ABIM Internal Medicine ITE Test Bank – Complete
Practice Questions with Verified Answers &
Explanations – Updated 2026/2027 In-Training Exam
Prep
ABIM INTERNAL MEDICINE ITE TEST BANK COMPLETE PRACTICE
QUESTIONS WITH VERIFIED ANSWERS & EXPLANATIONS UPDATED
2026/2027 IN-TRAINING EXAM PREP
SECTION 1: CARDIOVASCULAR DISEASE
1. A 62-year-old man with hypertension and dyslipidemia presents with crushing
substernal chest pain radiating to his left arm. Which initial diagnostic test is most
appropriate to evaluate for acute myocardial infarction?
A) Exercise stress echocardiography
B) Resting 12-lead electrocardiogram
C) Cardiac CT angiography
D) Cardiac MRI with gadolinium
Correct Answer: B
Rationale: A resting ECG is the first test to assess for ischemia or infarction in
patients presenting with chest pain. It is rapid, widely available, and can guide
immediate management decisions [citation:2].
1
,2. A patient presents with chest pain that is worse when lying flat and improves
when leaning forward. On auscultation, a scratchy sound is heard. Which ECG
finding is most specific for this condition?
A) ST-segment elevation in all leads
B) PR-segment depression
C) Diffuse ST-segment elevation with PR-segment depression
D) Q waves
Correct Answer: C
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation
(concave upward) with PR-segment depression across multiple leads. This
distinguishes it from myocardial infarction, which shows regional ST elevation
with reciprocal changes. PR-segment depression is highly specific for pericarditis
[citation:9].
3. A 70-year-old man with severe aortic stenosis (valve area 0.8 cm²) is
asymptomatic. What is the most appropriate management?
A) Observation with yearly echocardiogram
B) Aortic valve replacement
C) Antibiotic prophylaxis
D) Balloon valvuloplasty
Correct Answer: A
2
,Rationale: Patients with severe asymptomatic aortic stenosis can be managed
conservatively with close monitoring. Symptoms (dyspnea, angina, syncope)
warrant aortic valve replacement. Balloon valvuloplasty is reserved for patients
who are not surgical candidates [citation:9].
4. Which class of medications is relatively contraindicated in patients with severe
aortic stenosis?
A) ACE inhibitors
B) Beta-blockers
C) Calcium channel blockers
D) Nitrates
Correct Answer: D
Rationale: Nitrates are relatively contraindicated in severe aortic stenosis because
they reduce preload and can cause profound hypotension. ACE inhibitors, beta-
blockers, and calcium channel blockers can be used cautiously [citation:9].
5. A 52-year-old male presents with chest pain that occurs at rest and is associated
with transient ST-segment elevation on ECG. What is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) NSTEMI
Correct Answer: C
3
, Rationale: Prinzmetal's (variant) angina is characterized by chest pain at rest with
transient ST-segment elevation due to coronary artery vasospasm. Unlike stable
angina, it is not associated with exertion [citation:9].
6. A 40-year-old woman presents with exertional dyspnea and a loud S2 with a
right ventricular heave. Which condition is most likely?
A) Aortic stenosis
B) Mitral stenosis
C) Pulmonary hypertension
D) Atrial septal defect
Correct Answer: C
Rationale: A loud P2 component of the second heart sound and right ventricular
heave suggest right ventricular pressure overload, most commonly from pulmonary
hypertension [citation:2].
7. A patient with pheochromocytoma is being prepared for surgery. What is the
most appropriate initial management?
A) Alpha-blockade with phenoxybenzamine
B) Beta-blockade with propranolol
C) Calcium channel blocker
D) Surgical resection
Correct Answer: A
4
Practice Questions with Verified Answers &
Explanations – Updated 2026/2027 In-Training Exam
Prep
ABIM INTERNAL MEDICINE ITE TEST BANK COMPLETE PRACTICE
QUESTIONS WITH VERIFIED ANSWERS & EXPLANATIONS UPDATED
2026/2027 IN-TRAINING EXAM PREP
SECTION 1: CARDIOVASCULAR DISEASE
1. A 62-year-old man with hypertension and dyslipidemia presents with crushing
substernal chest pain radiating to his left arm. Which initial diagnostic test is most
appropriate to evaluate for acute myocardial infarction?
A) Exercise stress echocardiography
B) Resting 12-lead electrocardiogram
C) Cardiac CT angiography
D) Cardiac MRI with gadolinium
Correct Answer: B
Rationale: A resting ECG is the first test to assess for ischemia or infarction in
patients presenting with chest pain. It is rapid, widely available, and can guide
immediate management decisions [citation:2].
1
,2. A patient presents with chest pain that is worse when lying flat and improves
when leaning forward. On auscultation, a scratchy sound is heard. Which ECG
finding is most specific for this condition?
A) ST-segment elevation in all leads
B) PR-segment depression
C) Diffuse ST-segment elevation with PR-segment depression
D) Q waves
Correct Answer: C
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation
(concave upward) with PR-segment depression across multiple leads. This
distinguishes it from myocardial infarction, which shows regional ST elevation
with reciprocal changes. PR-segment depression is highly specific for pericarditis
[citation:9].
3. A 70-year-old man with severe aortic stenosis (valve area 0.8 cm²) is
asymptomatic. What is the most appropriate management?
A) Observation with yearly echocardiogram
B) Aortic valve replacement
C) Antibiotic prophylaxis
D) Balloon valvuloplasty
Correct Answer: A
2
,Rationale: Patients with severe asymptomatic aortic stenosis can be managed
conservatively with close monitoring. Symptoms (dyspnea, angina, syncope)
warrant aortic valve replacement. Balloon valvuloplasty is reserved for patients
who are not surgical candidates [citation:9].
4. Which class of medications is relatively contraindicated in patients with severe
aortic stenosis?
A) ACE inhibitors
B) Beta-blockers
C) Calcium channel blockers
D) Nitrates
Correct Answer: D
Rationale: Nitrates are relatively contraindicated in severe aortic stenosis because
they reduce preload and can cause profound hypotension. ACE inhibitors, beta-
blockers, and calcium channel blockers can be used cautiously [citation:9].
5. A 52-year-old male presents with chest pain that occurs at rest and is associated
with transient ST-segment elevation on ECG. What is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) NSTEMI
Correct Answer: C
3
, Rationale: Prinzmetal's (variant) angina is characterized by chest pain at rest with
transient ST-segment elevation due to coronary artery vasospasm. Unlike stable
angina, it is not associated with exertion [citation:9].
6. A 40-year-old woman presents with exertional dyspnea and a loud S2 with a
right ventricular heave. Which condition is most likely?
A) Aortic stenosis
B) Mitral stenosis
C) Pulmonary hypertension
D) Atrial septal defect
Correct Answer: C
Rationale: A loud P2 component of the second heart sound and right ventricular
heave suggest right ventricular pressure overload, most commonly from pulmonary
hypertension [citation:2].
7. A patient with pheochromocytoma is being prepared for surgery. What is the
most appropriate initial management?
A) Alpha-blockade with phenoxybenzamine
B) Beta-blockade with propranolol
C) Calcium channel blocker
D) Surgical resection
Correct Answer: A
4
