100+ Free ABIM Internal Medicine Practice Questions

The ABIM Internal Medicine initial certification exam is the board examination administered by the American Board of Internal Medicine for physicians who have completed at least 36 months of ACGME-accredited internal medicine residency. Certification is required (or strongly preferred) for hospital credentialing, insurance panel participation, and most employment opportunities for internists. The exam contains approximately 240 single-best-answer multiple-choice questions delivered in four 60-question modules of 2 hours each over a ~10-hour exam day at Pearson VUE Professional Centers.

The 2026 ABIM initial certification application fee is approximately $1,690. A late fee applies if the application is submitted after the standard deadline. Candidates should also budget for question banks (MKSAP, UWorld, NEJM Knowledge+), live or online review courses, and Pearson VUE travel. Total out-of-pocket preparation costs commonly reach $2,500 to $4,000 per attempt.

Candidates must hold an MD from an LCME-accredited U.S. or Canadian medical school, a DO from an AOA-accredited osteopathic college, or be an international medical graduate with a valid ECFMG certificate. They must complete at least 36 months in an ACGME-accredited internal medicine residency with satisfactory Program Director evaluation across the six ACGME core competencies. An active unrestricted medical license is required before the certificate is issued. Candidates have up to 7 years after residency completion to achieve initial certification.

ABIM uses a criterion-referenced passing standard set through standard-setting methodology; the scaled score required to pass has historically been near 366. The first-time pass rate is approximately 90% for U.S. MD/DO residency graduates, based on ABIM annual pass rate reports. Pass rates are lower for international medical graduates and for candidates on a second or third attempt. ABIM publishes its annual pass rate data by program and candidate type on its public reports page.

The ABIM blueprint allocates the largest shares to cardiovascular disease (~14%), followed by gastroenterology/hepatology, pulmonary, endocrine/metabolism, infectious disease, and hematology/oncology (~9% each), then nephrology (~6%), rheumatology, neurology, and psychiatry (~4% each), and smaller shares for geriatrics, dermatology, obstetrics/gynecology, ophthalmology/otolaryngology, preventive medicine/epidemiology, general internal medicine, allergy/immunology, and ethics/professionalism. Questions are written to current guidelines including ACC/AHA, ADA 2024, GOLD 2024, GINA 2024, KDIGO, IDSA, ACG 2024 H. pylori, USPSTF, and ACIP.

The Longitudinal Knowledge Assessment (LKA) is ABIM's alternative to the traditional 10-year high-stakes maintenance of certification (MOC) exam. The LKA delivers approximately 30 questions per quarter (~120 questions per year) over a 5-year assessment cycle through the ABIM online portal, with 4 minutes per question and open-book reference access. Diplomates receive per-question feedback immediately, and ABIM evaluates cumulative performance at the end of each 5-year period. Most diplomates now select the LKA. The traditional 10-year MOC exam remains available for those who prefer a single high-stakes assessment; either option satisfies the assessment requirement for continuing certification.

The ABIM Internal Medicine initial certification exam is delivered in four modules of 60 questions each, with 2 hours per module. Candidates receive 100 minutes of pooled break time that can be divided between modules as they choose, plus a tutorial before the exam and an optional survey after. The total testing day is approximately 10 hours. The exam is administered at Pearson VUE Professional Centers once per year, typically in late summer (August).

ABIM certification is maintained through a continuous 10-year cycle. Diplomates must hold an active unrestricted medical license, complete ABIM's MOC assessment (either the Longitudinal Knowledge Assessment every quarter over 5 years, or the traditional 10-year MOC exam), earn 100 MOC points every 5 years (with a variety of CME and practice improvement activities), and pay annual diplomate fees. Certification status is publicly reported on the ABIM website.