ITE BOARD REVIEW GENERAL
INTERNAL MEDICINE EXAM
WITH COMPLETE SOLUTIONS
100% VERIFIED 2026-2027!! |
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM | Comprehensive Examination
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM WITH COMPLETE SOLUTIONS 100% VERIFIED
2026-2027!! actual exam preparation document with verified
INTRODUCTION
This document is an important and very helpful preparation
resource for ITE BOARD REVIEW GENERAL INTERNAL
MEDICINE EXAM WITH COMPLETE SOLUTIONS 100%
VERIFIED 2026-2027!!. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
A 62-year-old man with heart failure with reduced ejection fraction (HFrEF) on
guideline-directed medical therapy presents with worsening dyspnea.
Echocardiogram shows LVEF 30%, moderate functional mitral regurgitation,
and a dilated left ventricle. Which of the following interventions has the
strongest evidence for improving survival in this patient?
A. Mitral valve repair surgery
B. Cardiac resynchronization therapy (CRT)
C. Transcatheter edge-to-edge repair (TEER)
D. Intra-aortic balloon pump counterpulsation
Correct Answer: B - Cardiac resynchronization therapy (CRT)
RATIONALE
CRT improves survival in HFrEF patients with LBBB and QRS 150
ms; the other options lack robust mortality benefit in this context.
TEER improves symptoms but not survival in functional MR. Surgery
and IABP are not first-line for chronic HFrEF.
Question 2
A 55-year-old woman with COPD (FEV1 50% predicted) presents with
increased sputum purulence, dyspnea, and a productive cough for 3 days. She
has had two exacerbations in the past year. According to GOLD 2024, what is
the most appropriate initial management?
A. Increase inhaled corticosteroid dose
B. Prescribe oral prednisone 40 mg daily for 5 days
C. Start antibiotics and increase bronchodilator frequency
D. Admit for intravenous antibiotics
Correct Answer: C - Start antibiotics and increase bronchodilator
frequency
Page 2
, RATIONALE
GOLD 2024 recommends antibiotics and increased bronchodilators
for exacerbations with increased sputum purulence and dyspnea.
Systemic steroids are indicated but the question asks initial
management; antibiotics are key when purulent sputum is present. ICS
escalation is not first-line.
Question 3
A 40-year-old man with known cirrhosis presents with confusion, asterixis, and
a serum ammonia of 120 µmol/L. He has been constipated for 3 days. Which of
the following is the most appropriate initial treatment?
A. Lactulose 30 mL every 2 hours until bowel movement
B. Rifaximin 550 mg twice daily
C. Neomycin 500 mg every 6 hours
D. L-ornithine L-aspartate infusion
Correct Answer: A - Lactulose 30 mL every 2 hours until bowel
movement
RATIONALE
Lactulose is first-line for acute hepatic encephalopathy, titrated to 2-3
soft stools per day. Rifaximin is for secondary prophylaxis. Neomycin
is not preferred due to nephrotoxicity/ototoxicity. L-ornithine
L-aspartate has limited evidence.
Question 4
A 68-year-old woman with type 2 diabetes and CKD stage 3 (eGFR 45
mL/min/1.73m²) has an HbA1c of 8.2% on metformin. Which of the following
add-on therapies provides the greatest cardiovascular and renal protection?
A. Sulfonylurea
B. DPP-4 inhibitor
C. SGLT2 inhibitor
Page 3
, D. Insulin
Correct Answer: C - SGLT2 inhibitor
RATIONALE
SGLT2 inhibitors reduce CKD progression and cardiovascular events
in patients with T2D and CKD. DPP-4 inhibitors are weight-neutral
and have minimal CV benefit. Sulfonylureas and insulin do not offer
renal protection.
Question 5
A 30-year-old woman presents with fatigue, arthralgias, and a malar rash. Labs
show ANA 1:640, anti-dsDNA positive, low C3/C4, and urine
protein/creatinine ratio of 1.2 g/g. Renal biopsy reveals class IV lupus
nephritis. Which of the following is the most appropriate induction therapy?
A. High-dose corticosteroids alone
B. Mycophenolate mofetil plus high-dose corticosteroids
C. Azathioprine plus low-dose corticosteroids
D. Rituximab monotherapy
Correct Answer: B - Mycophenolate mofetil plus high-dose
corticosteroids
RATIONALE
Class IV lupus nephritis requires induction with mycophenolate
mofetil or cyclophosphamide plus corticosteroids. Azathioprine is for
maintenance. Rituximab is not standard first-line induction. Steroids
alone are insufficient.
Question 6
A 72-year-old man with atrial fibrillation on warfarin presents with a
supratherapeutic INR of 8.5 and no bleeding. What is the most appropriate
management?
Page 4
INTERNAL MEDICINE EXAM
WITH COMPLETE SOLUTIONS
100% VERIFIED 2026-2027!! |
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM | Comprehensive Examination
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM WITH COMPLETE SOLUTIONS 100% VERIFIED
2026-2027!! actual exam preparation document with verified
INTRODUCTION
This document is an important and very helpful preparation
resource for ITE BOARD REVIEW GENERAL INTERNAL
MEDICINE EXAM WITH COMPLETE SOLUTIONS 100%
VERIFIED 2026-2027!!. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
A 62-year-old man with heart failure with reduced ejection fraction (HFrEF) on
guideline-directed medical therapy presents with worsening dyspnea.
Echocardiogram shows LVEF 30%, moderate functional mitral regurgitation,
and a dilated left ventricle. Which of the following interventions has the
strongest evidence for improving survival in this patient?
A. Mitral valve repair surgery
B. Cardiac resynchronization therapy (CRT)
C. Transcatheter edge-to-edge repair (TEER)
D. Intra-aortic balloon pump counterpulsation
Correct Answer: B - Cardiac resynchronization therapy (CRT)
RATIONALE
CRT improves survival in HFrEF patients with LBBB and QRS 150
ms; the other options lack robust mortality benefit in this context.
TEER improves symptoms but not survival in functional MR. Surgery
and IABP are not first-line for chronic HFrEF.
Question 2
A 55-year-old woman with COPD (FEV1 50% predicted) presents with
increased sputum purulence, dyspnea, and a productive cough for 3 days. She
has had two exacerbations in the past year. According to GOLD 2024, what is
the most appropriate initial management?
A. Increase inhaled corticosteroid dose
B. Prescribe oral prednisone 40 mg daily for 5 days
C. Start antibiotics and increase bronchodilator frequency
D. Admit for intravenous antibiotics
Correct Answer: C - Start antibiotics and increase bronchodilator
frequency
Page 2
, RATIONALE
GOLD 2024 recommends antibiotics and increased bronchodilators
for exacerbations with increased sputum purulence and dyspnea.
Systemic steroids are indicated but the question asks initial
management; antibiotics are key when purulent sputum is present. ICS
escalation is not first-line.
Question 3
A 40-year-old man with known cirrhosis presents with confusion, asterixis, and
a serum ammonia of 120 µmol/L. He has been constipated for 3 days. Which of
the following is the most appropriate initial treatment?
A. Lactulose 30 mL every 2 hours until bowel movement
B. Rifaximin 550 mg twice daily
C. Neomycin 500 mg every 6 hours
D. L-ornithine L-aspartate infusion
Correct Answer: A - Lactulose 30 mL every 2 hours until bowel
movement
RATIONALE
Lactulose is first-line for acute hepatic encephalopathy, titrated to 2-3
soft stools per day. Rifaximin is for secondary prophylaxis. Neomycin
is not preferred due to nephrotoxicity/ototoxicity. L-ornithine
L-aspartate has limited evidence.
Question 4
A 68-year-old woman with type 2 diabetes and CKD stage 3 (eGFR 45
mL/min/1.73m²) has an HbA1c of 8.2% on metformin. Which of the following
add-on therapies provides the greatest cardiovascular and renal protection?
A. Sulfonylurea
B. DPP-4 inhibitor
C. SGLT2 inhibitor
Page 3
, D. Insulin
Correct Answer: C - SGLT2 inhibitor
RATIONALE
SGLT2 inhibitors reduce CKD progression and cardiovascular events
in patients with T2D and CKD. DPP-4 inhibitors are weight-neutral
and have minimal CV benefit. Sulfonylureas and insulin do not offer
renal protection.
Question 5
A 30-year-old woman presents with fatigue, arthralgias, and a malar rash. Labs
show ANA 1:640, anti-dsDNA positive, low C3/C4, and urine
protein/creatinine ratio of 1.2 g/g. Renal biopsy reveals class IV lupus
nephritis. Which of the following is the most appropriate induction therapy?
A. High-dose corticosteroids alone
B. Mycophenolate mofetil plus high-dose corticosteroids
C. Azathioprine plus low-dose corticosteroids
D. Rituximab monotherapy
Correct Answer: B - Mycophenolate mofetil plus high-dose
corticosteroids
RATIONALE
Class IV lupus nephritis requires induction with mycophenolate
mofetil or cyclophosphamide plus corticosteroids. Azathioprine is for
maintenance. Rituximab is not standard first-line induction. Steroids
alone are insufficient.
Question 6
A 72-year-old man with atrial fibrillation on warfarin presents with a
supratherapeutic INR of 8.5 and no bleeding. What is the most appropriate
management?
Page 4
