ABIM Internal Medicine Initial Certification Examination Practice Test
Internal medicine board-style questions draw on clinical reasoning across common adult conditions, including gastrointestinal, endocrine, infectious, hematologic, ophthalmologic, musculoskeletal, and bone disorders. The practice bank uses patient vignettes, examination findings, and laboratory or imaging results to ask for diagnoses, interpretation of evidence, and appropriate next steps in care.
Exam overview
About the ABIM Internal Medicine Initial Certification Examination Exam
These cases exercise the ability to connect symptoms and objective findings to mechanisms and differential diagnoses. They ask you to interpret patterns such as microcytic anemia with depleted iron stores, inflammatory synovial fluid, adrenal hormone abnormalities, retinal ischemia, and esophageal motility failure. Other decisions involve identifying a likely medication adverse effect, selecting a test to measure hepatitis B replication, counseling a patient with infectious mononucleosis, and sequencing preoperative treatment for pheochromocytoma. Several questions focus on management choices, including evaluating iron-deficiency anemia in a patient without menstrual blood loss, responding to suspected septic arthritis, and preventing another fracture after a vertebral compression fracture. Work through each vignette by separating decisive findings from background details, then linking the clinical pattern to a safe diagnostic or treatment action.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A 56-year-old woman has progressive difficulty swallowing both solids and liquids. Esophageal manometry demonstrates impaired lower esophageal sphincter relaxation and absent peristalsis in the distal esophagus. Which diagnosis best explains these findings?
Show answer
Correct answer: AAchalasia is characterized by impaired relaxation of the lower esophageal sphincter and absent or abnormal distal esophageal peristalsis. It commonly causes dysphagia to both solids and liquids; manometry is the diagnostic gold standard.
A 62-year-old man with type 2 diabetes has recurrent episodes of sweating, tremor, and confusion before lunch. He takes metformin and glyburide; kidney function is normal. Which medication is the most likely cause of these episodes?
Show answer
Correct answer: BSulfonylureas such as glyburide stimulate insulin secretion and can cause hypoglycemia, particularly when meals are delayed or missed. Metformin used alone rarely causes hypoglycemia. The episodic autonomic and neuroglycopenic symptoms described are consistent with low blood glucose.
A 64-year-old man with hypertension develops sudden painless loss of vision in his left eye. Funduscopic examination shows retinal whitening with a cherry-red spot. Which underlying vascular event most likely caused this finding?
Show answer
Correct answer: ACentral retinal artery occlusion causes abrupt, painless monocular vision loss. Retinal ischemia produces a pale retina with a characteristic cherry-red fovea; this is an ocular emergency requiring urgent evaluation for an embolic source and stroke risk.
A 24-year-old woman presents with fever, sore throat, and fatigue. Examination shows posterior cervical lymphadenopathy and splenomegaly. A heterophile antibody test is positive. Which counseling is most appropriate?
Show answer
Correct answer: AInfectious mononucleosis can cause splenic enlargement and, rarely, rupture. Patients should avoid contact sports and activities with abdominal-trauma risk during the period of splenomegaly and early recovery.
A 52-year-old man with chronic hepatitis B has a positive hepatitis B surface antigen and a positive hepatitis B e antigen. Which additional test most directly quantifies active viral replication?
Show answer
Correct answer: AQuantitative serum HBV DNA measures viral replication and helps guide treatment decisions and monitoring. Surface antibody indicates immunity, alpha-fetoprotein is used in selected liver cancer surveillance contexts, and hepatitis C antibody tests for a different infection.
A 39-year-old woman has episodic headache, palpitations, sweating, and markedly elevated blood pressure. Imaging reveals an adrenal mass, and biochemical testing supports pheochromocytoma. Before adrenal surgery, which medication sequence is appropriate?
Show answer
Correct answer: BPreoperative alpha blockade is established first to control vasoconstriction and hypertension. A beta blocker may be added afterward for persistent tachycardia; starting beta blockade first can leave unopposed alpha-adrenergic vasoconstriction and precipitate severe hypertension.
A 59-year-old woman has fatigue and pallor. Hemoglobin is 9.8 g/dL, mean corpuscular volume is 72 fL, ferritin is low, and she has no menstrual bleeding. What is the most appropriate next step to evaluate the cause?
Show answer
Correct answer: AIron-deficiency anemia in a postmenopausal woman warrants evaluation for gastrointestinal blood loss, including upper and lower endoscopy, because occult malignancy and other lesions must be considered. The low ferritin supports iron deficiency rather than thalassemia trait.
How to use this practice test
The free practice bank contains 50 questions, and a session presents up to 20 randomly selected questions. After completing a session, review the results to identify which clinical patterns or decisions need further study. Use missed items to revisit the reasoning behind the diagnosis, test, counseling, or treatment choice.
Preparation tips
- For anemia cases, distinguish iron deficiency from other causes of microcytosis and connect iron studies to evaluation for gastrointestinal blood loss when menstrual loss is absent.
- Compare endocrine patterns by hormone level: use cortisol, ACTH, sodium, and potassium findings to recognize primary adrenal insufficiency, and recall alpha blockade before beta blockade for pheochromocytoma preparation.
- Practice interpreting urgent findings such as neutrophil-predominant synovial fluid and a cherry-red spot, then identify the immediate clinical concern and appropriate response.
- For medication and infection vignettes, link glyburide to hypoglycemia risk and review activity counseling for mononucleosis with splenomegaly.
- Review fracture-prevention decisions after a low-trauma vertebral fracture, including when a bisphosphonate is a typical initial option and how kidney function informs treatment selection.