ABIM Ultimate Test 4

Question 1

A 66-year-old woman with heart failure (EF 25%) presents with worsening dyspnea. She is already on carvedilol, lisinopril, and furosemide. Her potassium is 4.2 mEq/L. What additional medication most reduces mortality in this patient?

Accepted Answer

Spironolactone (aldosterone antagonist)

Answer

Aldosterone antagonists (spironolactone or eplerenone) are a pillar of HFrEF therapy with proven mortality benefit in patients with EF ≤35% and adequate renal function/potassium.

Question 2

A 40-year-old man with HIV (CD4 count 85/µL, not on ART) develops subacute fever, headache, and altered mental status over 3 weeks. CSF India ink preparation is positive. What is the best initial treatment?

Accepted Answer

Liposomal amphotericin B plus flucytosine induction

Answer

Cryptococcal meningitis in HIV is treated with liposomal amphotericin B plus flucytosine for at least 2 weeks induction before transitioning to fluconazole consolidation.

Question 3

A 52-year-old woman presents with a 3-month history of early satiety, dysphagia to solids and liquids, and regurgitation of undigested food. Esophageal manometry shows absent peristalsis and failure of LES relaxation. What is the diagnosis?

Accepted Answer

Achalasia

Answer

Achalasia is characterized by aperistalsis and incomplete lower esophageal sphincter relaxation on manometry, causing progressive dysphagia to both solids and liquids.

Question 4

A 68-year-old man is found to have a monoclonal IgG spike of 3.8 g/dL, bone marrow plasma cells 25%, serum calcium 11.8 mg/dL, and multiple lytic bone lesions on skeletal survey. Creatinine is 1.9 mg/dL. What is the diagnosis?

Accepted Answer

Multiple myeloma

Answer

Multiple myeloma is diagnosed by ≥10% clonal plasma cells plus at least one CRAB criterion (hyperCalcemia, Renal insufficiency, Anemia, Bone lesions).

Question 5

A 45-year-old man presents with sudden onset of tearing chest pain radiating to the back. BP is 180/100 mmHg in right arm and 140/80 mmHg in left arm. CXR shows widened mediastinum. What is the most appropriate immediate management?

Accepted Answer

IV labetalol to target HR <60 and SBP <120 mmHg

Answer

Type A aortic dissection management begins with IV beta-blockade (labetalol) to reduce aortic wall stress by lowering heart rate and blood pressure before urgent surgery.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Ultimate Test 4