100+ Free Arab Board Internal Medicine Clinical Exam Practice Questions

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Sample Arab Board Internal Medicine Clinical Exam Practice Questions

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

1A 74-year-old man presents with exertional presyncope and angina. On cardiovascular examination, you palpate a slow-rising, low-amplitude carotid pulse and auscultate a harsh crescendodecrescendo ejection systolic murmur at the right upper sternal border that peaks late in systole and radiates to the carotids. The second heart sound (S2) is soft and single. Which bedside physical finding most strongly correlates with severe aortic stenosis?

A.Early-peaking systolic murmur with a loud aortic component of S2

B.Pulsus parvus et tardus with late-peaking systolic murmur and paradoxical splitting of S2

C.Bounding, collapsing water-hammer pulse with wide pulse pressure

D.Systolic click followed by a late systolic murmur accentuated by standing

Explanation: Severe aortic stenosis is characterized by a slow-rising and diminished carotid pulse (pulsus parvus et tardus), a late-peaking harsh ejection systolic murmur, a single or soft S2, and paradoxical splitting of S2 due to delayed left ventricular ejection. In contrast, an early-peaking murmur with preserved S2 suggests mild to moderate stenosis.

2During a bedside clinical examination of a 55-year-old woman with peripheral edema and a pansystolic murmur at the lower left sternal edge, you suspect tricuspid regurgitation rather than mitral regurgitation. Which physical examination finding best differentiates tricuspid regurgitation from mitral regurgitation?

A.Murmur radiation to the left axilla

B.Augmentation of murmur intensity during inspiration (Carvallo sign)

C.Augmentation of murmur intensity during the strain phase of the Valsalva maneuver

D.Accentuation of the murmur in the left lateral decubitus position

Explanation: Carvallo sign refers to the inspiratory augmentation of right-sided murmurs, including tricuspid regurgitation, due to increased venous return to the right heart during negative intrathoracic pressure. Mitral regurgitation murmurs radiate to the axilla, do not increase on inspiration, and are loudest at the apex in the left lateral decubitus position.

3An 82-year-old woman presents with recurrent lightheadedness and bradycardia. On inspection of the jugular venous pulse (JVP), you observe intermittent, large, abrupt positive venous pulsations ('cannon a waves'). Which underlying cardiac electrophysiological condition is most likely responsible?

A.Atrial fibrillation with rapid ventricular response

B.Complete (third-degree) atrioventricular block

C.Constrictive pericarditis

D.Severe tricuspid regurgitation

Explanation: Intermittent cannon 'a' waves occur when the right atrium contracts against a closed tricuspid valve during atrioventricular (AV) dissociation, characteristic of complete (third-degree) AV block or ventricular tachycardia. Constrictive pericarditis produces elevated JVP with prominent y-descent (Friedreich sign) and Kussmaul sign, while tricuspid regurgitation produces prominent 'cv' systolic waves without 'a' waves.

4A 28-year-old man presents with sharp substernal chest pain that worsens on lying flat and improves when leaning forward. His 12-lead ECG shows widespread upward-concave ST-segment elevation with PR-segment depression in leads I, II, aVF, and V2-V6, accompanied by PR elevation in lead aVR. What is the most likely diagnosis?

A.Acute ST-elevation anterior myocardial infarction

B.Acute pericarditis

C.Brugada syndrome

D.Prinzmetal (vasospastic) angina

Explanation: Acute pericarditis characteristically produces positional pleuritic chest pain relieved by sitting forward, alongside widespread concave ST-segment elevation and PR-segment depression across multiple vascular territories with reciprocal PR elevation and ST depression in lead aVR. Acute STEMI causes localized convex ('tombstone') ST elevation with reciprocal ST depressions in anatomically opposing leads.

5A 68-year-old man with ischemic cardiomyopathy presents with severe acute dyspnea, orthopnea, and pink frothy sputum. Blood pressure is 185/105 mmHg, heart rate is 118 bpm, and oxygen saturation is 84% on ambient air. Bilateral diffuse coarse crackles and wheezes are present throughout all lung zones. What is the most appropriate initial combination therapy?

A.Intravenous beta-blocker, high-flow nasal cannula, and oral spironolactone

B.Non-invasive positive pressure ventilation (CPAP/BiPAP), intravenous loop diuretic, and intravenous vasodilator (nitroglycerin)

C.Immediate endotracheal intubation, intravenous diltiazem, and rapid 0.9% saline infusion

D.Intravenous digoxin, subcutaneous heparin, and oral sacubitril-valsartan

Explanation: In acute decompensated heart failure with hypertensive pulmonary edema (flash pulmonary edema), the immediate management triad consists of non-invasive positive pressure ventilation (CPAP/BiPAP) to recruit alveoli and reduce preload/afterload, intravenous loop diuretics (e.g., furosemide) for venodilation and diuresis, and intravenous vasodilators (e.g., nitroglycerin) to reduce systemic vascular resistance.

6A 42-year-old man with a history of intravenous drug use presents with high-grade fever, malaise, and a new regurgitant murmur. Bedside examination reveals non-tender erythematous macules on his palms and soles, painful violaceous nodules on the pulps of his fingers, and linear subungual hemorrhages. How are the painful finger pulp lesions and non-tender palmar macules classified according to the modified Duke criteria?

A.Both are minor immunologic phenomena

B.Painful nodules are Osler nodes (immunologic); non-tender macules are Janeway lesions (vascular)

C.Painful nodules are Janeway lesions (vascular); non-tender macules are Osler nodes (immunologic)

D.Both are major microbiological criteria

Explanation: Under the modified Duke criteria for infective endocarditis, painful violaceous nodules on finger and toe pads are Osler nodes (categorized under immunologic phenomena, resulting from immune complex deposition), whereas non-tender erythematous macules on the palms and soles are Janeway lesions (categorized under vascular phenomena, resulting from septic microemboli).

7A 58-year-old woman with metastatic breast cancer presents with acute dyspnea, lightheadedness, and tachycardia. On examination, blood pressure is 88/60 mmHg, heart sounds are distant and muffled, and jugular venous distension is marked with a flat y-descent. On sphygmomanometry, the systolic blood pressure drops by 18 mmHg during quiet inspiration. What is the definitive emergency bedside intervention?

A.Intravenous furosemide 80 mg bolus

B.Emergent bedside pericardiocentesis

C.Sublingual nitroglycerin and intravenous metoprolol

D.Immediate chest tube placement in the 5th intercostal space

Explanation: This patient presents with Beck's triad (hypotension, elevated JVP, muffled heart sounds) and marked pulsus paradoxus (> 10 mmHg inspiratory decline in SBP), diagnostic of acute cardiac tamponade. The definitive life-saving management is immediate emergency pericardiocentesis (or surgical subxiphoid pericardial window) to decompress the pericardial space and restore ventricular filling.

8A 22-year-old male athlete is evaluated for exertional chest tightness. Cardiac auscultation reveals a harsh crescendo-decrescendo systolic murmur heard best at the left lower sternal border without carotid radiation. Which bedside maneuver will increase the intensity of this murmur, helping confirm hypertrophic obstructive cardiomyopathy (HOCM)?

A.Prompt squatting from a standing position

B.Sustained isometric handgrip exercise

C.Valsalva maneuver (strain phase)

D.Passive leg raising

Explanation: The dynamic left ventricular outflow tract (LVOT) gradient in HOCM worsens when left ventricular cavity size decreases. Maneuvers that reduce preload or afterload—such as the strain phase of the Valsalva maneuver or standing abruptly—decrease LV end-diastolic volume, worsening outflow obstruction and increasing murmur intensity. Squatting, passive leg elevation, and handgrip increase LV volume or afterload, softening the murmur.

9A 65-year-old man presents to the resuscitation bay with sudden-onset palpitation, severe shortness of breath, and diaphoresis. Blood pressure is 74/45 mmHg, pulse is 165 bpm irregularly irregular, and pulse oximetry is 86%. ECG confirms rapid atrial fibrillation with a ventricular rate of 170 bpm. What is the immediate first-line management?

A.Intravenous amiodarone 300 mg infusion over 1 hour

B.Intravenous diltiazem bolus followed by oral bisoprolol

C.Emergent synchronized direct-current electrical cardioversion

D.Carotid sinus massage followed by intravenous adenosine 6 mg

Explanation: In any tachyarrhythmia presenting with hemodynamic instability (hypotension, acute pulmonary edema, chest pain, or altered mental status), the immediate management is emergent synchronized electrical cardioversion. Pharmacotherapy is reserved for hemodynamically stable patients.

10A 60-year-old man with prior anterior myocardial infarction presents with palpitations and wide QRS complex tachycardia (QRS duration 160 ms, rate 160 bpm). You are differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrant conduction. Which ECG finding provides the strongest diagnostic proof of ventricular tachycardia?

A.Rate regularity and narrow P waves in lead II

B.Presence of atrioventricular (AV) dissociation with fusion and capture beats

C.Pre-existing right bundle branch block pattern matching baseline ECG

D.QRS duration between 120 and 140 ms with normal axis

Explanation: The presence of atrioventricular (AV) dissociation—where P waves and QRS complexes march out independently—along with fusion and capture (Dressler) beats is pathognomonic for ventricular tachycardia. Over 90% of wide-complex tachycardias in patients with prior myocardial infarction are VT.

About the Arab Board Internal Medicine Clinical Exam Exam

The Arab Board Internal Medicine Final Clinical and Oral Examination is the definitive exit assessment for senior residents completing the multi-year ABHS residency training curriculum across Arab League member nations. Conducted by senior consultant examiners appointed by the Scientific Council of Internal Medicine, the examination rigorously tests bedside physical examination proficiency, real-time clinical judgment, diagnostic investigation synthesis (ECG, radiologic imaging, blood films, arterial blood gases, and lab panels), and immediate management of acute internal medicine emergencies. This resource provides an English-language clinical scenario question bank adapted from authentic Arab Board clinical and viva blueprints to hone diagnostic decision-making under exam conditions.

Assessment

Performance-based assessment

Time Limit

Approximately 2 to 3 hours

Passing Score

A standard passing mark of around 60% is established by the ABHS Scientific Council of Internal Medicine across clinical stations, bedside examinations, and oral viva panels.

Exam Fee

Set by ABHS and national councils (Arab Board of Health Specializations (ABHS) - Scientific Council of Internal Medicine)

Arab Board Internal Medicine Clinical Exam Exam Content Outline

15%

Cardiology

Bedside cardiovascular examination, heart murmurs, JVP waveforms, acute coronary syndromes, heart failure, arrhythmias, and hemodynamic emergencies.

13%

Pulmonology & Respiratory Medicine

Bedside chest examination, respiratory failure, mechanical ventilation, COPD, severe asthma, pulmonary embolism, interstitial lung diseases, and pleural fluid analysis.

13%

Gastroenterology & Hepatology

Bedside abdominal examination, acute GI bleeding, cirrhosis decompensation, spontaneous bacterial peritonitis, hepatic encephalopathy, acute pancreatitis, and IBD.

12%

Nephrology & Acid-Base Disorders

Acute kidney injury, glomerulonephritis, nephrotic syndrome, severe electrolyte disturbances (hyperkalemia, hyponatremia), and acid-base blood gas interpretation.

12%

Endocrinology & Metabolic Emergencies

Endocrine physical signs, diabetic ketoacidosis, hyperosmolar hyperglycemic state, thyroid storm, myxedema coma, adrenal crisis, Cushing syndrome, and pheochromocytoma.

10%

Hematology & Oncology

Blood film morphology, acute leukemias, thrombotic microangiopathies (TTP/HUS), HIT, multiple myeloma, febrile neutropenia, and tumor lysis syndrome.

Infectious Diseases

Septic shock resuscitation, acute bacterial meningitis CSF analysis, infective endocarditis Duke criteria, severe malaria, tuberculosis, and opportunistic infections.

Rheumatology & Autoimmune Disorders

Bedside joint examination, acute crystal arthritis, giant cell arteritis, systemic lupus erythematosus, systemic sclerosis, inflammatory myopathies, and vasculitis.

Neurology & Toxicology Emergencies

Acute stroke thrombolysis/thrombectomy, status epilepticus, myasthenic crisis, Guillain-Barré syndrome, subarachnoid hemorrhage, Wernicke encephalopathy, and anaphylaxis.

How to Pass the Arab Board Internal Medicine Clinical Exam Exam

What You Need to Know

Passing score: A standard passing mark of around 60% is established by the ABHS Scientific Council of Internal Medicine across clinical stations, bedside examinations, and oral viva panels.
Assessment: Performance-based assessment
Time limit: Approximately 2 to 3 hours
Exam fee: Set by ABHS and national councils

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Arab Board Internal Medicine Clinical Exam Study Tips from Top Performers

1Structure your clinical presentations methodically using the standard Arab Board format: concise clinical summary, positive and pertinent negative physical findings, prioritized differential diagnosis, and an evidence-based diagnostic and therapeutic plan.

2Practice rapid, systematic interpretation of bedside investigations, particularly 12-lead ECGs (rate, rhythm, axis, intervals, ischemic patterns), chest X-rays, arterial blood gas analyses, and peripheral blood smears.

3Master emergency resuscitation algorithms for life-threatening medical conditions including septic shock, acute pulmonary edema, hypertensive emergencies, DKA/HHS, thyroid storm, status epilepticus, and massive pulmonary embolism.

4Rehearse bedside physical examination routines with peer study groups under timed conditions, focusing on smooth technique, patient communication, and verbalizing clinical signs accurately.

Frequently Asked Questions

What is the structure of the Arab Board Internal Medicine Clinical Exam?

The Arab Board (ABHS) Internal Medicine Final Clinical and Oral Exam typically consists of bedside clinical stations—including long cases (full history and comprehensive examination with presentation to an examiner panel), short cases (focused physical examination of multiple clinical systems), and structured oral viva stations covering emergency management, ECG, imaging, and lab interpretation.

What is the passing score for the Arab Board Clinical Exam?

While the Arab Board of Health Specializations does not publish a universal fixed passing score, candidates are generally required to achieve a cumulative mark of at least 60% and pass a minimum threshold across individual clinical domains as determined by the Scientific Council of Internal Medicine.

How are clinical investigations evaluated in the oral viva stations?

Candidates are presented with real clinical artifacts—such as 12-lead ECGs, chest radiographs, CT and MRI scans, blood smears, echocardiogram loops, and arterial blood gas profiles—and must provide a systematic interpretation, differential diagnosis, and prioritized management plan within 5 to 10 minutes per station.

Are these 100 practice questions an official Arab Board examination paper?

No. These 100 scenario-based questions represent an English-language clinical MCQ study adaptation designed by medical educators to mirror the diagnostic reasoning, bedside physical findings, investigation interpretation, and clinical viva scenarios assessed in the ABHS Internal Medicine Clinical Exam.

100+ Free Arab Board Internal Medicine Clinical Exam Practice Questions

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