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Ace the ABIM Board Exam with Med-Challenger's proven Internal Medicine Board Review. Featuring over 1,700 ABIM Exam Review questions with detailed explanations and rationales following the American Board of Internal Medicine Exam Blueprint, board exam simulation, adaptive learning features, and hundreds of built-in CME credits, Med-Challenger's ABIM exam review is the best way to prepare for internal medicine exams and fulfill ABIM MOC requirements including ABIM MOC Points.

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internal medicine review - internal medicine question bank for internal medicine exam review, over 1700 ABIM exam questions and answers

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Over 1700 Internal Medicine Exam Review Questions & Answers

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Internal Medicine Course Information

Internal Medicine Review Course Information

Allergy / Immunology

Allergic Complications of Transfusions
Anaphylaxis
Asthma
Auto-Immune Systemic Disorders
Drug Allergy
Food Allergy
Primary Immunodeficiency Disorders
Rhinitis, Sinusitis, & Conjunctivitis
Skin Disorders
Urticaria and Angioedema

Cardiovascular Disease

Congenital Heart Disease in the Adult
Dysrhythmias/Conduction Defects
Endocarditis and Other Cardiovascular Infections
Hypertension
Ischemic Heart Disease
Myocardial Disease
Pericardial Disease
Syncope
Valvular Heart Disease
Vascular Disease

Dermatology

Acne/Rosacea
Dermatitis (Eczemas)
Dermatologic Immunology Disorders of Hair & Nails
Nodules and Tumors of the Skin
Papulosquamous Dermatoses
Photosensitivity Dermatoses
Pigment Disorders
Skin and Soft Tissue Infections
Vascular Dermatoses
Vesiculobullous Dermatoses

Endocrinology, Diabetes, and Metabolism

Adrenal Disorders
Anterior Pituitary Disorders
Diabetes Mellitus
Disorders of Calcium Metabolism and Bone
Hypoglycemia Not Due to Insulinoma
Hypothalamic Disorders
Lipid Disorders
Nutritional Disorders
Polyglandular Disorders
Posterior Pituitary and Water Metabolism
Thyroid Disorders

Gastroenterology

Biliary Tract Disease
Colonic and Anorectal Disease
Esophageal Disease
Liver Disease
Pancreatic Disease
Small Intestinal Disease
Stomach or Duodenum
Undiagnosed Gastrointestinal Hemorrhage

Geriatric Syndromes

Bowel and Bladder Function
Common Issues in the Elderly
Neurological Issues in the Elderly
Physical Impairment in the Elderly
Other Primary Geriatrics

Hematology

Coagulation Factor Disorders and Thrombotic Disorders
Genetic Disorders of Hemoglobin
Hematologic Malignancies
Hemolytic Anemia
Hypoproliferative Anemia
Leukocyte Disorders
Platelet Disorders
Transfusions & Bone Marrow Transplantation

Infectious Disease

AIDS and HIV Infection
Bacteremia, Sepsis Syndrome, & Fever of Unknown Origin
Enteric Infections
Infections of Joints and Bones
Lower Respiratory Tract Infections
Nosocomial / Procedure & Device-Associated Infections
Parasitic Infections
Prevention of Infectious Disease
Genitourinary Infections
Systemic Fungal Infections
Tick-Borne Illnesses
Upper Respiratory Tract Infections
Viral Infections

Nephrology/Urology

Acute Renal Failure
Chronic Kidney Disease
Glomerular Disorders
Nephrolithiasis
Prostate Disorders
Tubulointerstitial Disease
Urinary Tract Infections
Water and Electrolyte Balance
Other Urology

Neurology

Central Nervous System Infections
Cerebrovascular Disease
Cranial Neuropathy Diseases of Muscle and Neuromuscular Function
Disorders of Cerebral Function
Headache
Movement Disorders
Multiple Sclerosis and Other Demyelinating Diseases
Nerve Root Syndromes / Mechanical Lesions of the Spine
Peripheral Neuropathy
Seizures

Obstetrics / Gynecology

Breast Disorders
Diseases of the Vulva & Vagina
Family Planning and Reproductive Health
Menopause: Management, Risks, & Benefits of Therapy
Menstrual Disorders
Ovarian Disorders
Pregnancy
Uterine Disorders

Medical Oncology

Bone Tumors
Breast Cancer
Cancer Prevention, Screening, & Survivorship
Complications of Cancer and its Treatment
Endocrine Tumors and Endocrine Manifestations of Tumors
Gastrointestinal or Hepatic Cancer
Gynecologic Cancer
Lung Cancer
Neoplasms of the Head and Neck
Oncologic Emergencies
Urologic Cancer

Ophthalmology

Eye Infections & Other Ophthalmologic Disorders
Glaucoma and Cataracts
Retinal Disease

Otolaryngology / Dental Medicine

Diseases of the Ear
Diseases of the Oral Cavity, Pharynx, and Salivary Glands
Disorders of the Nose and Paranasal Sinuses

Psychiatry

Anxiety Disorders
Eating Disorders
Factitious Disorders
Mood Disorders
Personality Disorders
Schizophrenia and Delusional (Paranoid) Disorders
Somatoform Disorders

Pulmonary Disease

Evaluation and Management of Pulmonary Disorders
Interstitial, Inflammatory, & Parenchymal Lung Diseases
Obstructive Airway Disease
Pulmonary Vascular Disease
Sleep Medicine

Rheumatology / Orthopedics

Inflammatory Disorders of Joints - Immunologic
Inflammatory Disorders of Joints - Non-Immunologic
Non-Inflammatory Musculoskeletal Disorders

Critical Care Medicine

Cardiac Arrest and Therapeutic Hypothermia
Cardiac Issues in the ICU
Coronavirus (SARS-COV-2, COVID-19)
Critical Care Pharmacology
Endocrine Issues in the ICU
Ethical Dilemmas in the ICU
Gastroenterology in the ICU
General Care Issues in the ICU
Hematologic Issues in the ICU
Hemodynamic Monitoring
Infectious Disease Issues in the ICU
Management of Severe Obstructive Lung Disease
Neurology Issues in the ICU
Obstetrical Critical Care
Renal Issues in the ICU
Respiratory Failure
Shock
Surgical Critical Care Issues in the ICU
Thromboembolic Disease

Miscellaneous

Epidemiology
Ethics Pain
Management and Addiction Medicine

Sample Question 1

Which antibiotic is the best choice for empiric treatment of cystitis when Chlamydia is the suspected cause?

Azithromycin (Zithromax) 1 gram PO single dose
Ceftriaxone (Rocephin) 1 gram IM single dose
doxycycline 100 mg PO BID for 7 days
Ampicillin 2 grams PO BID for 7 days
Erythromycin 500 mg tid for 10 days

Educational Objective:

Treat chlamydial infection.

Key Point:

Azithromycin is the drug of choice against Chlamidia. Consider additional empiric treatment for gonorrhea.

Explanation:

Azithromycin single dose treatment has several advantages. It is highly effective, well-tolerated, has a high compliance, and it may be administered as a directly observed therapy (DOT) in health units and ERs.

Tetracycline and doxycycline are acceptable choices. Their disadvantages include duration and tolerability. Erythromycin is a poor choice because of tolerability and duration as well as emerging resistance. Ceftriaxone is not effective against Chlamydia.

Consideration of treatment for coinfection with N. gonorrhea is usually warranted.

References:

Birnbaumer DM, Sexually Transmitted Diseases.  In Rosen’s Emergency Medicine. 2014; 98: 1312-1325

Meyers DS, Halvorson H, Luckhaupt S. Screening for chlamydial infection: An evidence update for the U.S. Preventive Services Task Force. Ann Intern Med 2007; 147: 135

Geisler WM, Chlamydial Diseases, Goldman-Cecil Medicine, 2016; 318: 2007-2013.e2

Darville T, Neisseria gonorrhoeae (Gonococcus), Nelson Textbook of Pediatrics 2016; 192: 1365-1369.e1

Sample Question 2

A 64-year-old man presented to his physician with weakness, bleeding of the gums and "blood spots" on his skin of one-week duration. His past history included a history of non-Hodgkin lymphoma 13 years earlier, successfully treated with radiation and chemotherapy. Physical examination included vital signs of Temp:-98.4⁰F, Pulse-96 and regular, Blood Pressure 142/70 mm HG, and respiration 18/minute. There was pallor of the skin and mucus membranes. Multiple petechiae were noted over the lower and upper extremities. A CBC showed WBC 3200/ml with 87% myeloblasts, Hgb 9 Gm/L, Hct-28%, and platelet count of 13,000/ml. The liver and spleen were normal in size. Bone marrow aspirate confirmed a diagnosis of acute myeloblastic leukemia.

Which one of the following statements is correct in regards to second malignancies in general?

Approximately 90% of patients die from their 2nd malignancy.
The most common 2nd malignancy is lung cancer.
Acute leukemia is one of the ten most common 2nd malignancies.
The risk of 2nd malignancies is about 1 in 25 patients.

Educational Objective:

Summarize the epidemiologic characteristics of 2^nd malignancies.

Key Point:

Second malignancies occur in about 8% of patients. The most common second malignancy is lung cancer. Fifty percent of patients die from their 2^nd malignancy.

Explanation:

An analysis of over 2 million patients with one of the ten most frequent primary malignancies (breast, prostate, lung, pancreas, kidney, urinary bladder, colon, rectum, non-Hodgkin lymphoma, and melanoma) showed that about 1 in 8 patients developed a 2^nd malignancy. The highest rates of 2^nd malignancies were in patients whose first malignancy was either bladder cancer or non-Hodgkin lymphoma. Over 50% of patients die from their 2^nd malignancy, the most common of which is lung cancer (12%).

References:

Donin N, Filson C, Drakaki A, et al. Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer. 2016; 122: 3075-3086

Balducci L. Nonhematologic Complications of Treatment of Cancer in the Older-Aged Person. Management of Cancer in the Older Patient. 2012 ; 14: 127-132

Sample Question 3

A 30-year-old 32-weeks’ pregnant woman with pre-gestational diabetes reports vulvar itching, burning, and a whitish-thick discharge for the past 7 days. Exam demonstrates diffuse erythema of the vulva and vagina, with a thick white discharge adherent to the vaginal walls. No abnormal odor is noted. Pseudohyphae are noted on microscopy. Which of the following best describes her diagnosis?

trichomoniasis
bacterial vaginosis
vulvovaginal candidiasis
lichen simplex chronicus

Educational Objective:

Diagnose vulvovaginal candidiasis.

Key Point:

Suspect vulvovaginal candidiasis in a patient presenting with pruritus, erythema and white, thick, curd-like vaginal discharge. Diagnose with microscopy of wet mount.

Explanation:

The condition described is vulvovaginal candidiasis. Diagnosis is made by microscopy or culture. Treatment of vulvovaginal candidiasis includes oral fluconazole 150 mg in a single dose or topical antifungal preparations. In patients with complicated cases such as the one described, a second dose of fluconazole 150 mg given 3 days after the first increased the cure rate from 67% to 80%. Trichomoniasis is a sexually transmitted disease diagnosed by visualization of motile trichomonads on microscopy. Bacterial vaginosis does not typically affect the vulva and is characterized by a fishy odor, thin gray/green vaginal discharge, and clue cells on microscopy. Lichen simplex chronicus can be initiated by an underlying candida infection; however, it does not typically involve the vagina.

There is no evidence that fluconazole poses a risk to the fetus at any stage of development.

References:

Norgaard M, Pedersen L, Gislum M, et al: Maternal use of fluconazole and risk of congenital malformations: a Danish population-based cohort study. J Antimicrob Chemother, 2008; 62: 172-176

Galask RP, Elas D. Vulvovaginitis. Precis: An Update in Obstetrics and Gynecology. Gynecology. Fourth Edition. 2011; 67-77.

Chen TM. Differential diagnosis of vulvar lesions. Curso ENARM 2018. Published March 16, 2011. Accessed February 13, 2018.

Vaginitis. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Compendium of Selected Publications 2008; 1314-1325.

Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep. 2015; 17: 462

Sample Question 4

A 31-year-old man has been diagnosed with antisocial personality disorder after a number of arrests for theft and drug dealing as well as a history of fights. When providing an intervention for this patient, which of the following is most likely to apply?

motivate the patient to attend and engage with treatment
provide a firm daily routine
require regular drug testing
monitor sleeping patterns
confront the patient about undesirable behaviors

Educational Objective:

Treat antisocial personality disorder.

Key Point:

Patients with antisocial personality disorder should be consistently motivated to engage with treatment because of common non-compliance and treatment withdrawals.

Explanation:

Most people with antisocial personality disorder receive the majority of their treatment outside the health system; care such as education social care, housing. The patient in this case should be consistently motivated to attend and engage with treatment. This need arises because patients with antisocial personality disorder are particularly vulnerable to premature withdrawal from treatment and supportive interventions. The remaining options are not universally true for patients with antisocial personality disorder, but they may apply in some cases.

References:

National Collaborating Centre for Mental Health. Antisocial Personality Disorder: Treatment, Management and Prevention. 2009.

Personality disorders: borderline and antisocial (QS88). National Institute for Health and Care Excellence, 2016

Sample Question 5

A 36-year-old gravida 0 para 0 woman with a history of uterine leiomyoma presents to you for evaluation of vaginal bleeding. She states that she has a several-year history of heavy vaginal bleeding during her menses and notes that she has had painless vaginal bleeding for the past 2 days. She notes that it has been getting progressively heavier to the point that she is requiring 2 pads per hour. She also notes having some lightheadedness but has not passed out.

Prior to her visit with you, she was evaluated by a gynecologist and endometrial cancer was ruled out. She has not received any medical therapy for the heavy vaginal bleeding.

She is not sexually active and notes no history of sexually transmitted infections. She smokes 1 pack of cigarettes a day and has been smoking for 10 years. She does not drink or use illicit drugs. She does not take any medications and does not have any allergies.

Vital signs are: blood pressure 80/40 mm Hg, pulse 125 beats/minute and regular, temperature 99 °F, respiratory rate 14 breaths/minute, and oxygen saturation 100% on room air. General physical examination is remarkable for pallor. Pelvic examination is remarkable for active bleeding from the cervical os as well as blood in the vaginal vault. No cervical motion tenderness is present and there are no palpable masses.

Complete blood count shows a normal white cell count, normal platelets, and a hemoglobin level of 8 g/dL, which is down from 10 g/dL two weeks earlier. Chemistry values are normal and coagulation studies are within normal limits. Her blood type is A negative. A urine pregnancy test is negative.

In addition to fluid resuscitation and obtaining consent for blood products and consideration of transfusion of packed red blood cells, what is the next step in the management of this patient's condition?

intrauterine tamponade
emergent hysterectomy
intravenous estrogen
estrogen/progestin–based oral contraceptive regimen

Educational Objective:

Know how to treat severe vaginal bleeding.

Key Point:

Intrauterine tamponade is effective for the treatment of severe vaginal bleeding.

Explanation:

The next step in the management of this patient's condition would be intrauterine tamponade. This patient presents with hemodynamically unstable vaginal bleeding. The first step would be stabilizing the patient’s hemodynamic status with intravenous fluids and possible blood transfusion. The next step would be intrauterine tamponade with either gauze packing or balloon.

Intravenous estrogen could be used as an adjunct, but it would be contraindicated given that she is older than 35 years of age and smokes. Initiation of an estrogen/progestin–based oral contraceptive regimen would also be contraindicated given that she smokes and is older than 35 years of age. It would be best to attempt the conservative measures noted before considering a hysterectomy.

References:

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in non-pregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891-896.

Zacur HA. Managing an episode of severe or prolonged uterine bleeding. Accessed July 12, 2016.

Target Audience

Med-Challenger IM is intended for practitioners of family medicine or clinicians otherwise involved in the diagnosis and treatment of acute, emergent, or chronic medical problems.

Educational Objectives

The objective of this continuing medical education program is to provide an interactive review of the knowledge base of acute care and primary care medicine as appropriate by medical specialty. After completing this course, the participating clinician should be better equipped to:

Manage the broad spectrum of acute and chronic medical problems encountered in the practice of medicine.
Formulate appropriate differential diagnoses for patients presenting with acute medical problems of uncertain etiology.
Efficiently initiate therapeutic and diagnostic procedures for patients presenting with acute and chronic medical disorders.
Diagnose and treat acute and chronic: cardiovascular disorders; diseases of the eye, ear, nose, throat, skin and soft tissues; endocrinologic disorders; orthopedic and environmental injuries; gastrointestinal diseases; gynecologic and obstetric disorders; hematologic and oncologic problems; immunologic, allergic and rheumatologic diseases; infectious diseases; signs and symptoms; musculoskeletal disorders; pulmonary diseases; renal and urologic disorders; and intoxications and poisonings.
Demonstrate mastery of the knowledge and cognitive skills required to achieve objectives 1-4 by scoring at least 80% on all topics studied for CME credit.

Faculty

The following individuals have generously contributed to the content and/or editing of this program:

Editor-in-Chief:

Paul Griner, MD
Professor of Medicine, Emeritus
University of Rochester School of Medicine
Weston, MA

Contributing Editors:

Gerard Kiernan, MD
Hospitalist
Dartmouth Hitchcock Clinic
Keene, NH

Miguel G. Madariaga, MD, MSc, FACP, DLSHTM
Director, Center for Wound Healing and Hyperbaric Medicine
Physician, Infectious Disease
Doylestown Hospital
Doylestown, Pennsylvania

Rohan Sen, MD
Assistant Clinical Professor
Internal Medicine
Washington University School of Medicine
St. Louis, MO

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Challenger Corporation. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Designation Statement

AMA Credit - The Postgraduate Institute for Medicine designates this enduring material for a maximum of 157 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC Points - Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 159 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ANCC Credit - The maximum number of hours awarded for this Continuing Nursing Education activity is 157 contact hours.

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Internal Medicine Board Review
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FEATURE	MED-C IM	Rosh Review	MedStudy	Board Vitals
ABIM Review Questions & Full Explanations	1700+	1500+	1200	800
AMA Cat 1 CME Credits	157	100	No CME	40
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ABIM Cert / MOC Board Review
157 AMA Category 1 CME credits
157 ABIM MOC Points
Value $599

Urgent Care Board Review

Pass-guaranteed (BCUCM / ABUCM)
3300+ board-style exam questions
230 AMA PRA Category 1 credits
Value $599

State-required CME Course

CME Requirements by US state
Useful every year
Value $229

Care Center CME Requirements

ECG Interpretation: Basics and Special Cases

Review ECG Interpretation Basics and Special Cases
Value $229

Malpractice & Risk Management

Legal course for physicians
Value $229

Platform Features & Utilities

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