ITE BOARD REVIEW: GENERAL
INTERNAL MEDICINE EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS | LATEST VERSION 2025/2026.
1. Diagnose domestic abuse - ANS - 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 - ANS - 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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,3. Interpret Odds Ration - ANS - post-test odds = pretest odds x LR
- likelihood ratio: probability WITH disease/ patient withOUT disease
4. Manage Eustachian tube disfunction (blockage of tube) due to allergies/cold - ANS - #1:
nasal corticosteroids, decongestion, myringostomy
5. Diagnose at-risk drinking (14 drinks per week or 4 drinks in male/ 7 drinks per week or 3
drinks per occasion in females) - ANS - Risky/Hazardous - increases the risk of harmful
consequences
- Harmful - negative effects not not depend (defined by consequences not quantity)
- Dependence - desire, impaired control, increased withdrawal/tolerance despite harmful
consequences
- screening AUDIT/TWEAK (preg) --> assist
6. Manage symptomatic lumbar disc herniation - ANS - surgery shows no clear benefit
- shows in dermatome pattern --> MRI --> surgeon "where to put the knife"
- if asymptomatic then --> PT and exercises
7. Diagnose inappropriate drug use by medication reconciliation - ANS ...
8. Indication of pneumovax in < 65 y/o - ANS - 23 valent
- specific risk factors
- if vaccinated before 65, need booster at 65 or 5 years after initial if between 60-64 yo
- IMMUNOCOMPETENT: single vaccine with booster
- chronic CVD, HTN, chronic lung disease, chronic/URI disease, DM, alcoholism, CSF leak,
cochlear implant
- IMMUNOCOMPROMISED - 2 doses separated by 54
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, - HIV, CKD, nephrotic syndrome, malignancy, immunosuppressive meds, multiple myeloma,
congenital or acquired deficiency
- SPLENIA: 2 doses separated by 5 years
- functional asplenia (sickle cell disease, hemoglobinopathies)
- anatomic aspenia
9. Manage pharyngitis - ANS - 4 point centor score
- 1) fever 2) absence of cough 3) anterior lymphadenopathy 4) tonsillar exudates
- 0-1 = low risk --> no additional test
- 2-3 = antigen tests or throat culture --> possible abx
- 4 = testing --> empiric abx
- PCN treatment of choice --> GAS
- 10 day oral or 1 day IM PCN G, 10 day erythromycin/azithromycin (macrolide)
- Group C and G strep = GN and RA
10. Manage ASCUS in women with HPV - ANS - 21 yo --> PAP every 3 years
- OR
- 5 years with HPV DNA for 30-65
- ASCUS 1) colposcopy 2) HPV DNA testing then colposcopy 3) Repeat PAP in 6-12 months
11. Manage an ethical conflict - ANS - no gifts
12. Allergic conjunctivitis management - ANS - seasonal allergies/itching
- 1) oral antihistamines
- 2) topical antihistamines
- 3) artificial tears
- NO ABX
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
INTERNAL MEDICINE EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS | LATEST VERSION 2025/2026.
1. Diagnose domestic abuse - ANS - 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 - ANS - 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
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,3. Interpret Odds Ration - ANS - post-test odds = pretest odds x LR
- likelihood ratio: probability WITH disease/ patient withOUT disease
4. Manage Eustachian tube disfunction (blockage of tube) due to allergies/cold - ANS - #1:
nasal corticosteroids, decongestion, myringostomy
5. Diagnose at-risk drinking (14 drinks per week or 4 drinks in male/ 7 drinks per week or 3
drinks per occasion in females) - ANS - Risky/Hazardous - increases the risk of harmful
consequences
- Harmful - negative effects not not depend (defined by consequences not quantity)
- Dependence - desire, impaired control, increased withdrawal/tolerance despite harmful
consequences
- screening AUDIT/TWEAK (preg) --> assist
6. Manage symptomatic lumbar disc herniation - ANS - surgery shows no clear benefit
- shows in dermatome pattern --> MRI --> surgeon "where to put the knife"
- if asymptomatic then --> PT and exercises
7. Diagnose inappropriate drug use by medication reconciliation - ANS ...
8. Indication of pneumovax in < 65 y/o - ANS - 23 valent
- specific risk factors
- if vaccinated before 65, need booster at 65 or 5 years after initial if between 60-64 yo
- IMMUNOCOMPETENT: single vaccine with booster
- chronic CVD, HTN, chronic lung disease, chronic/URI disease, DM, alcoholism, CSF leak,
cochlear implant
- IMMUNOCOMPROMISED - 2 doses separated by 54
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, - HIV, CKD, nephrotic syndrome, malignancy, immunosuppressive meds, multiple myeloma,
congenital or acquired deficiency
- SPLENIA: 2 doses separated by 5 years
- functional asplenia (sickle cell disease, hemoglobinopathies)
- anatomic aspenia
9. Manage pharyngitis - ANS - 4 point centor score
- 1) fever 2) absence of cough 3) anterior lymphadenopathy 4) tonsillar exudates
- 0-1 = low risk --> no additional test
- 2-3 = antigen tests or throat culture --> possible abx
- 4 = testing --> empiric abx
- PCN treatment of choice --> GAS
- 10 day oral or 1 day IM PCN G, 10 day erythromycin/azithromycin (macrolide)
- Group C and G strep = GN and RA
10. Manage ASCUS in women with HPV - ANS - 21 yo --> PAP every 3 years
- OR
- 5 years with HPV DNA for 30-65
- ASCUS 1) colposcopy 2) HPV DNA testing then colposcopy 3) Repeat PAP in 6-12 months
11. Manage an ethical conflict - ANS - no gifts
12. Allergic conjunctivitis management - ANS - seasonal allergies/itching
- 1) oral antihistamines
- 2) topical antihistamines
- 3) artificial tears
- NO ABX
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
