ABIM Test 4

Question 1

A 25-year-old woman is referred for evaluation of iron-deficiency anemia unresponsive to oral iron supplementation. She reports loose stools and a 10-pound weight loss. IgA anti-tissue transglutaminase antibody is markedly elevated. What is the gold-standard confirmatory test?

Accepted Answer

Small bowel biopsy via upper endoscopy

Answer

Duodenal biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis remains the gold standard for confirming celiac disease.

Question 2

A 78-year-old man with hypertension and prior stroke is started on apixaban for new atrial fibrillation. His creatinine is 1.8 mg/dL. What is the correct dose of apixaban?

Accepted Answer

2.5 mg twice daily

Answer

Dose reduction to 2.5 mg twice daily is required when at least 2 of 3 criteria are met: age ≥80, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL; this patient meets age and creatinine criteria.

Question 3

A 52-year-old man presents with progressive dyspnea and bilateral lower extremity edema. Echo shows EF of 65% with E/e' ratio of 16 and left atrial enlargement. NT-proBNP is 1,200 pg/mL. What is the most likely diagnosis?

Accepted Answer

Heart failure with preserved ejection fraction (HFpEF)

Answer

Preserved EF with elevated filling pressures (elevated E/e' ratio), elevated natriuretic peptides, and left atrial enlargement in a symptomatic patient defines HFpEF.

Question 4

A 40-year-old HIV-positive man (CD4 count 80 cells/µL, viral load detectable) develops confusion, fever, and nuchal rigidity. CSF shows elevated opening pressure, 20 WBC/µL (mostly lymphocytes), low glucose, and India ink stain is positive. What is the treatment of choice?

Accepted Answer

Amphotericin B deoxycholate plus flucytosine for 2 weeks

Answer

IDSA guidelines recommend amphotericin B deoxycholate plus flucytosine for 2 weeks as induction therapy for cryptococcal meningitis in HIV-infected patients.

Question 5

A 67-year-old woman with a 40 pack-year smoking history has a 6-cm abdominal aortic aneurysm discovered incidentally on ultrasound. She is asymptomatic with no hemodynamic instability. What is the most appropriate management?

Accepted Answer

Endovascular aortic repair (EVAR) electively

Answer

AAAs ≥5.5 cm in women (and ≥5.5 cm in men) require repair; EVAR is the preferred approach when anatomy is suitable, performed electively in stable patients.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Test 4