Our Questions

Just like you’ll see on the actual exam. Based on the American Board of Internal Medicine format.

No “negatively phrased” questions, no “all of the following except”, no “A and B”…you know what we mean. In order for a test question to be high quality, it must satisfy two basic criteria:

  1. Must address important content
  2. Must be well structured
Question » Stem » Lead in click-05

A 22-year-old man with a history of asthma presents to his primary care physician for a checkup. Since his last visit, he has experienced a cough, difficulty breathing, and weight loss. He drinks two to three glasses of wine per week, smokes one to two cigarettes per week, and denies any drug use. Auscultation reveals wheezing, and pulmonary function tests show an increased total lung capacity. Echocardiography is unrevealing. Serum analysis demonstrates elevated liver transaminases. Which of the following is the most likely diagnosis?

Our Answer Choices

Building difficulty into the question. Meet the Challenge.

A question’s difficulty is defined by the choice of distractors. Good distractors determine the difficulty level of a question. Therefore, good distractors are one of the most important features of a high quality question.


Understanding why an answer choice is incorrect is just as important as knowing why it is correct

Our Explanations

Synthesized for optimized learning and recall & created with a purpose

Every question contains a detailed explanation for the correct and incorrect answer choices and integrated media for those that learn best by visual stimuli. Understanding a topic cannot be learned in isolation. You require context. We take deliberate steps to deliver a comprehensive explanation linking the most important components to master a topic.

This patient has alpha-1 antitrypsin deficiency, an inherited disorder that affects the lungs and liver. Alpha-1 antitrypsin is a protease inhibitor of elastase. In the lungs, alpha-1 antitrypsin deficiency causes COPD (emphysema and bronchiectasis) due to an imbalance between neutrophil elastase, which destroys elastase, and alpha-1 antitrypsin. This results in uninhibited elastase and decreased elastic tissue. In the liver, unsecreted variant alpha-1 antitrypsin proteins aggregate and polymerize within the endoplasmic reticulum of hepatocytes, causing cirrhosis. Alpha-1 antitrypsin deficiency is an autosomal codominant disorder. Heterozygous individuals are generally asymptomatic but have an increased risk of COPD, are encouraged not to smoke, and often have decreased levels of alpha-1 antitrypsin in the blood. Clinical manifestations of alpha-1 antitrypsin deficiency involve the lung (early-onset panacinar emphysema and bronchiectasis) and liver (cirrhosis). Pulmonary function testing demonstrates obstruction of airflow with increased total lung capacity and decreased forced expiratory volume in one second to forced vital capacity ratio. Chest X-ray reveals bullous changes that are more prominent at the lung bases. Alpha-1 antitrypsin deficiency is diagnosed with serum testing showing a level below 11 micromol/L. Elevated liver enzymes are also commonly seen. Treatment of alpha-1 antitrypsin deficiency involves encouraging patients to avoid tobacco and passive cigarette smoke exposure. Pulmonary function tests are used to monitor lung functions. Pulmonary rehabilitation, nutritional support, supplemental oxygen, preventive vaccinations, and prompt treatment of respiratory infections are all important for these patients. Some patients receive intravenous augmentation with pooled human alpha-1 antitrypsin. Lung and liver transplantation are needed when severe emphysema and end-stage liver disease develop.

Enhanced learning

Explanations contain integrated audio and visual content to further clarify meaning of the core concept. By representing information using audio cues and spatially with images, you are able to focus on meaning, reorganize and group similar ideas easily and make better use of your audio and visual memory.

More than just a question

Advanced reinforcement

To optimize recall and understanding of a topic we link concepts to help you express knowledge, thoughts and ideas and build relationships between them.


Taking Your Learning One Step Further

After each question explanation is a straightforward factoid-based question with a simple, memorizable answer that serves as reinforcement for the corresponding topic.

(Q) What is the primary function of endothelin?

(A) Endothelins are potent vasoconstrictors. Endothelin antagonists (e.g., bosentan) are used in the treatment of pulmonary artery hypertension.


Break it down, Keep it simple.

Boiling it down to the most high yield concepts


  • Patient will be complaining of generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain
  • PE will show periorbital edema, dry skin and coarse brittle hair
  • Labs will show high TSH and low free T4, antithyroid peroxidase and antithyroglobulin autoantibodies
  • Most commonly caused by Hashimoto’s thyroiditis
  • Treatment is levothyroxine
  • Comments: Takes about 6 weeks to see treatment effects. Monitor TSH
  • Hashimoto’s: Risk factor for non-Hodgkin lymphoma

Powerful Analytics

Progress, performance, predictions

“If you can’t measure it, you can’t manage it.” Rosh Review provides you with key statistics and robust analytics to create an efficient and effective learning strategy.


Focus your learning on what matters

Identify your strengths and weaknesses based on ABIMs Exam Blueprint

Peer comparison

Compare your answer choices to the answers provided by other medical students, internal medicine residents, and internists around the country.

Probability of Passing Your Exam

Using data generated by our previous users, we can predict your probability of passing the ABIM Certification Exam

Rosh Review is a high-quality question bank for internal medicine. It’s especially well suited for those who like to customize how they study, love visually pleasing explanations, and enjoy having a ton of questions available to answer.

Henry Lew, MD

Hospitalist and former IM Chief Resident, Kaiser Permanente Hawaii

Internal Medicine Question Topics

ABIM publishes a content blueprint for the material that will appear on your exam.

This blueprint is how we determine which material appears in your Qbank.

Allergy and Immunology 2%
Cardiovascular Disease 14%
Dermatology 3%
Endocrinology, Diabetes, and Metabolism 9%
Gastroenterology 9%
Geriatric Syndromes 3%
Hematology 6%
Infectious Disease 9%
Nephrology and Urology 6%
Neurology 4%


Obstetrics and Gynecology 3%
Medical Oncology 6%
Ophthalmology 1%
Otolaryngology and Dental Medicine 1%
Psychiatry 4%
Pulmonary Disease 9%
Rheumatology and Orthopedics 9%
Miscellaneous 2%


Internal Medicine

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