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