ABIM Ultimate Test 3

Question 1

A 67-year-old man with diabetes and hypertension presents with acute-onset flank pain radiating to the groin, microscopic hematuria, and a 6-mm ureteral stone on CT. He has no fever and his creatinine is at baseline. What is the most appropriate initial management?

Accepted Answer

Medical expulsive therapy with tamsulosin and analgesics

Answer

Uncomplicated ureteral stones ≤10 mm without infection or obstruction are managed with medical expulsive therapy; tamsulosin relaxes ureteral smooth muscle to facilitate passage.

Question 2

A 34-year-old woman has episodic hypertension, headaches, diaphoresis, and palpitations. 24-hour urine shows elevated metanephrines and normetanephrines. What is the most important pre-operative medication to initiate?

Accepted Answer

Alpha-blocker (phenoxybenzamine)

Answer

Alpha-blockade must be established before beta-blockade to prevent unopposed alpha-adrenergic vasoconstriction and hypertensive crisis during pheochromocytoma resection.

Question 3

A 70-year-old woman with atrial fibrillation is on warfarin with a stable INR of 2.4. She is scheduled for a colonoscopy with polypectomy. What is the most appropriate peri-procedural anticoagulation strategy?

Accepted Answer

Hold warfarin 5 days prior; bridge with LMWH if high stroke risk

Answer

High-bleed-risk procedures like polypectomy require warfarin to be held 5 days prior; bridging with LMWH is indicated for high thromboembolic risk (e.g., CHA₂DS₂-VASc ≥5 or mechanical valve).

Question 4

A 48-year-old man is found to have a fasting glucose of 130 mg/dL on two separate occasions. His HbA1c is 7.4%. He has BMI 31 and no cardiovascular disease. What is the preferred initial pharmacologic therapy?

Accepted Answer

Metformin

Answer

Metformin is the recommended first-line pharmacologic agent for type 2 diabetes unless contraindicated, given its efficacy, safety profile, low cost, and weight neutrality.

Question 5

A 55-year-old woman with rheumatoid arthritis on methotrexate 20 mg/week presents with progressive dyspnea and a dry cough. HRCT shows bilateral ground-glass opacities and fine reticulations. Her PFTs show a restrictive pattern. What is the most likely diagnosis?

Accepted Answer

Methotrexate-induced pneumonitis

Answer

Methotrexate pneumonitis is a hypersensitivity reaction that can occur at any dose and time; it presents with dry cough, dyspnea, fever, and bilateral infiltrates on imaging.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Ultimate Test 3