ABIM Internal Medicine Boards ITE – Comprehensive
2025/2026 Study Guide 150 Question and correct
detailed answers with Explanation.
Introduction & Coverage
Welcome to the ABIM Internal Medicine ITE 2025/2026 Study Guide The American
Board of Internal Medicine (ABIM) Internal Medicine In-Training Examination
(ITE) is a critical milestone for residents and fellows. It not only predicts performance on
the final ABIM Certification Examination but also identifies knowledge gaps early in
training. This Comprehensive Study Guide is specifically designed for the 2025–2026
testing cycle, reflecting the latest ABIM content blueprints, guideline updates, and
high-yield clinical pearls.
This guide distills thousands of pages of internal medicine into 150 board-style
practice questions, each with five answer choices (A–D) and detailed, italicized
explanations that emphasize:
Why the correct answer is right
Why each distractor is wrong
Clinical reasoning pearls tested on the ITE
How to Use This Guide
1. Review explanations thoroughly – The italicized text contains the “teaching point”
most often tested.
2. Track your weak areas – Use the Coverage table below to identify high-yield systems
needing review.
3. Integrate with MKSAP, UWorld, or NEJM Knowledge+ – This guide serves as a
focused supplement.
,1. A 68-year-old man with dyspnea, JVD, and Kussmaul sign. Echocardiogram shows
thickened pericardium. What is the next best step?
A) Colchicine
B) NSAIDs
C) Pericardiectomy
D) Diuretics
Answer: C
Constrictive pericarditis presents with elevated JVP, Kussmaul sign, and pericardial
thickening. Pericardiectomy is definitive treatment; colchicine/NSAIDs are for acute
pericarditis.
2. A 55-year-old with atrial fibrillation, HR 150, BP 80/50, and chest pain. Next step?
A) Oral metoprolol
B) IV diltiazem
C) Synchronized cardioversion
D) Aspirin only
Answer: C
Hemodynamically unstable atrial fibrillation (hypotension, chest pain) requires immediate
synchronized cardioversion per ACLS guidelines.
3. Anterior STEMI on ECG, symptom onset 45 minutes ago. After aspirin and oxygen,
next step?
A) Heparin drip
B) Emergent PCI
C) Tenecteplase
D) Nitroglycerin drip
,Answer: B
Primary PCI within 90 minutes of first medical contact is standard for STEMI. Fibrinolytics
if PCI delayed >120 minutes.
4. HFrEF patient (EF 30%) on lisinopril, metoprolol, furosemide. Still NYHA class III. Add?
A) Hydralazine
B) Spironolactone
C) Digoxin
D) Ivabradine
Answer: B
Mineralocorticoid receptor antagonists (spironolactone, eplerenone) improve mortality in
NYHA III–IV HFrEF.
5. Asymptomatic severe aortic stenosis (AVA 0.8 cm², peak velocity 4.5 m/s). Next step?
A) Aortic valve replacement
B) Balloon valvuloplasty
C) Clinical surveillance with echo in 6–12 months
D) Dobutamine stress echo
Answer: C
AVR is indicated only when symptoms develop or LVEF <50% in severe AS. Asymptomatic
patients are monitored.
6. Hypertrophic cardiomyopathy patient with syncope. Best long-term therapy?
A) Beta-blocker
B) Verapamil
C) ICD placement
D) Septal myectomy
Answer: C
Syncope in HCM is a risk factor for sudden cardiac death; ICD is recommended for primary
prevention.
, 7. Patient on diltiazem and metoprolol presents with HR 38, BP 90/60. Next step?
A) Atropine
B) IV calcium gluconate
C) Transvenous pacing
D) Aminophylline
Answer: B
Calcium channel blocker toxicity causes bradycardia/hypotension; IV calcium gluconate is
the antidote.
8. Harsh systolic murmur at right upper sternal border radiating to carotids. Diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Hypertrophic cardiomyopathy
D) Pulmonary stenosis
Answer: B
Crescendo-decrescendo murmur at RUSB radiating to carotids is classic for aortic stenosis.
9. TTE shows vegetations on mitral valve. Patient has fever and splinter hemorrhages.
Next step?
A) Empiric vancomycin alone
B) Blood cultures ×3 then vancomycin + gentamicin
C) Immediate surgery
D) Oral amoxicillin
Answer: B
Infective endocarditis requires three sets of blood cultures before antibiotics; empiric
therapy covers MSSA/MRSA/Strep.
10. Chest pain with diffuse ST elevations and PR depression. Diagnosis?
A) Acute MI
B) Pericarditis
2025/2026 Study Guide 150 Question and correct
detailed answers with Explanation.
Introduction & Coverage
Welcome to the ABIM Internal Medicine ITE 2025/2026 Study Guide The American
Board of Internal Medicine (ABIM) Internal Medicine In-Training Examination
(ITE) is a critical milestone for residents and fellows. It not only predicts performance on
the final ABIM Certification Examination but also identifies knowledge gaps early in
training. This Comprehensive Study Guide is specifically designed for the 2025–2026
testing cycle, reflecting the latest ABIM content blueprints, guideline updates, and
high-yield clinical pearls.
This guide distills thousands of pages of internal medicine into 150 board-style
practice questions, each with five answer choices (A–D) and detailed, italicized
explanations that emphasize:
Why the correct answer is right
Why each distractor is wrong
Clinical reasoning pearls tested on the ITE
How to Use This Guide
1. Review explanations thoroughly – The italicized text contains the “teaching point”
most often tested.
2. Track your weak areas – Use the Coverage table below to identify high-yield systems
needing review.
3. Integrate with MKSAP, UWorld, or NEJM Knowledge+ – This guide serves as a
focused supplement.
,1. A 68-year-old man with dyspnea, JVD, and Kussmaul sign. Echocardiogram shows
thickened pericardium. What is the next best step?
A) Colchicine
B) NSAIDs
C) Pericardiectomy
D) Diuretics
Answer: C
Constrictive pericarditis presents with elevated JVP, Kussmaul sign, and pericardial
thickening. Pericardiectomy is definitive treatment; colchicine/NSAIDs are for acute
pericarditis.
2. A 55-year-old with atrial fibrillation, HR 150, BP 80/50, and chest pain. Next step?
A) Oral metoprolol
B) IV diltiazem
C) Synchronized cardioversion
D) Aspirin only
Answer: C
Hemodynamically unstable atrial fibrillation (hypotension, chest pain) requires immediate
synchronized cardioversion per ACLS guidelines.
3. Anterior STEMI on ECG, symptom onset 45 minutes ago. After aspirin and oxygen,
next step?
A) Heparin drip
B) Emergent PCI
C) Tenecteplase
D) Nitroglycerin drip
,Answer: B
Primary PCI within 90 minutes of first medical contact is standard for STEMI. Fibrinolytics
if PCI delayed >120 minutes.
4. HFrEF patient (EF 30%) on lisinopril, metoprolol, furosemide. Still NYHA class III. Add?
A) Hydralazine
B) Spironolactone
C) Digoxin
D) Ivabradine
Answer: B
Mineralocorticoid receptor antagonists (spironolactone, eplerenone) improve mortality in
NYHA III–IV HFrEF.
5. Asymptomatic severe aortic stenosis (AVA 0.8 cm², peak velocity 4.5 m/s). Next step?
A) Aortic valve replacement
B) Balloon valvuloplasty
C) Clinical surveillance with echo in 6–12 months
D) Dobutamine stress echo
Answer: C
AVR is indicated only when symptoms develop or LVEF <50% in severe AS. Asymptomatic
patients are monitored.
6. Hypertrophic cardiomyopathy patient with syncope. Best long-term therapy?
A) Beta-blocker
B) Verapamil
C) ICD placement
D) Septal myectomy
Answer: C
Syncope in HCM is a risk factor for sudden cardiac death; ICD is recommended for primary
prevention.
, 7. Patient on diltiazem and metoprolol presents with HR 38, BP 90/60. Next step?
A) Atropine
B) IV calcium gluconate
C) Transvenous pacing
D) Aminophylline
Answer: B
Calcium channel blocker toxicity causes bradycardia/hypotension; IV calcium gluconate is
the antidote.
8. Harsh systolic murmur at right upper sternal border radiating to carotids. Diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Hypertrophic cardiomyopathy
D) Pulmonary stenosis
Answer: B
Crescendo-decrescendo murmur at RUSB radiating to carotids is classic for aortic stenosis.
9. TTE shows vegetations on mitral valve. Patient has fever and splinter hemorrhages.
Next step?
A) Empiric vancomycin alone
B) Blood cultures ×3 then vancomycin + gentamicin
C) Immediate surgery
D) Oral amoxicillin
Answer: B
Infective endocarditis requires three sets of blood cultures before antibiotics; empiric
therapy covers MSSA/MRSA/Strep.
10. Chest pain with diffuse ST elevations and PR depression. Diagnosis?
A) Acute MI
B) Pericarditis
