ABIM Ultimate Test 5

Question 1

A 72-year-old man with hypertension and hyperlipidemia presents with sudden painless loss of vision in his left eye. Fundoscopy shows a pale, edematous retina with a 'cherry-red spot' at the macula. What is the most likely diagnosis?

Accepted Answer

Central retinal artery occlusion

Answer

Central retinal artery occlusion causes sudden painless monocular vision loss with a pale retina and cherry-red spot due to preserved choroidal circulation at the fovea.

Question 2

A 65-year-old man with COPD on tiotropium presents with an acute exacerbation with increased dyspnea, purulent sputum, and reduced exercise tolerance. SpO₂ is 88% on room air. What is the appropriate target SpO₂ during oxygen supplementation?

Accepted Answer

88–92%

Answer

In COPD exacerbations, controlled oxygen therapy targeting SpO₂ 88–92% prevents hypercapnic respiratory failure by preserving hypoxic drive in CO₂ retainers.

Question 3

A 44-year-old woman presents with proximal muscle weakness, elevated CK of 4,200 U/L, and an erythematous rash over her knuckles (Gottron's papules) and eyelids (heliotrope rash). What malignancy must be screened for?

Accepted Answer

Ovarian cancer

Answer

Dermatomyositis is strongly associated with internal malignancy, most commonly ovarian, lung, breast, and GI cancers; age- and sex-appropriate cancer screening is mandatory at diagnosis.

Question 4

A 55-year-old man with known alcoholic cirrhosis (Child-Pugh B) presents with acute onset abdominal pain and fever. Diagnostic paracentesis shows PMN count of 350 cells/µL. What is the most appropriate treatment?

Accepted Answer

IV cefotaxime (or ceftriaxone) plus IV albumin

Answer

Spontaneous bacterial peritonitis (PMN ≥250/µL) is treated with IV third-generation cephalosporin plus albumin infusion (1.5 g/kg at diagnosis, 1 g/kg on day 3) to prevent hepatorenal syndrome.

Question 5

A 48-year-old man is found to have a serum calcium of 11.4 mg/dL and a PTH of 92 pg/mL (elevated). He is asymptomatic with normal renal function and bone density T-score of -1.8. What is the recommended management?

Accepted Answer

Observation with annual monitoring

Answer

Asymptomatic primary hyperparathyroidism without surgical criteria (Ca <1 mg/dL above ULN, age >50, T-score >-2.5, GFR >60) is managed with surveillance per AAES guidelines.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Ultimate Test 5