ABIM Internal Medicine Boards ITE – Comprehensive 2025/2026 Study Guide 150 Question and correct detailed answers with Explanation.

ABIM Internal Medicine Boards ITE – Comprehensive
2025/2026 Study Guide 150 Question and correct
detailed answers with Explanation.


SECTION 1:CARDIOVASCULAR DISEASE ws ws ws




Question 1 ws




A patient with chronic heart failure with reduced ejection fraction (HFrEF) on optimal
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medical therapy including sacubitril/valsartan, beta-blocker, and
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spironolactone continues to have NYHA class III symptoms. Left ventricular ejection f
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raction is 30%. There is no significant coronary disease. Which intervention has bee
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n shown to reduce mortality in this population?
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A) Implantable cardioverter-defibrillator (ICD) alone ws ws ws




B) Cardiac resynchronization therapy with defibrillator (CRT-D)
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C) Left ventricular assist device (LVAD) as destination therapy
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D) Heart transplantation listing ws ws




Correct Answer: B ws ws




Rationale: In patients with HFrEF, wide QRS (>150 ms) and LBBB, CRT-
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D reduces mortality and hospitalizations. ICD alone does not improve symptoms. LVA
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D and transplantation are reserved for advanced disease with refractory symptoms.
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Question 2 ws




A patient with acute decompensated heart failure presents with severe dyspnea, cool
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extremities, and a blood pressure of 85/50 mm Hg. Which hemodynamic profile is m
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ost consistent with these findings?
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,A) Warm and wet ws ws




B) Cold and wet ws ws




C) Cold and dry ws ws




D) Warm and dry ws ws




Correct Answer: B ws ws




Rationale: Cold and wet profile indicates low cardiac output (cold extremities) and co
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ngestion (wet). This patient requires inotropic support and vasodilators if
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tolerated, but hypotension limits vasodilator use.
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Question 3 ws




A patient with known coronary artery disease develops chest pain at rest with
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transient ST- ws




segment elevation on ECG. Cardiac troponin is elevated. Which is the most appropriat
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e next step in management?
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A) Immediate coronary angiography with PCI ws ws ws ws




B) Stress echocardiography ws




C) Medical management with dual antiplatelet therapy and heparin
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D) CT coronary angiography
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Correct Answer: A ws ws




Rationale: STEMI requires emergent reperfusion. Immediate angiography with PCI is i
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ndicated within 90 minutes. Stress testing is contraindicated in acute MI. Medical m
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anagement alone is insufficient. ws ws ws




Question 4 ws




A patient with atrial fibrillation and a CHA₂DS₂-
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VASc score of 4 is started on apixaban. Which laboratory parameter most directly affe
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cts the anticoagulant effect of apixaban and requires dose adjustment?
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,
, A) Prothrombin time ws




B) Activated partial thromboplastin time ws ws ws




C) Serum creatinine and body weightws ws ws ws




D) Platelet count ws




Correct Answer: C ws ws




Rationale: Apixaban is partially renally cleared and dose-
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adjusted based on serum creatinine (CrCl <25 mL/min) and body weight (<60 kg). PT
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and aPTT are not
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reliable for monitoring. Platelet count does not alter dosing.
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Question 5 ws




A patient with severe aortic stenosis (valve area 0.8 cm², mean gradient 50 mm Hg) is
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asymptomatic. Which finding would be an indication for aortic valve
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replacement?
A) Left ventricular ejection fraction 55%
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B) Abnormal exercise test with symptoms ws ws ws ws




C) Moderate mitral regurgitation ws ws




D) Left atrial enlargement
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Correct Answer: B ws ws




Rationale: In severe aortic stenosis, even if asymptomatic, an abnormal exercise test
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(development of symptoms, fall in blood pressure) is a class I indication for valve re
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placement. LVEF >50% is not an indication. ws ws ws ws ws ws




Question 6 ws




A patient presents with acute-
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onset chest pain, dyspnea, and hypotension. ECG shows low voltage and electrical alt
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ernans. Which is the most likely diagnosis?
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