. ABIM tests symptomatic management alongside definitive therapy.

Question 25

Most sensitive test for HIV screening?
A. Western blot only
B. 4th generation antigen/antibody test
C. CBC
D. Chest X-ray

Correct Answer: B. 4th generation test

Explanation:
Fourth-generation HIV tests detect both p24 antigen and antibodies, allowing earlier diagnosis. Western blot is confirmatory. Early detection improves outcomes and prevents transmission. ABIM frequently tests modern HIV screening strategies.

Question 26

A cirrhotic patient with ascites should receive:
A. High sodium diet
B. Sodium restriction and diuretics
C. No treatment
D. Only antibiotics

Correct Answer: B. Sodium restriction and diuretics

Explanation:
Ascites management includes sodium restriction and diuretics (spironolactone ± furosemide). Paracentesis may be needed for large ascites. High sodium worsens fluid retention. ABIM commonly tests ascites management in cirrhosis.

Question 27

Which condition increases risk of endocarditis?
A. Hypertension
B. Prosthetic heart valve
C. Asthma
D. Diabetes only

Correct Answer: B. Prosthetic heart valve

Explanation:
Prosthetic valves significantly increase risk of infective endocarditis and require prophylaxis before certain dental procedures. ABIM emphasizes high-risk cardiac conditions requiring prophylaxis and vigilance for endocarditis.

Question 28

A patient with sudden severe headache and neck stiffness needs:
A. CT head immediately
B. Antacids
C. Discharge
D. MRI next year

Correct Answer: A. CT head immediately

Explanation:
Suspected subarachnoid hemorrhage presents with sudden “worst headache of life.” Immediate non-contrast CT head is first diagnostic step. If negative but suspicion remains, lumbar puncture follows. ABIM frequently tests acute neurologic emergencies.

Question 29

Best medication for heart failure with reduced EF?
A. ACE inhibitor
B. NSAID
C. Calcium supplement
D. Antibiotic

Correct Answer: A. ACE inhibitor

Explanation:
ACE inhibitors improve survival and reduce hospitalization in HFrEF by reducing afterload and remodeling. Guideline-directed therapy also includes beta blockers, mineralocorticoid antagonists, and SGLT2 inhibitors. ABIM frequently tests evidence-based HF therapy.

Question 30

A hospitalized patient develops fever after central line placement. Next step?
A. Remove line and send cultures
B. Ignore
C. Only give acetaminophen
D. Discharge

Correct Answer: A. Remove line and send cultures

Explanation:
Suspected central line–associated bloodstream infection requires prompt line removal and blood cultures from line and peripheral sites. Early antibiotics are initiated. Delay increases sepsis risk. ABIM emphasizes early recognition and management of hospital-acquired infections.