The ABIM exam, administered by the American Board of Internal Medicine (or ABIM), is a comprehensive and challenging assessment for men and women who want to become certified as an internist. At present, more than 200,000 ABIM certificate holders are practicing in the United States.
The ABIM exam has been developed to measure knowledge and skill in a series of specialty areas. Fields with their own versions include: internal medicine; adolescent medicine; advanced heart failure and transplant cardiology; allergy and immunology; cardiovascular disease; clinical cardiac electrophysiology; critical care medicine; endocrinology, diabetes, and metabolism; gastroenterology; geriatric medicine; hematology; hospice and palliative medicine; infectious disease; interventional cardiology; medical oncology; nephrology; pulmonary disease; rheumatology; sleep medicine; sports medicine; and transplant hepatology.
All of these tests are administered by computer in testing centers around the country. The duration of an ABIM exam depends on whether it is being taken for initial certification or for recertification. The initial certification examination usually takes about 10 hours, although the cardiovascular disease specialty exam can take as long as 14 hours. The exam day is broken up into sessions, each of which contains no more than 60 questions; there are optional breaks between these sessions, although the precise arrangement of each ABIM exam may vary.
ABIM Study Guide
Start learning how to be successful on your ABIM exam. Our ABIM study guide is guaranteed to help you get the results you deserve on your ABIM test. Some test takers prefer to study using flashcards and so we have created the best ABIM flashcards that cover everything you need to know for the ABIM exam. Note that using multiple study aids will help you maximize the benefit from your study time.
ABIM Practice Test
1. Your Emergency Room patient is a 68-year-old man, who awoke with palpitations, chest pain, dyspnea and dizziness. He complains his heart is ‘pounding’ but denies any history of heart disease or hypertension. His blood pressure is 85/60 mm/Hg, and his pulse is rapid and irregular. Crackles are audible at his lung bases. His routine lab work is normal, including a troponin level. His EKG shows atrial fibrillation with a ventricular response of 130/minute. Choose the most appropriate treatment:
a. Intravenous digoxin
b. Intravenous beta-blocker
c. Immediate cardioversion
d. Delayed cardioversion after anticoagulation
2. A 57-year-old man presents with intermittent, mid-sternal chest pain, usually lasting 5 to10 minutes. It occurs both with effort and at rest. The pain radiates to his throat and sometimes responds to antacids. He takes amlodipine (Norvasc) 10 mg daily for high blood pressure; it is his only regular medication. He discontinued smoking about age 50. He denies other significant medical problems. He has a family history of hypertension and Type 2 diabetes. On examination, his blood pressure is 135/85 mm/Hg, pulse 76 and regular, height 70 inches, and weight 210 lbs. His chest is clear to auscultation, with no cardiac murmurs or rubs. The balance of the examination is negative. His electrocardiogram is normal. Choose the next logical procedure most likely to provide a diagnosis:
a. Troponin level
b. EGD endoscopy
c. Coronary angiography
d. Technetium Tc99m Sestamibi stress test
3. A 52-year-old man with Type 2 diabetes presents at your office for his annual physical examination. His only medication is metformin. His recent hemoglobin A1C result was 6.5%, and serum creatinine was 1.8 mg/dL. His blood pressure is elevated to 170/75 mm/Hg, but the rest of his examination is negative. His chest x-ray is normal, but his EKG suggests left ventricular hypertrophy. Choose the drug to treat his hypertension:
a. Angiotensin converting enzyme (ACE) inhibitor
b. Angiotensin receptor blocker (ARB)
d. Calcium channel blocker (CCB)
4. A middle-aged man presented to your Emergency Room with chest pain. Laboratory and EKG findings indicated a non-ST elevation myocardial infarction (NSTEMI). His angiography showed a 95% obstruction in a major branch of his left anterior descending artery (LAD). His other arteries appeared less than 40% obstructed. The surgeon performed balloon angioplasty and placed a drug-eluting stent in the severely obstructed vessel. Your patient reports he is pain-free after the procedure. His resting EKG is now normal and an isotopic stress test fails to show ischemia. Discharge your patient with all the following drugs EXCEPT:
c. ACE inhibitor
5. When differentiating diastolic heart failure (DHF) from systolic heart failure (SHF), it is important to remember:
a. The left ventricular ejection fraction (LVEF) is usually above 40% to 50% in a DHF patient
b. Diuretics are contraindicated in DHF
c. DHF has a poorer prognosis than SHF
d. Beta-blockers and calcium channel blockers have been shown to improve lifespan for DHF patients
1. C: Immediate cardioversion. The man’s cardiac rhythm is atrial fibrillation (AF) with a rapid ventricular response. AF is the most common arrhythmia, originating in the atria or pulmonary veins. Typical EKG findings are an irregularly irregular rhythm with no visible P-waves. The rhythm may be asymptomatic, but is associated with a rapid ventricular rate and signs of cardiovascular instability. The optimal therapy for acute arrhythmia (onset less than 48 hours) with severe cardiovascular symptoms is synchronized electrical cardioversion. Patients with chronic AF require several weeks of anticoagulants (usually warfarin), followed by elective cardioversion. Prescribe either beta-blockers or digoxin for rate control, or rhythm control with sotalol or amiodarone. There is no clear cut best practice. Anticoagulation is always indicated to reduce stroke risk from thromboemboli originating in the atrial appendage.
2. D: Technetium Tc99m Sestamibi stress test. Your primary objective is to determine if your patient has coronary artery disease (CAD). His history of smoking, high blood pressure, and possibly diabetes already elevate his risk. A lipid profile would only corroborate his risk for CAD. An EGD endoscopy would rule out an upper gastrointestinal cause of his symptoms, such as gastroesophageal reflux or esophageal spasm. Many patients have both coronary artery disease and gastrointestinal reflux. An elevated troponin level may indicate recent myocardial damage, but is likely to be normal or equivocal in this patient. Since he is presently stable and pain-free, an isotopic stress test is preferable to immediate angiography. Consider angiography, and possible angioplasty and stenting, after reviewing the results of his stress test.
3. B: Angiotensin receptor blocker (ARB). Hypertension is common among diabetics, and contributes to such complications as myocardial infarction, heart failure, stroke, diabetic nephropathy, and microvascular disease. The American Diabetes Association (ADA) recommends reducing the diabetic’s blood pressure below 130/80 mm/Hg (rather than below 140/90 mm/Hg for the general population with isolated hypertension). Rarely is a single drug sufficient to achieve the ADA’s target goal. Your patient’s elevated creatinine and LVH indicate end organ damage, so immediate antihypertensive therapy is required; begin ARB therapy because of its renal protective action and low incidence of side- effects. Add additional drugs with different mechanisms of action to reach the target goal, instead of increasing the dose of a single agent. If the diabetic has ischemic heart disease, add a dihydropyridine CCB or beta-blocker.
4. B: Warfarin. Warfarin is not usually indicated for coronary artery disease patients, unless their CAD is complicated by atrial fibrillation or venous thromboembolism. Clopidogrel, a platelet inhibitor, is generally prescribed to diminish the chance of stent thrombosis. However, 15% to 48% of patients are resistant, so higher doses of clopidogrel or another anti-platelet drug (e.g., prasugrel) may be employed. If your patient’s bleeding risk is low, add Aspirin for dual anti-platelet therapy. A statin is definitely indicated, even if your patient’s LDL cholesterol is in the normal range. Many cardiologists believe LDL cholesterol should be reduced to less than 70 mg/dL in CAD patients. Angiotensin converting enzyme (ACE) inhibitors have a protective effect on the brains, hearts, and kidneys of CAD patients, in addition to their antihypertensive action.
5. A: The left ventricular ejection fraction (LVEF) is usually above 40% or 50% in a DHF patient
Systolic heart failure (SHF) means the heart cannot pump enough blood efficiently in its active phase. Diastolic heart failure (DHF) means the heart cannot relax enough during its resting phase. DHF shares many clinical features with SHF, including similar symptoms, impaired physical capacity, and lowered quality of life. However, the left ventricular ejection fraction (LVEF) of the DHF patient is preserved, often above 40% to 50%. DHF patients have a better survival rate. Sometimes, DHF evolves into SHF, with a reduced LVEF. Diuretics may reduce the sodium and water retention of DHF, in a manner similar to that of SHF. Calcium channel blockers (e.g., verapamil) or beta-blockers (e.g., propranolol) may benefit patients with either sinus rhythm or atrial fibrillation. Angiotensin receptor blockers may improve DHF hypertrophy and stiffening, as in SHF. There is no evidence that these drugs prolong survival or reduce morbidity, but they relieve symptoms.