ABIM Ultimate Test 2

Question 1

A 58-year-old man with type 2 diabetes presents with a serum creatinine of 2.4 mg/dL and a urine albumin-to-creatinine ratio of 450 mg/g. Which medication class provides the greatest kidney-protective benefit beyond blood pressure control in this patient?

Accepted Answer

SGLT2 inhibitor

Answer

SGLT2 inhibitors (e.g., empagliflozin, canagliflozin) have demonstrated significant cardiorenal protection in diabetic kidney disease independent of glycemic control.

Question 2

A 45-year-old woman is found to have a TSH of 0.02 mIU/L and free T4 of 2.8 ng/dL. She reports palpitations, heat intolerance, and a 10-lb weight loss. Thyroid uptake scan shows diffusely increased uptake. What is the most appropriate next step?

Accepted Answer

Start methimazole

Answer

Diffusely increased radioiodine uptake in the setting of hyperthyroidism is consistent with Graves' disease; methimazole is the preferred first-line antithyroid drug in non-pregnant adults.

Question 3

A 72-year-old woman presents with sudden-onset severe headache, neck stiffness, and photophobia. CT head is negative. CSF shows xanthochromia and 8,500 red blood cells/µL that do not clear. What is the most likely diagnosis?

Accepted Answer

Subarachnoid hemorrhage

Answer

Xanthochromia with a bloody, non-clearing CSF tap in the context of a thunderclap headache is pathognomonic for subarachnoid hemorrhage.

Question 4

A 55-year-old man with known cirrhosis develops confusion, asterixis, and jaundice. His INR is 2.1, bilirubin 8.4 mg/dL, and creatinine 2.8 mg/dL. By which scoring system is he best stratified for transplant priority?

Accepted Answer

MELD-Na score

Answer

MELD-Na (Model for End-stage Liver Disease with sodium) is the standard scoring system used by UNOS to prioritize liver transplant candidates.

Question 5

A 38-year-old woman with SLE develops worsening dyspnea and bilateral pleural effusions. Lab work shows complement levels C3 45 mg/dL (low) and anti-dsDNA 1:640. Urine protein is 4.2 g/24h. What is the most likely cause of her effusions?

Accepted Answer

Nephrotic syndrome with hypoalbuminemia

Answer

Markedly elevated proteinuria with low complement in SLE indicates active nephritis causing nephrotic syndrome; hypoalbuminemia from protein loss leads to transudative effusions.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Ultimate Test 2