INTERNAL MEDICINE REVIEW ABIM
PART 1 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS | LATEST
VERSION 2025/2026.
What is a positive stress test - ANS Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - ANS St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - ANS Myocardial perfusion imaging
with adenosine,
NOT exercising!
When to not use doutamine for stress - ANS History of VT,
severe HTN,
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Low BP,
poor echo images
When to not use adenosine for stress - ANS Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures - ANS RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - ANS tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - ANS RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - ANS cardiogenic shock
high RA,
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,PA very elevated
high PCWP
nl SBP - ANS mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP - ANS pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats - ANS pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle) - ANS Aortic regurgitation,
HOCM
What causes pulsus alternans - ANS Severe LV dysfunction
What causes pulsus tardus - ANS Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - ANS -standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, increase cardiac volume,
increased murmurs
except MVP, HOCM
-sustained handgrip:
increases systemic resistance
decreases murmur in HOCM, AS
What causes a physiologic split S2 - ANS Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2 - ANS Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2 - ANS LBBB,
RV pacing,
HOCM
What causes an S3? - ANS Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
PART 1 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS | LATEST
VERSION 2025/2026.
What is a positive stress test - ANS Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - ANS St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - ANS Myocardial perfusion imaging
with adenosine,
NOT exercising!
When to not use doutamine for stress - ANS History of VT,
severe HTN,
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Low BP,
poor echo images
When to not use adenosine for stress - ANS Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures - ANS RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - ANS tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - ANS RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - ANS cardiogenic shock
high RA,
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,PA very elevated
high PCWP
nl SBP - ANS mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP - ANS pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats - ANS pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle) - ANS Aortic regurgitation,
HOCM
What causes pulsus alternans - ANS Severe LV dysfunction
What causes pulsus tardus - ANS Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - ANS -standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, increase cardiac volume,
increased murmurs
except MVP, HOCM
-sustained handgrip:
increases systemic resistance
decreases murmur in HOCM, AS
What causes a physiologic split S2 - ANS Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2 - ANS Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2 - ANS LBBB,
RV pacing,
HOCM
What causes an S3? - ANS Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
