10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The Internal Medicine exam has 200 questions and runs 4 hours.
These 10 free Internal Medicine questions are organized by exam domain, so you can see how each part of the Board Certification in Internal Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Allergy & Immunologies 3% of exam
Question 1
During treatment for pyelonephritis, a 72-kg woman at 29 weeks of gestation develops hoarseness, stridor, and wheezing four minutes after intravenous ceftriaxone begins. Blood pressure falls to 76/42 mm Hg and pulse rises to 128/min. No urticaria is visible. The infusion is stopped, emergency assistance is called, and oxygen, left-lateral positioning, and intravenous crystalloid are provided. Which medication should be given immediately?
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Correct answer: C - Epinephrine 0.5 mg intramuscularly in the anterolateral thigh
Domain 2: Cardiology 12% of exam
Question 2
A 54-year-old man has newly diagnosed persistent atrial fibrillation. Echocardiography shows rheumatic mitral stenosis with a valve area of 1.1 cm² and a left ventricular ejection fraction of 60%. He has no hypertension, diabetes, vascular disease, heart failure, or previous thromboembolism; his CHA₂DS₂-VASc score is 0. Renal and hepatic function are normal, and there is no bleeding contraindication. For long-term stroke prevention, which prescription is appropriate?
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Correct answer: C - Dose-adjusted warfarin (INR 2.0-3.0)
Domain 3: Dermatology 6% of exam
Question 3
Five weeks after starting allopurinol, a 61-year-old man develops fever, facial edema, and a widespread morbilliform eruption. Examination shows cervical lymphadenopathy but no pustules, skin tenderness, epidermal detachment, or mucosal erosions. Eosinophils are 2,100/µL, alanine aminotransferase is 684 U/L, and creatinine has risen from 1.0 to 1.8 mg/dL. Which diagnosis best explains this combination of findings?
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Correct answer: A - Drug reaction with eosinophilia and systemic symptoms
Domain 4: Endocrinology 8% of exam
Question 4
After two days of vomiting and poor intake, a 49-year-old woman taking empagliflozin for type 2 diabetes develops abdominal pain and deep, rapid breathing. Glucose is 178 mg/dL, beta-hydroxybutyrate 5.6 mmol/L, venous pH 7.22, bicarbonate 11 mmol/L, and potassium 3.1 mmol/L. Creatinine is 0.9 mg/dL, and urine output is preserved. Empagliflozin has been stopped and balanced crystalloid started. Which treatment order should be entered next?
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Correct answer: A - Replete potassium and delay insulin until potassium exceeds 3.5 mmol/L
Domain 5: Gastroenterology 10% of exam
Question 5
At follow-up for a Helicobacter pylori-positive duodenal ulcer, a 46-year-old man reports completing 14 days of bismuth quadruple therapy six weeks earlier. Mild intermittent dyspepsia remains, but there is no bleeding, weight loss, or vomiting. A stool antigen test obtained this week is negative. He has continued omeprazole daily and has taken no further antibiotics or bismuth. What would establish eradication reliably?
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Correct answer: B - Repeat urea breath testing after two weeks off omeprazole
Domain 7: Hematology 5% of exam
Question 6
On day 7 after hip-fracture repair, a man receiving prophylactic unfractionated heparin develops a new popliteal deep venous thrombosis. His platelet count was 360,000/µL before heparin, 348,000/µL on day 4, and is now 164,000/µL; the laboratory reference interval is 150,000-400,000/µL. There is no bleeding, infection, or other apparent cause of the decline, and renal and hepatic function are normal. PF4/heparin antibody testing has been sent. While the result is pending, anticoagulation should be:
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Correct answer: B - Changed to therapeutic argatroban, with all heparin stopped
Domain 8: Infectious Disease 11% of exam
Question 7
An 83-year-old woman is brought from assisted living because she has become inattentive and disoriented. Diphenhydramine was added for insomnia three nights ago. She has no dysuria, new urgency, suprapubic pain, or flank tenderness. Temperature is 36.8°C, blood pressure 132/74 mm Hg, and leukocyte count 7,600/µL. A urine sample sent during the initial assessment contains pyuria and grows more than 100,000 CFU/mL of Escherichia coli. How should this result change her care?
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Correct answer: D - Observe without antibiotics and assess other causes
Domain 9: Nephrology 7% of exam
Question 8
A patient admitted with pneumococcal pneumonia is breathing rapidly. Before substantial intravenous fluid administration, simultaneous studies show sodium 138 mmol/L, chloride 102 mmol/L, bicarbonate 12 mmol/L, albumin 4.0 g/dL, and lactate 6.2 mmol/L. Arterial pH is 7.38 and PaCO₂ is 21 mm Hg. The laboratory anion-gap reference interval, excluding potassium, is 8-12 mmol/L. Which acid-base interpretation accounts for the entire pattern?
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Correct answer: C - High-anion-gap metabolic acidosis with respiratory alkalosis
Domain 12: Pulmonary and Critical Care 10% of exam
Question 9
Despite repeated inhaled bronchodilators, systemic corticosteroids, and controlled oxygen, a 69-year-old man hospitalized for a COPD exacerbation remains tachypneic at 30 breaths/min with accessory-muscle use. On 2 L/min oxygen, saturation is 90%; arterial pH is 7.28, PaCO₂ 68 mm Hg, and bicarbonate 31 mmol/L. He is alert, cooperative, hemodynamically stable, and clearing secretions without difficulty. There is no vomiting. Which mode of respiratory support is indicated?
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Correct answer: D - A trial of bilevel noninvasive ventilation
Domain 14: General Internal Medicine 10% of exam
Question 10
A 58-year-old man calls about a positive screening fecal immunochemical test. He feels well, has a hemoglobin concentration of 14.1 g/dL, and has noticed no recent rectal bleeding. He takes low-dose aspirin for established coronary disease and has a history of hemorrhoids. He asks whether either could explain the result. The next step in colorectal evaluation is:
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Correct answer: B - Arrange a diagnostic colonoscopy
The rest of the Internal Medicine blueprint
The Internal Medicine exam also covers these domains. Drill them in the full free practice test:
Domain 6: Genetic Disorders1% of exam
Domain 10: Neurology8% of exam
Domain 11: Oncology4% of exam
Domain 13: Rheumatology5% of exam
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The full bank has 1,020 more Internal Medicine questions with explanations.