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ABIM Internal Medicine In-Training Examination
(ITE) Test Bank | Complete 150-Question Practice
Examination with Verified Answers and Detailed
Rationales 2026–2027 | Internal Medicine Board
Preparation | Graded A+ | 100% Pass Guaranteed
Description:** This comprehensive 150-question test bank is designed
for internal medicine residents preparing for the ABIM In-Training
Exam (ITE). The exam mirrors the actual ITE blueprint with scenario-
based questions covering all subspecialties of internal medicine
including cardiology, pulmonology, gastroenterology, endocrinology,
infectious disease, hematology, oncology, nephrology, rheumatology,
neurology, and more. Each question includes clinical vignettes followed
by correct answers with detailed rationales explaining underlying
pathophysiology and evidence-based guidelines.
---
## SECTION 1: CARDIOVASCULAR DISEASE
Question 1
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A 68-year-old man with chronic heart failure with reduced ejection
fraction (HFrEF) on optimal medical therapy including
sacubitril/valsartan, beta-blocker, and spironolactone continues to have
NYHA class III symptoms. Left ventricular ejection fraction is 30%.
There is no significant coronary disease. Which intervention has been
shown to reduce mortality in this population?
A) Implantable cardioverter-defibrillator (ICD) alone
B) Cardiac resynchronization therapy with defibrillator (CRT-D)
C) Left ventricular assist device (LVAD) as destination therapy
D) Heart transplantation listing
Answer: B
*In patients with HFrEF with wide QRS (>150 ms) and LBBB, CRT-D
reduces mortality and hospitalizations. ICD alone does not improve
symptoms. LVAD and transplantation are reserved for advanced disease
with refractory symptoms.*
---
Question 2
A patient with acute decompensated heart failure presents with severe
dyspnea, cool extremities, and a blood pressure of 85/50 mm Hg. Which
hemodynamic profile is most consistent with these findings?
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A) Warm and wet
B) Cold and wet
C) Cold and dry
D) Warm and dry
Answer: B
*The "cold and wet" profile indicates low cardiac output (cold
extremities) and congestion (wet). This patient requires inotropic support
and vasodilators if tolerated, but hypotension limits vasodilator use.*
---
Question 3
A patient presents with acute-onset chest pain, dyspnea, and
hypotension. ECG shows low voltage and electrical alternans. Which is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Cardiac tamponade
D) Aortic dissection
Answer: C
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*The triad of hypotension, low voltage, and electrical alternans is classic
for cardiac tamponade. Echocardiography confirms pericardial effusion
with right atrial and right ventricular collapse.*
---
Question 4
A patient with hypertrophic cardiomyopathy (HCM) has a left
ventricular outflow tract gradient of 80 mm Hg at rest and symptoms of
dyspnea and syncope. Which medication is most likely to exacerbate the
gradient?
A) Metoprolol
B) Verapamil
C) Disopyramide
D) Nitroglycerin
Answer: D
*Nitroglycerin reduces preload and afterload, increasing outflow tract
obstruction in HCM. Beta-blockers and verapamil reduce gradient.
Disopyramide is a negative inotrope used to reduce obstruction.*
---
ABIM Internal Medicine In-Training Examination
(ITE) Test Bank | Complete 150-Question Practice
Examination with Verified Answers and Detailed
Rationales 2026–2027 | Internal Medicine Board
Preparation | Graded A+ | 100% Pass Guaranteed
Description:** This comprehensive 150-question test bank is designed
for internal medicine residents preparing for the ABIM In-Training
Exam (ITE). The exam mirrors the actual ITE blueprint with scenario-
based questions covering all subspecialties of internal medicine
including cardiology, pulmonology, gastroenterology, endocrinology,
infectious disease, hematology, oncology, nephrology, rheumatology,
neurology, and more. Each question includes clinical vignettes followed
by correct answers with detailed rationales explaining underlying
pathophysiology and evidence-based guidelines.
---
## SECTION 1: CARDIOVASCULAR DISEASE
Question 1
,2 | Page
A 68-year-old man with chronic heart failure with reduced ejection
fraction (HFrEF) on optimal medical therapy including
sacubitril/valsartan, beta-blocker, and spironolactone continues to have
NYHA class III symptoms. Left ventricular ejection fraction is 30%.
There is no significant coronary disease. Which intervention has been
shown to reduce mortality in this population?
A) Implantable cardioverter-defibrillator (ICD) alone
B) Cardiac resynchronization therapy with defibrillator (CRT-D)
C) Left ventricular assist device (LVAD) as destination therapy
D) Heart transplantation listing
Answer: B
*In patients with HFrEF with wide QRS (>150 ms) and LBBB, CRT-D
reduces mortality and hospitalizations. ICD alone does not improve
symptoms. LVAD and transplantation are reserved for advanced disease
with refractory symptoms.*
---
Question 2
A patient with acute decompensated heart failure presents with severe
dyspnea, cool extremities, and a blood pressure of 85/50 mm Hg. Which
hemodynamic profile is most consistent with these findings?
,3 | Page
A) Warm and wet
B) Cold and wet
C) Cold and dry
D) Warm and dry
Answer: B
*The "cold and wet" profile indicates low cardiac output (cold
extremities) and congestion (wet). This patient requires inotropic support
and vasodilators if tolerated, but hypotension limits vasodilator use.*
---
Question 3
A patient presents with acute-onset chest pain, dyspnea, and
hypotension. ECG shows low voltage and electrical alternans. Which is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Cardiac tamponade
D) Aortic dissection
Answer: C
, 4 | Page
*The triad of hypotension, low voltage, and electrical alternans is classic
for cardiac tamponade. Echocardiography confirms pericardial effusion
with right atrial and right ventricular collapse.*
---
Question 4
A patient with hypertrophic cardiomyopathy (HCM) has a left
ventricular outflow tract gradient of 80 mm Hg at rest and symptoms of
dyspnea and syncope. Which medication is most likely to exacerbate the
gradient?
A) Metoprolol
B) Verapamil
C) Disopyramide
D) Nitroglycerin
Answer: D
*Nitroglycerin reduces preload and afterload, increasing outflow tract
obstruction in HCM. Beta-blockers and verapamil reduce gradient.
Disopyramide is a negative inotrope used to reduce obstruction.*
---
