A 58-year-old man with diabetes presents with 2 hours of crushing substernal chest pain. ECG shows 3 mm ST elevation in V2–V4. Door-to-balloon time at the PCI-capable hospital is expected to be within 60 minutes. What is the recommended reperfusion strategy?
Cardiovascular
Question · Easy
Which four-drug combination is considered first-line guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF)?
Chapter 0: The ABIM Exam, Blueprint & Study Strategy
0.1 Exam Format, Question Types & the 2026 Blueprint
Study guide
A 72-year-old woman with hypertension, diabetes, and prior stroke has newly diagnosed nonvalvular atrial fibrillation. Her CHA2DS2-VASc is 5. What is the most appropriate stroke prevention?
Question · Hard
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According to the 2017 ACC/AHA hypertension guideline, which of the following blood pressure thresholds defines stage 1 hypertension?
A 45-year-old woman presents with sudden pleuritic chest pain and dyspnea. She has no risk factors for PE, no unilateral leg swelling, HR 85, SaO2 98%, no hemoptysis, and no prior DVT/PE. She meets all 8 PERC criteria. What is the next step?
Question · Medium
After a drug-eluting stent for stable CAD, what is the minimum recommended duration of dual antiplatelet therapy (ASA + P2Y12 inhibitor) in a patient at standard bleeding risk?
0.2 Eligibility, Registration, Fees & Exam-Day Logistics
A 60-year-old man with tearing chest pain radiating to the back has BP 200/110 on the right arm and 170/90 on the left. CT angiography shows a type A aortic dissection. What is the initial management?
Which symptom triad is classic for severe aortic stenosis?
A 55-year-old presents with chest pain, ECG shows new LBBB, and initial high-sensitivity troponin is elevated. HEART score is 7. What is the most appropriate disposition?
In hypertrophic obstructive cardiomyopathy, which of the following maneuvers increases the intensity of the systolic murmur?
0.3 Scoring, the Passing Standard & Score Reports
A 68-year-old with 40 pack-years smoking presents with chronic dyspnea. Post-bronchodilator FEV1/FVC is 0.62 with FEV1 55% predicted. He reports mMRC grade 2 dyspnea and one moderate exacerbation in the past year. Per GOLD 2024, which group is this?
Pulmonary
For a patient with COPD GOLD Group E (≥2 moderate exacerbations or ≥1 hospitalization) and blood eosinophils of 350 cells/µL, what is the preferred initial inhaler regimen?
Per GINA 2024, a 30-year-old with mild persistent asthma should be started on which regimen?
A 60-year-old man with daytime somnolence, witnessed apneas, and BMI 35 has an apnea-hypopnea index (AHI) of 35/hour on polysomnography. What is the first-line therapy?
0.4 Building a Blueprint-Weighted Study Plan
A 65-year-old man has progressive dyspnea and dry cough. HRCT shows peripheral basal reticulation and honeycombing consistent with usual interstitial pneumonia (UIP). Which antifibrotic therapies are approved for IPF?
In a mechanically ventilated ARDS patient, what tidal volume should be targeted based on predicted body weight (PBW)?
A 45-year-old with chronic reflux symptoms has new dysphagia, 10-pound weight loss, and anemia. What is the most appropriate next step?
Gastroenterology
According to the ACG 2024 H. pylori guideline, what is the recommended first-line eradication therapy for treatment-naïve adults in areas of high clarithromycin resistance?
Chapter 1: Cardiovascular Disease (14% of Exam)
1.1 Ischemic Heart Disease & Acute Coronary Syndromes
A 28-year-old with bloody diarrhea, tenesmus, and abdominal pain is diagnosed with mild-to-moderate left-sided ulcerative colitis. What is first-line induction therapy?
A 35-year-old woman with chronic diarrhea, weight loss, and iron deficiency has elevated IgA tTG antibodies. What is the next step to confirm celiac disease?
Which score is currently used by OPTN for adult liver transplant waitlist prioritization in the United States?
For a cirrhotic patient, what is the recommended HCC surveillance strategy?
1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI
A 55-year-old with chronic hepatitis C, genotype 1a, no cirrhosis, is treatment naïve. Which pangenotypic DAA regimen is appropriate?
A 62-year-old woman with type 2 diabetes (A1c 8.2%), eGFR 55, and established ASCVD should have which added agent for maximum cardiovascular and renal benefit per ADA 2024?
Endocrinology
Which of the following is the most appropriate initial therapy for overt hypothyroidism in a 45-year-old non-pregnant adult?
A 38-year-old woman presents with palpitations, heat intolerance, weight loss, and diffuse goiter. TSH is suppressed, free T4 elevated, and TSH receptor antibodies are positive. What is the diagnosis?
1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention
A 50-year-old with fatigue, hyperpigmentation, and orthostatic hypotension is found to have low cortisol and elevated ACTH. What is the diagnosis?
A 70-year-old postmenopausal woman has a DEXA T-score of −2.8 at the femoral neck with no fragility fracture. Per current guidelines, what is first-line pharmacotherapy?
After discontinuing denosumab, what is the key risk that must be mitigated?
A previously healthy 40-year-old outpatient with community-acquired pneumonia has no comorbidities and no recent antibiotic use. What is appropriate empiric therapy per IDSA/ATS 2019?
Infectious Disease
1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias
A 30-year-old HIV-positive patient with CD4 count of 150 cells/µL should receive prophylaxis against which infection?
A 24-year-old sexually active MSM wants HIV PrEP. Which is an evidence-based regimen?
A febrile patient with a new cardiac murmur has two blood cultures growing viridans streptococci and a TTE showing a mitral valve vegetation. Which diagnostic criteria confirm endocarditis?
A 72-year-old with suspected sepsis has lactate 4.2, hypotension unresponsive to 30 mL/kg crystalloid. Per Surviving Sepsis Campaign 2021, what is the first-line vasopressor?
1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy
A 35-year-old from an endemic country has a 12-mm induration on tuberculin skin test and a normal chest X-ray without symptoms. What is the diagnosis and management?
A 45-year-old woman with menorrhagia has ferritin 12 ng/mL, Hgb 10.2, MCV 72. What is the diagnosis?
Hematology Oncology
A 72-year-old with fatigue and pancytopenia has hypercellular marrow with dysplasia in two cell lines and 4% blasts. Which score predicts prognosis and guides therapy in MDS?
A 45-year-old with pancytopenia, coagulopathy, and promyelocytes with Auer rods on peripheral smear — what leukemia subtype requires urgent specific induction?
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