ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
COMPREHENSIVE STUDY GUIDE (2026)
1. Diagnose domestic abuse
- answer-- definition: intentional violent/controlling behavior towards
intimate partner
- RF: h/o abuse, psych, substance, decr. age, decr. socioeconomics
- presentation: somatic symtpoms, vaginal, UTI, STI/ associated with
substance abuse, risky sexual behavior, eating disorders, limited
access to health care
- no gold standard for screening but goals: assist with health, asses
for safety, maintain supportive relationship
2. Manage vasovagal syncope
- answer-- definition: neurocardiogenic syncope "faint" prodromal phase
N/V/clammy --> withdrawal of sympathetic, increase in
parasympathetic/vagal tone, decr. blood pressure, decr. HR
- if no surge in vagal tone --> then no decr. in HR --> vasodepressor
syncope
- provoked: standing, dehydration, preload reduction (diuretics or
vasodilators)
- risk stratification: no good tool
- management: no hospitalization, exception: old people --> risk for
face/trauma or secondary cause needs to be ruled out
- instruct on abortive/preventative strategies, isometric counter-pressure
maneuvers include leg crossing, hand grip, squatting and muscle tensing,
no BB
Administer appropriate vaccines to an older patient
- answer-...
46. (a) B0133
Manage depression
- answer-Major depression: ≥5 symptoms including either depressed
mood or anhedonia for ≥2 weeks
Minor depression: 2-4 symptoms for ≥2 weeks
Dysthymia: ≥2 symptoms for ≥2 years
Screening: rec for all adults, use PHQ2 → > 2 weeks, depressed/hopeless
and little interest/pleasure in doing things?
Diagnosis: Four categories of depression are relevant to internal medicine:
, • major depression
• minor depression (also known as subthreshold depression)
• bipolar disorder
• dysthymia
Symptom criteria: DSIGECAPS → average of 7 symptoms reported
• depressed mood
• loss of interest in daily activities
• (appetite) weight loss or gain
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue
• feelings of worthlessness or guilt
• diminished ability to concentrate
• recurrent thoughts of death or suicide
47. (b) B0133
Manage depression
- answer-Therapy:
sertraline is safe for patients with cardiovascular disease
bupropion has fewer effects on sexual function and weight gain
mirtazapine causes sedation and weight gain (useful for patients with
weight loss)
venlafaxine can cause nausea and increased blood pressure
First episode of depression: Initiate treatment and continue at the dosage
required to achieve remission for an additional 4 to 9 months.
First recurrence of depression: Increase maintenance treatment to one to
two times the interepisode interval (for example, choose 18 to 36 months if
the second episode occurs 18 months after the first episode).
Three or more recurrences of depression, recurrence within 1 year of
successful treatment, or suicide attempt
*Watch for serotonin syndrome taking SSRIs
48. B0135
Determine colon cancer screening interval in a patient with a family history
of colon cancer
COMPREHENSIVE STUDY GUIDE (2026)
1. Diagnose domestic abuse
- answer-- definition: intentional violent/controlling behavior towards
intimate partner
- RF: h/o abuse, psych, substance, decr. age, decr. socioeconomics
- presentation: somatic symtpoms, vaginal, UTI, STI/ associated with
substance abuse, risky sexual behavior, eating disorders, limited
access to health care
- no gold standard for screening but goals: assist with health, asses
for safety, maintain supportive relationship
2. Manage vasovagal syncope
- answer-- definition: neurocardiogenic syncope "faint" prodromal phase
N/V/clammy --> withdrawal of sympathetic, increase in
parasympathetic/vagal tone, decr. blood pressure, decr. HR
- if no surge in vagal tone --> then no decr. in HR --> vasodepressor
syncope
- provoked: standing, dehydration, preload reduction (diuretics or
vasodilators)
- risk stratification: no good tool
- management: no hospitalization, exception: old people --> risk for
face/trauma or secondary cause needs to be ruled out
- instruct on abortive/preventative strategies, isometric counter-pressure
maneuvers include leg crossing, hand grip, squatting and muscle tensing,
no BB
Administer appropriate vaccines to an older patient
- answer-...
46. (a) B0133
Manage depression
- answer-Major depression: ≥5 symptoms including either depressed
mood or anhedonia for ≥2 weeks
Minor depression: 2-4 symptoms for ≥2 weeks
Dysthymia: ≥2 symptoms for ≥2 years
Screening: rec for all adults, use PHQ2 → > 2 weeks, depressed/hopeless
and little interest/pleasure in doing things?
Diagnosis: Four categories of depression are relevant to internal medicine:
, • major depression
• minor depression (also known as subthreshold depression)
• bipolar disorder
• dysthymia
Symptom criteria: DSIGECAPS → average of 7 symptoms reported
• depressed mood
• loss of interest in daily activities
• (appetite) weight loss or gain
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue
• feelings of worthlessness or guilt
• diminished ability to concentrate
• recurrent thoughts of death or suicide
47. (b) B0133
Manage depression
- answer-Therapy:
sertraline is safe for patients with cardiovascular disease
bupropion has fewer effects on sexual function and weight gain
mirtazapine causes sedation and weight gain (useful for patients with
weight loss)
venlafaxine can cause nausea and increased blood pressure
First episode of depression: Initiate treatment and continue at the dosage
required to achieve remission for an additional 4 to 9 months.
First recurrence of depression: Increase maintenance treatment to one to
two times the interepisode interval (for example, choose 18 to 36 months if
the second episode occurs 18 months after the first episode).
Three or more recurrences of depression, recurrence within 1 year of
successful treatment, or suicide attempt
*Watch for serotonin syndrome taking SSRIs
48. B0135
Determine colon cancer screening interval in a patient with a family history
of colon cancer
