Practice Test GeeksABIM - American Board of Internal Medicine Practice Test
← All ABIM Flashcard Decks

Ultimate Test Flashcards

7 cards from real ABIM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Ultimate Test flashcards as text

  1. A 67-year-old man with diabetes and hypertension presents with acute-onset flank pain radiating to the groin, microscopic hematuria, and a 6-mm ureteral stone on CT. He has no fever and his creatinine is at baseline. What is the most appropriate initial management?

    Answer: Medical expulsive therapy with tamsulosin and analgesics

    Uncomplicated ureteral stones ≤10 mm without infection or obstruction are managed with medical expulsive therapy; tamsulosin relaxes ureteral smooth muscle to facilitate passage.

  2. A 34-year-old woman has episodic hypertension, headaches, diaphoresis, and palpitations. 24-hour urine shows elevated metanephrines and normetanephrines. What is the most important pre-operative medication to initiate?

    Answer: Alpha-blocker (phenoxybenzamine)

    Alpha-blockade must be established before beta-blockade to prevent unopposed alpha-adrenergic vasoconstriction and hypertensive crisis during pheochromocytoma resection.

  3. A 70-year-old woman with atrial fibrillation is on warfarin with a stable INR of 2.4. She is scheduled for a colonoscopy with polypectomy. What is the most appropriate peri-procedural anticoagulation strategy?

    Answer: Hold warfarin 5 days prior; bridge with LMWH if high stroke risk

    High-bleed-risk procedures like polypectomy require warfarin to be held 5 days prior; bridging with LMWH is indicated for high thromboembolic risk (e.g., CHA₂DS₂-VASc ≥5 or mechanical valve).

  4. A 48-year-old man is found to have a fasting glucose of 130 mg/dL on two separate occasions. His HbA1c is 7.4%. He has BMI 31 and no cardiovascular disease. What is the preferred initial pharmacologic therapy?

    Answer: Metformin

    Metformin is the recommended first-line pharmacologic agent for type 2 diabetes unless contraindicated, given its efficacy, safety profile, low cost, and weight neutrality.

  5. A 55-year-old woman with rheumatoid arthritis on methotrexate 20 mg/week presents with progressive dyspnea and a dry cough. HRCT shows bilateral ground-glass opacities and fine reticulations. Her PFTs show a restrictive pattern. What is the most likely diagnosis?

    Answer: Methotrexate-induced pneumonitis

    Methotrexate pneumonitis is a hypersensitivity reaction that can occur at any dose and time; it presents with dry cough, dyspnea, fever, and bilateral infiltrates on imaging.

  6. A 29-year-old woman at 32 weeks gestation presents with severe headache, visual changes, and BP 160/110 mmHg on two readings 4 hours apart. Urine protein is 3+ on dipstick. What complication must be urgently prevented?

    Answer: Eclamptic seizure

    Severe-range preeclampsia requires IV magnesium sulfate for seizure prophylaxis and urgent antihypertensive therapy to prevent eclampsia and end-organ damage.

  7. A 75-year-old man presents with progressive fatigue, macrocytic anemia (MCV 110 fL), and symmetric paresthesias of the lower extremities. Serum B12 is 98 pg/mL. Anti-intrinsic factor antibodies are positive. Which finding would confirm the underlying diagnosis?

    Answer: Elevated methylmalonic acid and homocysteine

    Elevated methylmalonic acid (MMA) and homocysteine confirm functional B12 deficiency and are pathognomonic for pernicious anemia when anti-intrinsic factor antibodies are present.