ITE BOARD REVIEW GENERAL
INTERNAL MEDICINE EXAM
WITH COMPLETE SOLUTIONS
100% VERIFIED 2026-2027!! |
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM | Comprehensive Examination
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM WITH COMPLETE SOLUTIONS 100% VERIFIED
2026-2027!! actual exam preparation document with verified
INTRODUCTION
This document is an important and very helpful preparation
resource for ITE BOARD REVIEW GENERAL INTERNAL
MEDICINE EXAM WITH COMPLETE SOLUTIONS 100%
VERIFIED 2026-2027!!. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
A patient with chronic kidney disease and metabolic acidosis is started on
sodium bicarbonate. Which parameter most directly determines the target
serum bicarbonate to minimize progression of kidney disease?
A. Serum bicarbonate of 22 mEq/L
B. Serum bicarbonate of 18 mEq/L
C. Serum bicarbonate of 26 mEq/L
D. Serum bicarbonate of 20 mEq/L
Correct Answer: A - Serum bicarbonate of 22 mEq/L
RATIONALE
Current KDIGO and ASN guidance supports maintaining serum
bicarbonate 22 mEq/L to slow CKD progression; lower targets (18-20)
are associated with worse outcomes. Higher targets (26) risk metabolic
alkalosis and are not supported by evidence. Thus, 22 mEq/L is the
evidence-based threshold.
Question 2
Which of the following best explains why direct oral anticoagulants are
preferred over warfarin in nonvalvular atrial fibrillation with a
CHA2DS2-VASc score of 4?
A. They require no monitoring and have fewer food/drug interactions.
B. They are reversible with vitamin K.
C. They are safe in mechanical mitral valves.
D. They have a lower cost than warfarin.
Correct Answer: A - They require no monitoring and have fewer
food/drug interactions.
Page 2
, RATIONALE
DOACs offer predictable pharmacokinetics, no routine INR
monitoring, and fewer dietary/drug interactions compared to warfarin,
which is why guidelines favor them in nonvalvular AF. They are not
reversed by vitamin K, are contraindicated in mechanical valves, and
often cost more.
Question 3
A patient with type 2 diabetes on metformin and a GLP-1 receptor agonist has
an eGFR of 28 mL/min/1.73m². Which action is most appropriate regarding
metformin?
A. Continue metformin at current dose.
B. Discontinue metformin.
C. Reduce metformin dose by 50%.
D. Switch to a sulfonylurea.
Correct Answer: B - Discontinue metformin.
RATIONALE
Metformin is contraindicated when eGFR <30 mL/min/1.73m² due to
increased risk of lactic acidosis; it should be discontinued. Dose
reduction is recommended for eGFR 30-45, not below 30.
Sulfonylureas are not preferred due to hypoglycemia risk in CKD.
Question 4
Which finding on a peripheral blood smear is most characteristic of thrombotic
thrombocytopenic purpura (TTP)?
A. Schistocytes
B. Target cells
C. Auer rods
D. Reed-Sternberg cells
Correct Answer: A - Schistocytes
Page 3
, RATIONALE
TTP is a thrombotic microangiopathy marked by microangiopathic
hemolytic anemia with schistocytes on smear, thrombocytopenia, and
end-organ injury. Target cells suggest liver disease or
hemoglobinopathy; Auer rods indicate AML; Reed-Sternberg cells
indicate Hodgkin lymphoma.
Question 5
A previously healthy adult presents with fever, cough, and diffuse bilateral
infiltrates. Which parameter best predicts mortality in severe
community-acquired pneumonia?
A. CURB-65 score
B. Sputum culture result
C. Chest X-ray pattern
D. Duration of symptoms
Correct Answer: A - CURB-65 score
RATIONALE
The CURB-65 score (Confusion, Urea, Respiratory rate, Blood
pressure, age 65) is a validated tool for assessing severity and
mortality risk in CAP, guiding site-of-care decisions. Culture, imaging
pattern, and symptom duration are not validated mortality predictors.
Question 6
Which autoantibody is most specific for systemic lupus erythematosus and
associated with a lower risk of lupus nephritis?
A. Anti-dsDNA
B. Anti-Smith
C. Anti-Ro
D. Anti-histone
Correct Answer: B - Anti-Smith
Page 4
INTERNAL MEDICINE EXAM
WITH COMPLETE SOLUTIONS
100% VERIFIED 2026-2027!! |
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM | Comprehensive Examination
ITE BOARD REVIEW GENERAL INTERNAL MEDICINE
EXAM WITH COMPLETE SOLUTIONS 100% VERIFIED
2026-2027!! actual exam preparation document with verified
INTRODUCTION
This document is an important and very helpful preparation
resource for ITE BOARD REVIEW GENERAL INTERNAL
MEDICINE EXAM WITH COMPLETE SOLUTIONS 100%
VERIFIED 2026-2027!!. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
A patient with chronic kidney disease and metabolic acidosis is started on
sodium bicarbonate. Which parameter most directly determines the target
serum bicarbonate to minimize progression of kidney disease?
A. Serum bicarbonate of 22 mEq/L
B. Serum bicarbonate of 18 mEq/L
C. Serum bicarbonate of 26 mEq/L
D. Serum bicarbonate of 20 mEq/L
Correct Answer: A - Serum bicarbonate of 22 mEq/L
RATIONALE
Current KDIGO and ASN guidance supports maintaining serum
bicarbonate 22 mEq/L to slow CKD progression; lower targets (18-20)
are associated with worse outcomes. Higher targets (26) risk metabolic
alkalosis and are not supported by evidence. Thus, 22 mEq/L is the
evidence-based threshold.
Question 2
Which of the following best explains why direct oral anticoagulants are
preferred over warfarin in nonvalvular atrial fibrillation with a
CHA2DS2-VASc score of 4?
A. They require no monitoring and have fewer food/drug interactions.
B. They are reversible with vitamin K.
C. They are safe in mechanical mitral valves.
D. They have a lower cost than warfarin.
Correct Answer: A - They require no monitoring and have fewer
food/drug interactions.
Page 2
, RATIONALE
DOACs offer predictable pharmacokinetics, no routine INR
monitoring, and fewer dietary/drug interactions compared to warfarin,
which is why guidelines favor them in nonvalvular AF. They are not
reversed by vitamin K, are contraindicated in mechanical valves, and
often cost more.
Question 3
A patient with type 2 diabetes on metformin and a GLP-1 receptor agonist has
an eGFR of 28 mL/min/1.73m². Which action is most appropriate regarding
metformin?
A. Continue metformin at current dose.
B. Discontinue metformin.
C. Reduce metformin dose by 50%.
D. Switch to a sulfonylurea.
Correct Answer: B - Discontinue metformin.
RATIONALE
Metformin is contraindicated when eGFR <30 mL/min/1.73m² due to
increased risk of lactic acidosis; it should be discontinued. Dose
reduction is recommended for eGFR 30-45, not below 30.
Sulfonylureas are not preferred due to hypoglycemia risk in CKD.
Question 4
Which finding on a peripheral blood smear is most characteristic of thrombotic
thrombocytopenic purpura (TTP)?
A. Schistocytes
B. Target cells
C. Auer rods
D. Reed-Sternberg cells
Correct Answer: A - Schistocytes
Page 3
, RATIONALE
TTP is a thrombotic microangiopathy marked by microangiopathic
hemolytic anemia with schistocytes on smear, thrombocytopenia, and
end-organ injury. Target cells suggest liver disease or
hemoglobinopathy; Auer rods indicate AML; Reed-Sternberg cells
indicate Hodgkin lymphoma.
Question 5
A previously healthy adult presents with fever, cough, and diffuse bilateral
infiltrates. Which parameter best predicts mortality in severe
community-acquired pneumonia?
A. CURB-65 score
B. Sputum culture result
C. Chest X-ray pattern
D. Duration of symptoms
Correct Answer: A - CURB-65 score
RATIONALE
The CURB-65 score (Confusion, Urea, Respiratory rate, Blood
pressure, age 65) is a validated tool for assessing severity and
mortality risk in CAP, guiding site-of-care decisions. Culture, imaging
pattern, and symptom duration are not validated mortality predictors.
Question 6
Which autoantibody is most specific for systemic lupus erythematosus and
associated with a lower risk of lupus nephritis?
A. Anti-dsDNA
B. Anti-Smith
C. Anti-Ro
D. Anti-histone
Correct Answer: B - Anti-Smith
Page 4
