The American Board of Internal Medicine (ABIM) certification exam is one of the most demanding board examinations in medicine. Passing it confirms that a physician has met the rigorous standards required to practice internal medicine independently. Preparing thoroughly requires mastering a broad range of clinical topics, from cardiology and pulmonology to nephrology and infectious disease.
This free ABIM practice test PDF gives you printable, exam-style questions you can study anywhere — at home, during a commute, or between clinical shifts. Download the file, print it out, and work through each question to identify the content areas where you need the most reinforcement before your board date.
Cardiovascular disease consistently accounts for the largest single content block on the ABIM exam, comprising approximately 15–20% of questions. You should be comfortable diagnosing and managing acute coronary syndromes, heart failure with reduced and preserved ejection fraction, valvular disease, arrhythmias, and hypertensive emergencies. Pay close attention to guideline-directed medical therapy — the exam tests not just diagnosis but appropriate pharmacologic management, including beta-blockers, ACE inhibitors, ARNIs, SGLT2 inhibitors, and antiarrhythmic agents.
Pulmonary and critical care medicine represents another high-yield block. Core topics include chronic obstructive pulmonary disease (COPD) exacerbations, asthma management, interstitial lung diseases, pulmonary hypertension, pleural effusion workup, and ventilator management in the ICU. For critical care, master the management of septic shock, ARDS, and respiratory failure. Know when to initiate non-invasive positive pressure ventilation versus invasive mechanical ventilation and how to titrate PEEP and FiO2 in ARDS following the Berlin criteria.
Gastroenterology questions on the ABIM exam cover both luminal GI disease and liver pathology in roughly equal measure. For luminal GI, you will need to know the workup and management of inflammatory bowel disease (Crohn’s disease versus ulcerative colitis), peptic ulcer disease, GI bleeding, celiac disease, irritable bowel syndrome, and colorectal cancer screening guidelines. Be familiar with the step-up approach to IBD therapy — from aminosalicylates and corticosteroids through immunomodulators and biologic agents.
Hepatology topics include cirrhosis and its complications (ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal bleeding, hepatorenal syndrome), viral hepatitis B and C (including current direct-acting antiviral regimens for HCV), non-alcoholic fatty liver disease, autoimmune hepatitis, and hepatocellular carcinoma surveillance. The Child-Pugh and MELD scoring systems come up regularly, especially in the context of transplant eligibility and prognosis in decompensated cirrhosis.
The endocrinology section tests diabetes management extensively. Know the glycemic targets for different patient populations, the mechanism and indications for each class of antidiabetic agent (including GLP-1 agonists, SGLT2 inhibitors, and insulin regimens), and the management of diabetic ketoacidosis and hyperglycemic hyperosmolar state. Thyroid disease is another high-yield area — hypothyroidism, hyperthyroidism (including Graves’ disease and toxic multinodular goiter), thyroid nodule workup, and thyroid cancer management are all fair game. Adrenal disorders (Cushing’s syndrome, primary adrenal insufficiency, pheochromocytoma) and pituitary pathology also appear regularly.
Nephrology questions frequently involve the interpretation of urine studies, fractional excretion calculations, and the differential diagnosis of acute kidney injury (prerenal, intrinsic, and postrenal). Master the approach to hyponatremia and hypernatremia — calculating osmolality, identifying the underlying mechanism, and choosing the correct correction rate to avoid osmotic demyelination syndrome. Chronic kidney disease staging, indications for dialysis, and glomerulonephritis workup (including ANCA-associated vasculitis and anti-GBM disease) round out this section.
Infectious disease questions span community-acquired pneumonia (CAP) treatment guidelines, tuberculosis (latent versus active, treatment regimens), HIV management (when to start ART, opportunistic infection prophylaxis and treatment, immune reconstitution inflammatory syndrome), endocarditis (Duke criteria, antibiotic selection, indications for surgery), and tickborne illnesses. For ID, emphasis is placed on selecting the correct empiric antibiotic regimen, recognizing resistant organisms, and de-escalating therapy based on culture data.
Rheumatology on the ABIM board exam covers the major inflammatory arthritides — rheumatoid arthritis, seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, reactive arthritis), gout and pseudogout (crystal identification, treatment of acute flares and urate-lowering therapy targets), and connective tissue diseases such as SLE, Sjögren’s syndrome, systemic sclerosis, and inflammatory myopathies. Know the serology panels associated with each condition, including anti-dsDNA, anti-Sm, anti-Ro/La, anti-Scl-70, anti-Jo-1, and ANCA patterns.
Consistent, structured study is the most reliable path to passing the ABIM certification exam. Work through practice questions daily, review each explanation carefully regardless of whether you answered correctly, and return to weak areas repeatedly. When you are ready to test yourself under realistic conditions, use our full abim practice test to simulate the exam experience online with immediate feedback on every question.