ABIM Internal Medicine ITE Test Bank – Complete
Practice Questions with Verified Answers &
Explanations – Updated 2025/2026 In-Training Exam
Prep
Hypertrophic obstructive cardiomyopathy - answer-:Sx: Shortness of breath or asymptomatic
PE: Late peaking systolic murmur, intensity decreases with handgrip & increases with squatting
Pearls:
1) the murmur,
2) tachycardia (shortened left ventricular diastolic filling time),
3) lung crackles,
4) absence of jugular vein distention, and
5) worsening with furosemide-induced diuresis.
Treat with BBs
Coarctation of aorta - answer-:Sx: Asymptomatic, headache
PE: Hypertension, diminished or absent lower extremity
pulses, systolic murmur, bruit over chest wall
Progressive supranuclear palsy - answer-:Sx: Gait impairment, falls, dysphagia, dysarthria
PE: Inability to look up & side to side
,Asthma severity?
Daily sx
>1/week night awakening
60%<PEF<80 - answer-:Moderate persistent.
Add LABA or medium dose ICS
Alt: LTRA, theo, or zileuton
+low dose ICS
Cont tx: step up, reeval in 2-6wks
Asthma severity?
Several x/day
Nightly awakenings
PEF <60% - answer-:Severe persistent.
Medium dose ICS + LABA or
high dose ICS + LABA
consider omalizumab for allergies
cont tx: steroids,
step up 1-2steps
Recurrent asthma exacerbations
Sx return shortly after steroids stopped
Eosinophilia
"fingers-in-glove" central infiltrate
central mucus impaction
bronchiectasis - answer-:Allergic Bronchopulmonary Aspergillosis
,(also think Churg-Strauss - up to 80% eos!)
Screen: Antigen skinprick test
Tx: itra + steroids
young adult male
hemoptysis
dyspnea
glomerulonephritis
iron def anemia - answer-:Goodpasture syndrome
- note no upper airway signs, F, wght loss that would suggest Wegeners
Tx: immunosupp, plasmapheresis
If severe pulmonary hemorrhages, nephrectomy may help!
What lung function test to follow for lung-toxic drugs (amio, chemo)? - answer-:DLCO.
First test to become abnl in ILD
Upper lobe infiltrates on CXR suggests ... - answer-:silicosis
Tb
Coal Workers' Penumoconiosis
Berylliosis
Eosinophilic granuloma
Ankylosing spondylitis
PCP with inhaled pentamidine
Hep B
anorexia, F, wght loss
, cough +/- hemoptysis
skin nodules
abd pain, episodic
tender testicles - answer-:Polyarteritis Nodosa
nongranulomatous necrotizing vasculitis of sm/med arteries
30% assoc with Hep B
Tx: cytoxan, prednisone
ILD with a pneumothorax
pre-menopausal woman
chylous effusions - answer-:LAM: Lymphangioleiomyomatosis
Immature smooth muscle proliferation in lymphatic, vascular, and alveolar wall structures:
constrictions, cysts form.
Assoc with Tuberous Sclerosis
CXR: honeycombing diffusely
Tx: oophorectomy with progestin.
A-a gradient calculation - answer-:A-a gradient =
149- (PaO2 + 1.25xPaCO2)
Normal is 5-15.
Increases normally with age
Lower lobe infiltrates on CXR suggests ... - answer-:Rheumatoid fibrosis
Scleroderma
Practice Questions with Verified Answers &
Explanations – Updated 2025/2026 In-Training Exam
Prep
Hypertrophic obstructive cardiomyopathy - answer-:Sx: Shortness of breath or asymptomatic
PE: Late peaking systolic murmur, intensity decreases with handgrip & increases with squatting
Pearls:
1) the murmur,
2) tachycardia (shortened left ventricular diastolic filling time),
3) lung crackles,
4) absence of jugular vein distention, and
5) worsening with furosemide-induced diuresis.
Treat with BBs
Coarctation of aorta - answer-:Sx: Asymptomatic, headache
PE: Hypertension, diminished or absent lower extremity
pulses, systolic murmur, bruit over chest wall
Progressive supranuclear palsy - answer-:Sx: Gait impairment, falls, dysphagia, dysarthria
PE: Inability to look up & side to side
,Asthma severity?
Daily sx
>1/week night awakening
60%<PEF<80 - answer-:Moderate persistent.
Add LABA or medium dose ICS
Alt: LTRA, theo, or zileuton
+low dose ICS
Cont tx: step up, reeval in 2-6wks
Asthma severity?
Several x/day
Nightly awakenings
PEF <60% - answer-:Severe persistent.
Medium dose ICS + LABA or
high dose ICS + LABA
consider omalizumab for allergies
cont tx: steroids,
step up 1-2steps
Recurrent asthma exacerbations
Sx return shortly after steroids stopped
Eosinophilia
"fingers-in-glove" central infiltrate
central mucus impaction
bronchiectasis - answer-:Allergic Bronchopulmonary Aspergillosis
,(also think Churg-Strauss - up to 80% eos!)
Screen: Antigen skinprick test
Tx: itra + steroids
young adult male
hemoptysis
dyspnea
glomerulonephritis
iron def anemia - answer-:Goodpasture syndrome
- note no upper airway signs, F, wght loss that would suggest Wegeners
Tx: immunosupp, plasmapheresis
If severe pulmonary hemorrhages, nephrectomy may help!
What lung function test to follow for lung-toxic drugs (amio, chemo)? - answer-:DLCO.
First test to become abnl in ILD
Upper lobe infiltrates on CXR suggests ... - answer-:silicosis
Tb
Coal Workers' Penumoconiosis
Berylliosis
Eosinophilic granuloma
Ankylosing spondylitis
PCP with inhaled pentamidine
Hep B
anorexia, F, wght loss
, cough +/- hemoptysis
skin nodules
abd pain, episodic
tender testicles - answer-:Polyarteritis Nodosa
nongranulomatous necrotizing vasculitis of sm/med arteries
30% assoc with Hep B
Tx: cytoxan, prednisone
ILD with a pneumothorax
pre-menopausal woman
chylous effusions - answer-:LAM: Lymphangioleiomyomatosis
Immature smooth muscle proliferation in lymphatic, vascular, and alveolar wall structures:
constrictions, cysts form.
Assoc with Tuberous Sclerosis
CXR: honeycombing diffusely
Tx: oophorectomy with progestin.
A-a gradient calculation - answer-:A-a gradient =
149- (PaO2 + 1.25xPaCO2)
Normal is 5-15.
Increases normally with age
Lower lobe infiltrates on CXR suggests ... - answer-:Rheumatoid fibrosis
Scleroderma
