Internal Medicine Review ABIM part 1 Questions and Answers Updated 2026

Internal Medicine Review ABIM part 1
Questions and Answers Updated
2026
WhatMisMaMpositiveMstressMtestM-MAnswerMFlatMorMDownMslopingM

St-segmentMdepressionM>1MmmM

occurringM80MmsecMafterMjMpoint



WhenMtoMstopMaMstressMtestM-MAnswerMStMsegmentMdepressionM>M2Mmm,M

ventricularMtachycardia,

dropMinMSBPM>M15,M

CP,M

dyspnea,M

lightheadedness



StressMtestMofMchoiceMwithMaMLBBBMorMventricularMpacing?M-
MAnswerMMyocardialMperfusionMimagingMwithMadenosine,

NOTMexercising!



WhenMtoMnotMuseMdoutamineMforMstressM-MAnswerMHistoryMofMVT,M

severeMHTN,M

LowMBP,M

poorMechoMimages



WhenMtoMnotMuseMadenosineMforMstressM-MAnswerMBronchospasm,M

severeMvalvularMdysfunction,M

severeMcarotidMstenosis,M

2ndMdegreeMheartMblock,Mt

heophyllineMdependent



NormalsMforMPAMcatheterMpressuresM-MAnswerMRAM<8

RVM30/8

,PCWPM3-12

PAPM12-20M/M3-12



DiastolicMpressuresM

elevatedM&MequalizedM

inMallMchambers,

MlowMBPM-MAnswerMtamponadeM

orMrestrictiveMpericarditis



ElevatedMRAMandMPAMpressures,M

decreasedMorMnlMPCWP,M

hypotensionM-MAnswerMRVMMI



ElevatedMPCWP,MRAMpressure

decreasedMSBP/cardiacMoutputM-MAnswerMcardiogenicMshock



highMRA,M

PAMveryMelevated

highMPCWP

nlMSBPM-MAnswerMmitralMstenosisMwithMRVMfailure



ElevatedMPAP,MRAP

nlMPCWP,MSBPM-MAnswerMpulmonaryMHTN



decrMinMSBP>10mmHgMwithMnlMinspiration;M

palpatedMasMweakenedMpulseMwithMinspirationM&

moreMheartMcontractionsMtoMpulseMbeatsM-MAnswerMpulsusMparadoxus:

ConstrictiveMorMrestrictiveMpericarditis,M

asthma,M

tensionMpneumothorax

,WhatMgivesMyouMpulsusMbisferiensM

(twoMsystolicMpeaksMperMcycle)M-MAnswerMAorticMregurgitation,M

HOCM



WhatMcausesMpulsusMalternansM-MAnswerMSevereMLVMdysfunction



WhatMcausesMpulsusMtardusM-MAnswerMAorticMstenosis



HowMdoMpositionalMmaneuversMaffectMbloodMflowMandMmurmursM-MAnswerM-
standing/valsalva:

decreasedMcardiacMfilling,M

decreasesMmostMmurmursM

exceptMMVPMandMHOCM



-squatting/MlyingMdown:M

increaseMcardiacMvolume,M

increasedMmurmursM

exceptMMVP,MHOCM



-sustainedMhandgrip:M

increasesMsystemicMresistance

decreasesMmurmurMinMHOCM,MAS



WhatMcausesMaMphysiologicMsplitMS2M-MAnswerMIncreasedMbloodMvolumeMinMtheMRVM

prolongsMsystoleMandM

delaysMpulmonaryMvalveMclosure



WhatMcausesMaMfixedMsplitMS2M-MAnswerMPulmonaryMstenosis,M

PE,M

LVMpacer,M

RBBB,M

, MRM(earlyMAVMclosure),M

ASD,M

RVMfailue



WhatMcausesMaMparadoxicMsplitMS2M-MAnswerMLBBB,M

RVMpacing,M

HOCM



WhatMcausesManMS3?M-MAnswerMRapidMLVMfilling:

acuteMventricularMdecompensation,M

severeMARMorMMR



WhatMareMtheMpartsMofMtheMvenousMwaveform?M-MAnswerMAMwaveM-
MatrialMcontraction



XMdescentM-MatriaMrelax,MRVMfillsMrapidly

BottomMofMxMdescentMisMTCMvalveMclosure



VMwaveM-MventricleMcontactingMagainstMclosedMTCMvalve



YMdescentM-MTCMvalveMopens,M

passiveMemptyingMintoMventricle



WhatMgivesMelevatedMaMandMvMwavesM-MAnswerMPulmonaryMHTN,M

RVMinfarction



LargeMrMsideMvMwavesM-MAnswerMSeptalMrupture



LargeMvMwavesM-MAnswerMTRM(right),M

MRM(left)