ABIM Test 3

Question 1

A 66-year-old man with atrial fibrillation and CHA₂DS₂-VASc score of 4 is on warfarin (INR 2.4). He develops hematuria and hemoglobin drops from 13 to 10 g/dL. What is the most appropriate management of anticoagulation?

Accepted Answer

Hold warfarin and reverse with vitamin K; resume after source identified and treated

Answer

Significant bleeding warrants holding anticoagulation and identifying the source; warfarin should be resumed once hemostasis is achieved given his high stroke risk.

Question 2

A 29-year-old woman presents with amenorrhea, galactorrhea, and a serum prolactin of 180 ng/mL. MRI shows a 12-mm pituitary lesion. Which treatment is most appropriate?

Accepted Answer

Cabergoline

Answer

Cabergoline is the preferred dopamine agonist for macroprolactinomas due to superior efficacy and tolerability compared to bromocriptine.

Question 3

A 70-year-old man with COPD (FEV₁ 45% predicted) is admitted with acute exacerbation. After 48 hours of bronchodilators and systemic corticosteroids, he remains hypercapnic (PaCO₂ 68 mmHg, pH 7.28). Which intervention has been shown to reduce mortality and need for intubation in this setting?

Accepted Answer

Noninvasive positive-pressure ventilation (NIPPV)

Answer

NIPPV reduces intubation rates, ICU length of stay, and mortality in COPD exacerbations with hypercapnic respiratory failure.

Question 4

A 48-year-old woman with rheumatoid arthritis on methotrexate and prednisone presents with subacute onset of fever, non-productive cough, and dyspnea. CT shows bilateral ground-glass opacities. LDH is elevated. Which pathogen is most likely?

Accepted Answer

Pneumocystis jirovecii

Answer

Immunosuppressed patients on chronic corticosteroids are at high risk for Pneumocystis jirovecii pneumonia, which presents with bilateral ground-glass opacities and elevated LDH.

Question 5

A 55-year-old man with known coronary artery disease has an LDL of 95 mg/dL on high-intensity statin therapy. What is the most appropriate next step to further reduce his cardiovascular risk?

Accepted Answer

Add ezetimibe

Answer

Ezetimibe added to statin therapy was shown in IMPROVE-IT to further reduce major cardiovascular events in high-risk patients, making it the preferred add-on agent.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Test 3