ABIM Internal Medicine ITE Test Bank –
Practice Questions with Verified Answers &
Explanations
Page 1 of 301
,Question 1
which medication class should not be given to patients with lewy body dementia
Correct Answer
1st generation antipsychotics
1. A 62-year-old man presents to the ED with 1 hour of severe, crushing
substernal chest pain. ECG shows 3 mm ST-segment elevation in leads II, III,
and aVF. Blood pressure is 110/70 mm Hg. Which of the following is the
most appropriate next step in management?
A) Administer sublingual nitroglycerin and observe
B) Obtain a transthoracic echocardiogram
C) Activate the cardiac catheterization lab for primary PCI
D) Administer intravenous thrombolytics
Correct Answer: C
Explanation: The patient has an acute inferior STEMI. The treatment of
choice is primary percutaneous coronary intervention (PCI) with a door-to-
balloon time goal of <90 minutes. Thrombolytics are only indicated if PCI
cannot be performed within 120 minutes. Nitroglycerin should be used with
extreme caution or avoided in inferior STEMIs due to the risk of right
ventricular infarction and severe hypotension.
2. A 58-year-old woman with a history of hypertension and type 2 diabetes
is evaluated for routine care. Her BP is 138/84 mm Hg on lisinopril. Her
HbA1c is 7.2%. Her 10-year ASCVD risk is 12%. Which of the following lipid-
lowering therapies is most appropriate?
A) No lipid-lowering therapy is indicated
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Correct Answer: C
Explanation: Patients aged 40-75 with diabetes mellitus and an ASCVD risk
≥7.5% should be started on a high-intensity statin (e.g., atorvastatin 40-80
mg or rosuvastatin 20-40 mg) to reduce the risk of cardiovascular events.
3. A 70-year-old man with a history of heart failure with reduced ejection
fraction (HFrEF, EF 30%) is on lisinopril, carvedilol, and spironolactone. He
remains symptomatic with NYHA class II symptoms. His BP is 110/70 mm
Hg, and potassium is 4.2 mEq/L. Which of the following is the most
Page 2 of 301
,appropriate next step in his pharmacologic management?
A) Add digoxin
B) Switch lisinopril to sacubitril-valsartan
C) Add amlodipine
D) Add isosorbide dinitrate
Correct Answer: B
Explanation: In patients with HFrEF who remain symptomatic on an
ACEi/ARB, beta-blocker, and MRA, replacing the ACEi/ARB with an ARNI
(sacubitril-valsartan) is recommended to further reduce morbidity and
mortality. A 36-hour washout period is required when switching from an
ACEi to an ARNI to prevent angioedema.
4. A 68-year-old woman presents with a 2-month history of progressive
dyspnea on exertion and two episodes of near-syncope while walking. On
exam, her carotid upstroke is delayed, and a harsh, crescendo-decrescendo
systolic murmur is heard at the right upper sternal border. What is the
most appropriate initial diagnostic test?
A) Electrocardiogram
B) Transthoracic echocardiogram
C) Exercise stress test
D) Cardiac magnetic resonance imaging
Correct Answer: B
Explanation: The clinical presentation is classic for severe aortic stenosis (AS).
A transthoracic echocardiogram is the initial test of choice to confirm the
diagnosis, assess valve morphology, and measure the transvalvular gradient
and valve area. Stress testing is contraindicated in symptomatic severe AS.
5. A 24-year-old man presents with sharp, pleuritic chest pain that
improves when he leans forward. He had a viral upper respiratory infection
1 week ago. ECG shows diffuse ST-segment elevations and PR-segment
depressions. Which of the following is the most appropriate treatment?
A) High-dose corticosteroids
B) Ibuprofen and colchicine
C) Sublingual nitroglycerin
D) Heparin infusion
Correct Answer: B
Explanation: The patient has acute pericarditis. First-line therapy is high-
dose NSAIDs (like ibuprofen or aspirin) plus colchicine to speed resolution
and prevent recurrence. Corticosteroids are reserved for refractory cases or
specific etiologies (e.g., autoimmune) as they increase the risk of recurrence.
Page 3 of 301
, 6. A 75-year-old man is evaluated in the clinic. He has a history of atrial
fibrillation, hypertension, and type 2 diabetes. His current medications
include apixaban, lisinopril, and metformin. His CHA2DS2-VASc score is 4.
He asks if he can stop taking apixaban because he feels well. What is the
most appropriate response?
A) Discontinue apixaban and start aspirin
B) Continue apixaban indefinitely
C) Discontinue apixaban and monitor with a Holter monitor
D) Switch apixaban to clopidogrel
Correct Answer: B
Explanation: Patients with nonvalvular atrial fibrillation and a CHA2DS2-VASc
score ≥2 in men or ≥3 in women should receive oral anticoagulation to
prevent stroke. Apixaban is a direct oral anticoagulant (DOAC) and is
preferred over warfarin. Aspirin and clopidogrel are not adequate for stroke
prevention in AFib.
7. A 55-year-old man presents to the ED with sudden onset of severe
tearing chest pain radiating to his back. His blood pressure is 190/110 mm
Hg in the right arm and 160/90 mm Hg in the left arm. A chest x-ray shows
a widened mediastinum. What is the most appropriate initial medical
therapy?
A) Intravenous labetalol
B) Intravenous nitroprusside
C) Oral captopril
D) Intravenous heparin
Correct Answer: A
Explanation: The patient likely has an acute aortic dissection. Initial medical
management requires rapid reduction of blood pressure and heart rate to
decrease aortic wall shear stress (dP/dt). Intravenous beta-blockers (like
labetalol or esmolol) should be given before vasodilators (like nitroprusside)
to prevent reflex tachycardia, which would worsen the dissection.
8. A 60-year-old woman is evaluated for a routine physical. She feels well.
Her blood pressure is 146/90 mm Hg, confirmed on repeat measurement.
She has no other medical conditions. Her BMI is 28. Fasting glucose and
lipids are normal. Which of the following is the most appropriate first-line
antihypertensive medication?
A) Lisinopril
B) Amlodipine
C) Metoprolol
D) Losartan
Correct Answer: B
Page 4 of 301
Practice Questions with Verified Answers &
Explanations
Page 1 of 301
,Question 1
which medication class should not be given to patients with lewy body dementia
Correct Answer
1st generation antipsychotics
1. A 62-year-old man presents to the ED with 1 hour of severe, crushing
substernal chest pain. ECG shows 3 mm ST-segment elevation in leads II, III,
and aVF. Blood pressure is 110/70 mm Hg. Which of the following is the
most appropriate next step in management?
A) Administer sublingual nitroglycerin and observe
B) Obtain a transthoracic echocardiogram
C) Activate the cardiac catheterization lab for primary PCI
D) Administer intravenous thrombolytics
Correct Answer: C
Explanation: The patient has an acute inferior STEMI. The treatment of
choice is primary percutaneous coronary intervention (PCI) with a door-to-
balloon time goal of <90 minutes. Thrombolytics are only indicated if PCI
cannot be performed within 120 minutes. Nitroglycerin should be used with
extreme caution or avoided in inferior STEMIs due to the risk of right
ventricular infarction and severe hypotension.
2. A 58-year-old woman with a history of hypertension and type 2 diabetes
is evaluated for routine care. Her BP is 138/84 mm Hg on lisinopril. Her
HbA1c is 7.2%. Her 10-year ASCVD risk is 12%. Which of the following lipid-
lowering therapies is most appropriate?
A) No lipid-lowering therapy is indicated
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Correct Answer: C
Explanation: Patients aged 40-75 with diabetes mellitus and an ASCVD risk
≥7.5% should be started on a high-intensity statin (e.g., atorvastatin 40-80
mg or rosuvastatin 20-40 mg) to reduce the risk of cardiovascular events.
3. A 70-year-old man with a history of heart failure with reduced ejection
fraction (HFrEF, EF 30%) is on lisinopril, carvedilol, and spironolactone. He
remains symptomatic with NYHA class II symptoms. His BP is 110/70 mm
Hg, and potassium is 4.2 mEq/L. Which of the following is the most
Page 2 of 301
,appropriate next step in his pharmacologic management?
A) Add digoxin
B) Switch lisinopril to sacubitril-valsartan
C) Add amlodipine
D) Add isosorbide dinitrate
Correct Answer: B
Explanation: In patients with HFrEF who remain symptomatic on an
ACEi/ARB, beta-blocker, and MRA, replacing the ACEi/ARB with an ARNI
(sacubitril-valsartan) is recommended to further reduce morbidity and
mortality. A 36-hour washout period is required when switching from an
ACEi to an ARNI to prevent angioedema.
4. A 68-year-old woman presents with a 2-month history of progressive
dyspnea on exertion and two episodes of near-syncope while walking. On
exam, her carotid upstroke is delayed, and a harsh, crescendo-decrescendo
systolic murmur is heard at the right upper sternal border. What is the
most appropriate initial diagnostic test?
A) Electrocardiogram
B) Transthoracic echocardiogram
C) Exercise stress test
D) Cardiac magnetic resonance imaging
Correct Answer: B
Explanation: The clinical presentation is classic for severe aortic stenosis (AS).
A transthoracic echocardiogram is the initial test of choice to confirm the
diagnosis, assess valve morphology, and measure the transvalvular gradient
and valve area. Stress testing is contraindicated in symptomatic severe AS.
5. A 24-year-old man presents with sharp, pleuritic chest pain that
improves when he leans forward. He had a viral upper respiratory infection
1 week ago. ECG shows diffuse ST-segment elevations and PR-segment
depressions. Which of the following is the most appropriate treatment?
A) High-dose corticosteroids
B) Ibuprofen and colchicine
C) Sublingual nitroglycerin
D) Heparin infusion
Correct Answer: B
Explanation: The patient has acute pericarditis. First-line therapy is high-
dose NSAIDs (like ibuprofen or aspirin) plus colchicine to speed resolution
and prevent recurrence. Corticosteroids are reserved for refractory cases or
specific etiologies (e.g., autoimmune) as they increase the risk of recurrence.
Page 3 of 301
, 6. A 75-year-old man is evaluated in the clinic. He has a history of atrial
fibrillation, hypertension, and type 2 diabetes. His current medications
include apixaban, lisinopril, and metformin. His CHA2DS2-VASc score is 4.
He asks if he can stop taking apixaban because he feels well. What is the
most appropriate response?
A) Discontinue apixaban and start aspirin
B) Continue apixaban indefinitely
C) Discontinue apixaban and monitor with a Holter monitor
D) Switch apixaban to clopidogrel
Correct Answer: B
Explanation: Patients with nonvalvular atrial fibrillation and a CHA2DS2-VASc
score ≥2 in men or ≥3 in women should receive oral anticoagulation to
prevent stroke. Apixaban is a direct oral anticoagulant (DOAC) and is
preferred over warfarin. Aspirin and clopidogrel are not adequate for stroke
prevention in AFib.
7. A 55-year-old man presents to the ED with sudden onset of severe
tearing chest pain radiating to his back. His blood pressure is 190/110 mm
Hg in the right arm and 160/90 mm Hg in the left arm. A chest x-ray shows
a widened mediastinum. What is the most appropriate initial medical
therapy?
A) Intravenous labetalol
B) Intravenous nitroprusside
C) Oral captopril
D) Intravenous heparin
Correct Answer: A
Explanation: The patient likely has an acute aortic dissection. Initial medical
management requires rapid reduction of blood pressure and heart rate to
decrease aortic wall shear stress (dP/dt). Intravenous beta-blockers (like
labetalol or esmolol) should be given before vasodilators (like nitroprusside)
to prevent reflex tachycardia, which would worsen the dissection.
8. A 60-year-old woman is evaluated for a routine physical. She feels well.
Her blood pressure is 146/90 mm Hg, confirmed on repeat measurement.
She has no other medical conditions. Her BMI is 28. Fasting glucose and
lipids are normal. Which of the following is the most appropriate first-line
antihypertensive medication?
A) Lisinopril
B) Amlodipine
C) Metoprolol
D) Losartan
Correct Answer: B
Page 4 of 301
