100+ Free ABPS Internal Medicine Practice Questions

Pass your ABPS Internal Medicine Certification Examination exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

Historically high first-time pass rate for residency-trained internists (BCIM does not publish exact statistics) Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

A 56-year-old man with diabetes presents with 90 minutes of substernal chest pressure. ECG shows 3 mm ST elevation in V2-V4. The PCI-capable hospital can achieve a door-to-balloon time within 60 minutes. What is the recommended reperfusion strategy?

Primary percutaneous coronary intervention

Fibrinolytic therapy with tenecteplase

Aspirin and heparin alone

Delayed angiography in 24 hours

to track

Same family resources

More ABPS Board Certifications Prep

Continue through related practice pages, study guides, comparisons, and articles from the same exam family.

Practice Pages

ABPS Administrative Medicine Practice100 questions ABPS Anesthesiology (BCA) Practice100 questions ABPS Dermatology (BCD) Practice100 questions ABPS Diagnostic Radiology (BCDR) Practice100 questions ABPS Disaster Medicine Practice100 questions ABPS Emergency Medicine (BCEM) Practice100 questions

2026 Statistics

Key Facts: ABPS Internal Medicine Exam

200

Total MCQ Items

ABPS BCIM Internal Medicine exam

~4 hr

Total Exam Time

Computer-based testing

~14%

Cardiovascular Weight

Largest single domain on the BCIM 2026 outline

~$2,000

2026 Exam Fee

ABPS/BCIM (verify current schedule)

IM Residency

Required Training

Accredited internal medicine residency or ABPS-recognized equivalent

4 Drugs

HFrEF GDMT Pillars

ARNI + beta-blocker + MRA + SGLT2i per AHA/ACC/HFSA 2022

The ABPS Internal Medicine Certification Exam is a 200-item, ~4-hour computer-based test administered by BCIM/ABPS for residency-trained internists. The blueprint weighs Cardiovascular (~14%), Pulmonary/Critical Care (~12%), Gastroenterology/Hepatology (~11%), Endocrinology (~10%), Hematology/Oncology (~10%), Infectious Diseases (~10%), Nephrology/Acid-Base (~9%), Rheumatology (~7%), Neurology (~6%), and a combined Allergy/Derm/Geriatrics/Prevention/Ethics block (~11%). The 2026 fee is approximately $2,000; eligibility requires an unrestricted MD/DO license and completion of an accredited IM residency.

Sample ABPS Internal Medicine Practice Questions

Try these sample questions to test your ABPS Internal Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 56-year-old man with diabetes presents with 90 minutes of substernal chest pressure. ECG shows 3 mm ST elevation in V2-V4. The PCI-capable hospital can achieve a door-to-balloon time within 60 minutes. What is the recommended reperfusion strategy?

A.Primary percutaneous coronary intervention

B.Fibrinolytic therapy with tenecteplase

C.Aspirin and heparin alone

D.Delayed angiography in 24 hours

Explanation: STEMI guidelines (ACC/AHA/SCAI 2021) call for primary PCI within 90 minutes of first medical contact at a PCI-capable facility. Fibrinolysis is reserved for cases when PCI cannot be performed within 120 minutes. Medical therapy alone or delayed angiography is inappropriate for STEMI.

2Which four-drug combination is recommended as first-line guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF)?

A.ARNI, beta-blocker, MRA, SGLT2 inhibitor

B.ACE inhibitor, thiazide, digoxin, amiodarone

C.Nitrate, hydralazine, calcium channel blocker, furosemide

D.ARB, alpha-blocker, digoxin, loop diuretic

Explanation: AHA/ACC/HFSA 2022 establishes four-pillar GDMT for HFrEF: ARNI (or ACEi/ARB), evidence-based beta-blocker (carvedilol, metoprolol succinate, bisoprolol), MRA (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). All four reduce mortality and should be initiated and titrated rapidly.

3A 72-year-old woman with hypertension, diabetes, and prior stroke is found to have new nonvalvular atrial fibrillation. Her CHA2DS2-VASc is 5. What is the most appropriate stroke prevention?

A.Oral anticoagulation with a direct oral anticoagulant

B.Aspirin 81 mg daily

C.Aspirin plus clopidogrel

D.No therapy until symptoms develop

Explanation: ACC/AHA/HRS 2023 recommends oral anticoagulation for nonvalvular AF when CHA2DS2-VASc is greater than or equal to 2 in men or 3 in women. DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) are preferred over warfarin in most patients. Antiplatelet therapy does not replace anticoagulation in AF.

4According to the 2017 ACC/AHA hypertension guideline, which threshold defines stage 1 hypertension?

A.SBP 130-139 or DBP 80-89 mm Hg

B.SBP 140-159 or DBP 90-99 mm Hg

C.SBP greater than or equal to 160 or DBP greater than or equal to 100

D.SBP 120-129 and DBP less than 80

Explanation: The 2017 ACC/AHA guideline defines stage 1 hypertension as SBP 130-139 or DBP 80-89 mm Hg. Stage 2 is SBP greater than or equal to 140 or DBP greater than or equal to 90. Elevated BP is SBP 120-129 with DBP less than 80. Pharmacotherapy is recommended for stage 1 if 10-year ASCVD risk is greater than or equal to 10 percent or there is comorbid disease, and for all patients with stage 2.

5A 45-year-old woman has sudden pleuritic chest pain and dyspnea. She has no PE risk factors, no leg swelling, HR 85, SaO2 98 percent, no hemoptysis, no prior DVT/PE, and meets all 8 PERC criteria. What is the next step?

A.No further PE workup is needed

B.CT pulmonary angiography

C.D-dimer

D.Ventilation/perfusion scan

Explanation: In a low pre-test probability patient (Wells less than 2) who meets all 8 PERC criteria, post-test PE probability is less than 2 percent and no further testing is indicated. Adding D-dimer in this setting only generates false positives.

6After a drug-eluting stent for stable CAD, what is the minimum recommended duration of dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) at standard bleeding risk?

A.6 months

B.1 month

C.24 months

D.Lifelong

Explanation: For DES placed for stable CAD at standard bleeding risk, ACC/AHA/SCAI 2021 recommends a minimum of 6 months of DAPT. Minimum DAPT is 12 months after ACS. Shorter durations may be considered in selected high bleeding risk scenarios.

7A 60-year-old man has tearing chest pain radiating to the back. BP is 200/110 mm Hg on the right and 170/90 on the left. CT angiography shows a Stanford type A aortic dissection. What is the initial management?

A.Emergent cardiothoracic surgery consult with IV esmolol then nitroprusside

B.IV alteplase

C.High-dose statin and discharge

D.IV heparin and observation

Explanation: Stanford type A dissection (involving ascending aorta) is a surgical emergency. Initial medical therapy targets HR less than 60 and SBP less than 120 with an IV beta-blocker first (esmolol or labetalol) before adding a vasodilator (nitroprusside) to prevent reflex tachycardia. Thrombolysis and anticoagulation are contraindicated.

8Which symptom triad is classic for severe aortic stenosis?

A.Angina, syncope, heart failure

B.Chest pain, palpitations, edema

C.Fever, rash, arthralgia

D.Dyspnea, hemoptysis, pleuritic pain

Explanation: The classic triad of severe symptomatic aortic stenosis is angina (median survival 5 years), syncope (3 years), and heart failure (2 years). Symptomatic severe AS is a Class I indication for valve replacement (SAVR or TAVR per surgical risk and anatomy).

9A 55-year-old presents with chest pain. ECG shows a new left bundle branch block and the initial high-sensitivity troponin is elevated. HEART score is 7. What is the most appropriate disposition?

A.Admit for urgent invasive evaluation

B.Discharge with outpatient stress test

C.Observe in the ED for 6 hours and discharge if repeat troponin negative

D.CT coronary angiography and discharge if normal

Explanation: HEART score 7-10 is high risk (about 50 percent MACE at 6 weeks). Elevated troponin with new LBBB suggests a STEMI equivalent. Immediate admission with urgent invasive angiography is indicated.

10In hypertrophic obstructive cardiomyopathy (HOCM), which maneuver increases the intensity of the systolic murmur?

A.Valsalva strain phase

B.Squatting

C.Passive leg raise

D.Sustained handgrip

Explanation: Valsalva strain and standing decrease preload and LV cavity size, worsening LVOT obstruction in HOCM and increasing the murmur. Squatting, leg raise, and handgrip increase preload or afterload and decrease the HOCM murmur. This is opposite to aortic stenosis (which softens with Valsalva).

About the ABPS Internal Medicine Exam

The ABPS Internal Medicine Certification Examination, administered by the Board of Certification in Internal Medicine (BCIM) under the American Board of Physician Specialties (ABPS), validates the cognitive and clinical-judgment competencies expected of an internist. The blueprint covers cardiovascular disease (ACC/AHA hypertension thresholds, four-pillar HFrEF GDMT, ACS reperfusion, AF stroke prevention), pulmonary and critical care (GOLD 2024 COPD groups, GINA 2024 ICS-formoterol Track 1, ARDSnet, Sepsis-3 / Surviving Sepsis 2024), gastroenterology and hepatology (ACG 2024 H. pylori, MELD-Na, AASLD HCC surveillance, HCV pangenotypic DAAs), nephrology (KDIGO 2024 CKD, hyponatremia, AKI, dialysis indications), endocrinology (ADA 2024 SGLT2/GLP-1 priority, thyroid and adrenal disorders, osteoporosis), hematology and oncology (DOAC selection, USPSTF cancer screening, anemia workup), infectious diseases (IDSA CAP/HAP/IE/meningitis, HIV ART, hepatitis serologies, ACIP), rheumatology (ACR 2020 gout, RA DMARDs, SLE, GCA/PMR), neurology (acute stroke, seizure, Parkinson, MS), allergy/immunology, dermatology relevant to IM, geriatrics (Beers criteria, falls, delirium), preventive medicine (USPSTF 2026 grade A/B), and ethics. Eligibility requires an MD/DO with valid unrestricted license and successful completion of an accredited internal medicine residency or an ABPS-recognized equivalent training pathway.

Questions

200 scored questions

Time Limit

~4 hours CBT

Passing Score

Criterion-referenced scaled score set by BCIM (modified Angoff standard)

Exam Fee

~$2,000 examination fee (ABPS/BCIM 2026 — verify current schedule) (American Board of Physician Specialties (ABPS) — Board of Certification in Internal Medicine (BCIM))

ABPS Internal Medicine Exam Content Outline

~14%

Cardiovascular Disease

ACC/AHA 2017 hypertension stages (≥130/80 stage 1), four-pillar HFrEF GDMT (ARNI, beta-blocker, MRA, SGLT2 inhibitor) per AHA/ACC/HFSA 2022, STEMI primary PCI within 90 minutes (fibrinolysis if PCI >120 min), CHA2DS2-VASc-guided DOACs for nonvalvular AF, valvular disease (severe AS triad — angina, syncope, HF), HOCM physical exam (Valsalva increases murmur), aortic dissection management (esmolol then nitroprusside), DAPT duration (≥6 mo for stable DES, ≥12 mo for ACS), PERC/Wells/HEART risk stratification, and 2018 AHA/ACC dyslipidemia statin intensity.

~12%

Pulmonary & Critical Care

GOLD 2024 COPD Groups A/B/E (groups C and D consolidated into E), triple therapy (LABA + LAMA + ICS) when blood eosinophils ≥300, GINA 2024 as-needed low-dose ICS-formoterol (Track 1) replacing SABA-only, OSA CPAP for AHI ≥15, IPF antifibrotics (pirfenidone and nintedanib — PANTHER-IPF showed prednisone+azathioprine+NAC harm), ARDSnet 6 mL/kg PBW with plateau ≤30, Sepsis-3 / Surviving Sepsis Campaign 2024 hour-1 bundle, IDSA/ATS CAP guidelines (CURB-65), latent TB IGRA, pulmonary hypertension WHO groups.

~11%

Gastroenterology & Hepatology

GERD alarm features mandate EGD (dysphagia, weight loss, anemia, age >60, family hx GI cancer), ACG 2024 H. pylori bismuth quadruple therapy first-line in high clarithromycin resistance, IBD induction (5-ASA for mild-moderate UC, biologics for moderate-severe), celiac diagnosis requires duodenal biopsy on gluten, MELD-Na for cirrhosis prioritization, AASLD HCC surveillance ultrasound every 6 months, HCV pangenotypic DAAs (glecaprevir-pibrentasvir 8 weeks; sofosbuvir-velpatasvir 12 weeks), acute pancreatitis Atlanta criteria, IDSA/SHEA 2021 fidaxomicin first-line for C. difficile.

~10%

Endocrinology

ADA 2024 — SGLT2 inhibitors or GLP-1 RAs in established ASCVD/HF/CKD regardless of A1c (SGLT2 if HF or CKD predominates; GLP-1 if ASCVD or obesity), levothyroxine 1.6 µg/kg/day for overt hypothyroidism, Graves disease (methimazole, RAI, surgery), Addison disease (low cortisol with elevated ACTH and hyperpigmentation), pheochromocytoma 10% rule with alpha then beta blockade, Cushing syndrome workup (24-hour UFC, low-dose dexamethasone, late-night salivary cortisol), osteoporosis (bisphosphonate first-line; denosumab causes rebound vertebral fractures on discontinuation), DKA vs HHS management, MEN1/MEN2 syndromes.

~10%

Hematology & Oncology

Iron deficiency anemia (oral vs IV iron in malabsorption/CKD), B12/folate deficiency (methylmalonic acid distinguishes), sickle cell disease (hydroxyurea, voxelotor, crizanlizumab), DVT/PE — CHEST 2021 favors apixaban/rivaroxaban DOACs, HIT 4Ts and argatroban/bivalirudin, ITP and TTP (PLASMIC score, plasma exchange), tumor lysis syndrome (rasburicase, allopurinol), USPSTF cancer screening (colon 45-75, lung LDCT 50-80 with 20 pack-years, breast 40-74 per 2024 update), febrile neutropenia (IDSA cefepime ± vancomycin).

~10%

Infectious Diseases

IDSA CAP/HAP/VAP guidelines, IE Duke criteria and HACEK organisms, bacterial meningitis empiric ceftriaxone + vancomycin (add ampicillin if >50 or immunocompromised for Listeria), osteomyelitis MRI plus bone biopsy, Lyme staging and doxycycline, HIV ART INSTI-based first-line and PrEP eligibility, hepatitis B serology interpretation, latent TB (IGRA, 3HP or 4R per CDC), C. difficile fidaxomicin, sepsis bundle, antimicrobial stewardship principles, and 2024 ACIP RSV adult immunization recommendations.

~9%

Nephrology & Acid-Base

KDIGO 2024 CKD staging (eGFR + albuminuria), SGLT2 inhibitors for CKD with albuminuria regardless of diabetes, hyponatremia workup (volume status, urine osmolality and sodium), AKI KDIGO criteria, acute interstitial nephritis (drugs — NSAIDs, PPIs, beta-lactams), polycystic kidney disease (tolvaptan), nephrotic vs nephritic syndromes, anion-gap metabolic acidosis (MUDPILES) with Winter's formula, hyperkalemia ECG and treatment ladder, contrast-associated AKI, and dialysis indications (AEIOU).

~7%

Rheumatology & Musculoskeletal

ACR/EULAR 2010 RA classification with methotrexate first-line DMARD, SLE diagnosis (ANA, anti-dsDNA, anti-Smith, hydroxychloroquine for all), gout per ACR 2020 (ULT to <6 mg/dL with allopurinol, HLA-B*5801 testing in Asian and Black patients), pseudogout (CPPD), giant cell arteritis (start steroids before biopsy; tocilizumab), polymyalgia rheumatica, ANCA-associated vasculitis (rituximab vs cyclophosphamide), spondyloarthropathies (HLA-B27), fibromyalgia 2016 ACR criteria.

~6%

Neurology for Internists

Acute stroke (IV alteplase ≤4.5 hours, mechanical thrombectomy ≤24 hours per DAWN/DEFUSE-3), TIA ABCD2 risk stratification, seizure first-vs-recurrent and AED selection, migraine acute (triptans) and prophylactic (CGRP mAbs, beta-blockers, topiramate), Parkinson disease (carbidopa-levodopa), multiple sclerosis DMTs, peripheral neuropathy workup, normal-pressure hydrocephalus triad (gait, urinary, cognitive), delirium vs dementia (CAM, MoCA), and Bell palsy (steroids ± antivirals).

~11%

Allergy/Immunology, Dermatology, Geriatrics, Prevention & Ethics

Anaphylaxis IM epinephrine first, drug allergy testing, USPSTF 2026 grade A/B recommendations (cancer screening, statin primary prevention, AAA, lipid screening), ACIP 2024-2026 immunizations (RSV ≥75, shingles RZV), Beers criteria for inappropriate elderly prescribing, falls assessment (TUG), advance directives and POLST, capacity vs competency (capacity is decision-specific and clinical), futility and goals-of-care, Stevens-Johnson syndrome/TEN, erythema multiforme, and basal cell/squamous cell/melanoma identification (ABCDE).

How to Pass the ABPS Internal Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by BCIM (modified Angoff standard)
Exam length: 200 questions
Time limit: ~4 hours CBT
Exam fee: ~$2,000 examination fee (ABPS/BCIM 2026 — verify current schedule)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABPS Internal Medicine Study Tips from Top Performers

1Memorize the four-pillar HFrEF regimen (ARNI + evidence-based beta-blocker + MRA + SGLT2 inhibitor) per the AHA/ACC/HFSA 2022 guideline. Initiate and titrate all four rapidly — each independently lowers mortality. Pair this with the 2017 ACC/AHA hypertension thresholds (stage 1 ≥130/80) and CHA2DS2-VASc-guided DOACs for nonvalvular AF — these three guidelines anchor the cardiovascular block.

2Lock in GOLD 2024 COPD: Groups A/B/E (C and D were consolidated into E in GOLD 2023), triple therapy (LABA + LAMA + ICS) when blood eosinophils ≥300 cells/µL or with frequent exacerbations, and SABA-only is no longer recommended. For asthma, GINA 2024 Track 1 = as-needed low-dose ICS-formoterol from Step 1 onward — not SABA monotherapy.

3ADA 2024: SGLT2 inhibitors or GLP-1 receptor agonists are added in patients with established ASCVD, heart failure, or CKD regardless of A1c. Choose SGLT2 if HF or CKD predominates (cardiorenal protection); choose GLP-1 if ASCVD or obesity predominates (MACE and weight). Sulfonylureas and TZDs lack CV benefit and are deprioritized.

4Sepsis-3 / Surviving Sepsis 2024 hour-1 bundle: lactate, blood cultures before antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4, and vasopressors (norepinephrine first) to maintain MAP ≥65. Pair with ARDSnet 6 mL/kg PBW and plateau pressure ≤30 cm H2O — these are repeated high-yield items.

5ACG 2024 H. pylori: bismuth quadruple therapy (PPI + bismuth + tetracycline + metronidazole) × 14 days is preferred first-line in the U.S. due to clarithromycin resistance >15%. Rifabutin triple therapy is also first-line. Clarithromycin triple therapy is no longer first-line. Confirm eradication with urea breath test or stool antigen at least 4 weeks after therapy.

6USPSTF 2026 high-yield grade A/B updates: colorectal cancer screening 45-75, lung LDCT 50-80 with ≥20 pack-years and quit <15 years, breast cancer biennial 40-74 (2024 update from 50-74), AAA one-time ultrasound in men 65-75 with smoking history, and statin primary prevention 40-75 with ≥1 risk factor and 10-year ASCVD ≥10%.

Frequently Asked Questions

What is the ABPS Internal Medicine Certification Examination?

The ABPS Internal Medicine Certification Examination is administered by the Board of Certification in Internal Medicine (BCIM) under the American Board of Physician Specialties (ABPS). It validates the cognitive and clinical-judgment competencies expected of internists across cardiology, pulmonary/critical care, gastroenterology and hepatology, nephrology, endocrinology, hematology and oncology, infectious diseases, rheumatology, neurology, allergy/immunology, dermatology relevant to IM, geriatrics, preventive medicine, and ethics.

Who is eligible to take the BCIM Internal Medicine exam?

Candidates must hold an MD, DO, or equivalent doctoral medical degree with a valid unrestricted medical license and have successfully completed an accredited internal medicine residency program (or an ABPS-recognized equivalent training pathway). Letters of reference attesting to clinical competence and adherence to the ABPS Code of Ethics and Professionalism are required at application.

What is the format of the exam?

The BCIM Internal Medicine exam is a computer-based test of approximately 200 single-best-answer multiple-choice questions delivered over about 4 hours. Items are blueprinted to the BCIM content outline: Cardiovascular (~14%), Pulmonary/Critical Care (~12%), GI/Hepatology (~11%), Endocrine (~10%), Heme/Onc (~10%), Infectious Diseases (~10%), Nephrology (~9%), Rheumatology (~7%), Neurology (~6%), and a combined Allergy/Derm/Geriatrics/Prevention/Ethics block (~11%). Testing is offered at secure CBT centers, with remote-proctored options per the BCIM schedule.

How much does the 2026 exam cost?

The 2026 BCIM Internal Medicine examination fee is approximately $2,000 — always verify the current schedule on the ABPS website. Candidates should also budget for board review courses (~$500-$1,500) and ongoing Continuous Certification (CC) fees after passing. Cancellation and refund policies follow the BCIM schedule with decreasing refunds as the exam date approaches.

When is the 2026 exam administered?

BCIM offers the Internal Medicine examination at multiple test administrations each year per the published ABPS/BCIM schedule. Candidates schedule specific appointments after their application is approved. Exact 2026 dates and registration windows should be confirmed on the ABPS Internal Medicine page.

How is the exam scored?

BCIM uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports typically include domain-level feedback so candidates know their strongest and weakest content areas.

What are the highest-yield 2026 topics?

Highest-yield 2026 topics include ACC/AHA HFrEF four-pillar GDMT (ARNI + beta-blocker + MRA + SGLT2i), GOLD 2024 COPD Groups A/B/E with triple therapy when eosinophils ≥300, GINA 2024 ICS-formoterol Track 1 (no SABA-only), ADA 2024 SGLT2/GLP-1 priority for ASCVD/HF/CKD, ACG 2024 H. pylori bismuth quadruple therapy, KDIGO 2024 CKD with SGLT2i for albuminuria, AASLD HCC surveillance every 6 months, IDSA/SHEA 2021 fidaxomicin first-line C. difficile, USPSTF 2026 cancer screening updates, ACR 2020 gout ULT-to-target, and CHEST 2021 DOAC selection for VTE.

How should I study for this exam?

Use a structured 6-12 month plan layered on clinical work. Map study to the BCIM blueprint: begin with cardiopulmonary and critical care, then GI/hepatology, nephrology and endocrine, then heme/onc, infectious diseases, and rheumatology, and close with neurology, geriatrics, prevention, and ethics. Use ACP MKSAP or equivalent question banks, primary-source guidelines (ACC/AHA, GOLD, GINA, ADA, KDIGO, IDSA, ACR, USPSTF, AASLD), and high-volume MCQ practice. Complete 2-3 timed full-length mock exams in the final 6-8 weeks.