ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

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ITE Practice Test

Updated for October 2026
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The ITE exam (In-Training Examination) is a critical assessment for medical residents across various specialties, including Internal Medicine, Family Medicine, Anesthesia, and Pediatrics. Designed to mirror board certification exams, the ITE helps residents gauge their knowledge and identify areas for improvement before taking their final boards.

Our free ITE practice exam resources provide realistic questions to help you prepare. Whether you are studying for the ACP ITE exam, the ABFM ITE exam, or the Anesthesia ITE exam, practicing with high-quality questions is essential for achieving a top percentile score.

⏱️
9h
Time Limit
📝
300
Questions
✅
Varies
Pass Score
💵
$0
Residency Covered
What changed for the ACP IM-ITE in 2026
  • 2026 testing window: The 2026 ACP Internal Medicine In-Training Examination (IM-ITE) is administered by residency programs from Thursday, August 13 through Friday, September 4, 2026; programs may test on one or several days inside that window. (source)
  • Delivery: The IM-ITE is a web-based exam delivered through the NBME platform; for 2026 programs choose in-person testing, remote proctoring (Zoom, MS Teams or Webex), or a mix of both. (source)
  • Format and time: The exam has 300 questions; total testing time is 9 hours, with 7 hours of exam time plus several 10-minute breaks and a 1-hour lunch. There is no penalty for guessing and the exam cannot be failed. (source)
  • Fee: The 2026 registration fee is $145 (USD) per registrant, paid by the program; regular registration ran April 29 to July 13, 2026, and a $30 per-registrant late fee applies from July 14, 2026. (source)
  • Blueprint: The IM-ITE is modeled on the ABIM Internal Medicine Certification Exam blueprint: Cardiovascular Disease 14%; Endocrinology 9%; Gastroenterology 9%; Infectious Disease 9%; Pulmonary Disease 9%; Rheumatology/Orthopedics 9%; Hematology 6%; Medical Oncology 6%; Nephrology/Urology 6%; Neurology 4%; Psychiatry 4%; Dermatology, Geriatrics and Ob/Gyn 3% each; Allergy/Immunology 2%; Ophthalmology 1%; Otolaryngology/Dental 1%; Miscellaneous 2%. (source)
  • Scoring: Score reports give each examinee's percent correct and percentile rank (by PGY level) for the total test and each content area, plus the educational objectives of questions answered incorrectly; there is no pass/fail cut score. (source)
  • Results timing: Preliminary feedback goes to program directors (PGY1-5) on September 14, 2026, about 10 business days after the window closes; final score reports post to the MyNBME portal on October 14, 2026 for distribution by programs. Residents receive scores from their program, not from ACP or NBME. (source)
  • Accommodations: Special-accommodation requests for the 2026 exam were due July 24, 2026 and must be submitted through the program director; a free online practice exam is opened a few weeks before the window. (source)

Last verified: September 17, 2026 against the American College of Physicians (ACP) IM-ITE program pages and the 2026 IM-ITE information sheet.

Did you know? Scoring well on the ITE exam is a strong predictor of passing your future board certification exam. Residents who score above the 50th percentile are significantly more likely to pass their boards on the first attempt.

ITE Practice Test Questions

Prepare for the ITE - Internal Medicine In-Training Exam exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.

ITE Cardiovascular Medicine
ITE Exam Questions covering Cardiovascular Medicine. Master ITE Test concepts for certification prep.
ITE Endocrinology
Free ITE Practice Test featuring Endocrinology. Improve your ITE Exam score with mock test prep.
ITE General Internal Medicine
ITE Mock Exam on General Internal Medicine. ITE Study Guide questions to pass on your first try.
ITE Pulmonology
ITE Test Prep for Pulmonology. Practice ITE Quiz questions and boost your score.
ITE Allergy and Immunology
ITE Questions and Answers on Allergy and Immunology. Free ITE practice for exam readiness.
ITE Cardiovascular Disease
ITE Mock Test covering Cardiovascular Disease. Online ITE Test practice with instant feedback.
ITE Dermatology
Free ITE Quiz on Dermatology. ITE Exam prep questions with detailed explanations.
ITE Diabetic Ketoacidosis and HHS
ITE Practice Questions for Diabetic Ketoacidosis and HHS. Build confidence for your ITE certification exam.
ITE Endocrinology and Metabolism
ITE Test Online for Endocrinology and Metabolism. Free practice with instant results and feedback.
ITE Gastroenterology and Hepatology
ITE Study Material on Gastroenterology and Hepatology. Prepare effectively with real exam-style questions.
ITE Hematology and Oncology
Free ITE Test covering Hematology and Oncology. Practice and track your ITE exam readiness.
ITE Infectious Disease Management
ITE Exam Questions covering Infectious Disease Management. Master ITE Test concepts for certification prep.
ITE - Internal Medicine In-Training Diabet...
Free ITE Practice Test featuring - Internal Medicine In-Training Diabetic Ketoacidosis and HHS. Improve your ITE Exam score with mock test prep.
ITE - Internal Medicine In-Training Valvul...
ITE Mock Exam on - Internal Medicine In-Training Valvular Heart Disease Management. ITE Study Guide questions to pass on your first try.
ITE Nephrology and Hypertension
ITE Test Prep for Nephrology and Hypertension. Practice ITE Quiz questions and boost your score.
ITE Neurology
ITE Questions and Answers on Neurology. Free ITE practice for exam readiness.
ITE Pulmonary and Critical Care
ITE Mock Test covering Pulmonary and Critical Care. Online ITE Test practice with instant feedback.
ITE Rheumatology
Free ITE Quiz on Rheumatology. ITE Exam prep questions with detailed explanations.
ITE Valvular Heart Disease Management
ITE Practice Questions for Valvular Heart Disease Management. Build confidence for your ITE certification exam.
FREE ITE PRACTICE TEST

ITE Internal Medicine In-Training Exam Questions and Answers

Click to flip and test your knowledge on key medical concepts

📚 🫀What is the first-line treatment for acute pericarditis?
NSAIDs and Colchicine are the standard first-line therapy for acute pericarditis.
🎯 🩺Which murmur is associated with aortic stenosis?
A systolic crescendo-decrescendo murmur heard best at the right upper sternal border.
💡 🍬What is the diagnostic threshold for diabetes using A1C?
An HbA1c level of 6.5% or higher is diagnostic for diabetes mellitus.
🔑 🫁What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae is the most frequent pathogen causing CAP.
📝 🦠What is the treatment for latent TB infection?
Isoniazid for 9 months or Rifampin for 4 months are common regimens.
⭐ 🩸What does improved TSH with low Free T4 indicate?
This pattern is diagnostic of primary hypothyroidism.
ITE EXAM QUESTIONS QUIZ

ITE Internal Medicine In-Training Exam Questions and Answers

Prepare effectively for your residency in-service exam with our detailed ITE exam study guide. Whether you are taking the IM ITE exam or the Family Medicine ITE exam, understanding the basics is crucial for success.

📚 ITE Basics

What is the ITE exam?
The ITE (In-Training Examination) is a standardized test administered annually to medical residents to assess their medical knowledge and preparedness for board certification exams in their specialty.
Who takes the ITE exam?
Residents in specialties like Internal Medicine, Family Medicine, Pediatrics, and Anesthesia take the ITE exam annually throughout their residency training program.
Why is the ITE exam important?
ITE scores correlate with board pass rates. Program directors use ITE exam results to identify residents who may need additional academic support before taking their boards.
Is the ITE exam mandatory?
Yes, most residency programs require residents to take the ITE exam every year to track progress and ensure milestones are being met.

📝 ITE Format

How many questions are on the ITE exam?
The ACP Internal Medicine ITE has 300 questions (2026 administration). The Family Medicine ITE exam consists of approximately 240 questions.
How long is the ITE exam?
For the Internal Medicine ITE, total testing time is 9 hours: 7 hours of exam time plus several 10-minute breaks and a 1-hour lunch break.
What is the ITE exam format?
The exam consists of multiple-choice questions (MCQs) that test clinical knowledge, diagnosis, and management skills across various medical subspecialties.
Is the ITE exam computer-based?
Yes, the ITE exam is a computer-based test administered at residency programs or designated testing centers.

📅 ITE Registration

When are ITE exam dates?
ITE exam dates vary by specialty. Internal Medicine usually tests in August/September, while Family Medicine tests in October. Check with your program coordinator.
How do I register for the ITE exam?
Registration is handled by your residency program. Residents do not typically register themselves individually for the ITE exam.
What is the ITE exam cost?
The cost is usually covered by your residency program as part of your training expenses. Individual residents rarely pay out of pocket.
Can I reschedule my ITE exam?
Since the exam is administered within a specific window by your program, rescheduling is limited and must be coordinated through your program director.

📊 ITE Results

When are ITE exam results released?
Preliminary IM-ITE feedback reaches program directors about 10 business days after the testing window closes, and final score reports are posted roughly 5 weeks after the window (October 14, 2026 for the 2026 exam). Your program director will share your score report.
What is a good ITE exam score?
Scores are reported as percent correct and a percentile rank compared with residents at the same PGY level. The IM-ITE cannot be failed and has no passing score; many programs treat the 50th percentile or higher as on track for the ABIM boards.
Does the ITE exam affect graduation?
While failing the ITE doesn't prevent graduation, consistent low scores may trigger remediation plans to ensure you pass your board exams.
How do I interpret my ITE score?
Your score report will show your percentile rank compared to other residents in your year (PGY-1, PGY-2, etc.) nationwide.

💡 ITE Tips

How should I study for the ITE exam?
Use question banks like MKSAP (for IM) or NEJM Knowledge+. Consistent practice with ITE exam questions is the most effective study method.
When should I start studying?
Start studying 3-6 months before the exam. Many residents use a "question a day" strategy throughout the year to prepare for the ITE exam.
Are there ITE practice exams?
Yes, many professional societies offer previous years' ITE exam papers or mock tests for practice.
What resources are best for ITE prep?
For Internal Medicine, MKSAP is the gold standard. For Family Medicine, the AAFP question bank is highly recommended for ITE prep.
START ITE REVIEWER QUIZ

ITE Internal Medicine In-Training Exam Questions and Answers

Total Scored Questions
150

Estimated score calculation

105 out of 150 correct
70%

Required to Pass: ~70% (Estimated)

Your Score: 105 correct ✓ PASS

Your residency program invests significantly in the ITE exam to ensure your board success. Take advantage of this paid opportunity to assess your readiness.

ITE TEST QUESTIONSFREE ITE EXAM PREP

ITE Internal Medicine In-Training Exam Questions and Answers

Valid Hospital ID / Photo ID
Program-assigned Login Credentials
Water and Snacks (if allowed)
Arrive 15 minutes early
Comfortable clothing (layers)
Turn off pager/cell phone
Review exam tutorial beforehand
Good night's sleep!

Ready to Ace the ITE Exam?

Start practicing with our free ITE exam questions today and boost your chances of scoring in the top percentile.

ITE Internal Medicine In-Training Exam Questions and Answers

The ITE exam itself does not need renewal, as it is an annual requirement during residency. However, it leads to board certification, which has maintenance requirements.

📅
Board Cycle
10 Years
📚
CME Credits
Varies
🔄
Maintenance
of Certification (MOC)

After residency, you will transition from the ITE exam to board certification exams and subsequent Maintenance of Certification (MOC) requirements to keep your license active.

Pros

  • Industry-recognized credential boosts your resume
  • Higher earning potential (10-20% salary increase on average)
  • Demonstrates commitment to professional development
  • Opens doors to advanced career opportunities

Cons

  • Exam preparation requires significant time investment (4-8 weeks)
  • Registration costs $145 per resident in 2026 (paid by the program; $30 late fee after July 13)
  • May require continuing education to maintain
  • Some employers may not require certification

Sample ITE - Internal Medicine In-Training Exam Practice Questions

Try these questions from our free ITE - Internal Medicine In-Training Exam practice tests. The correct answer and an explanation follow each question.

  1. Which physical exam finding is most characteristic of severe aortic regurgitation?

    • A. Slow-rising carotid pulse (pulsus parvus et tardus)
    • B. Wide pulse pressure with bounding/water-hammer pulse
    • C. Fixed split S2
    • D. Middiastolic rumble at the apex

    Answer: B. Wide pulse pressure with bounding/water-hammer pulse

    Severe AR causes volume overload of the LV, producing a wide pulse pressure (elevated systolic, low diastolic) and a bounding, collapsing (water-hammer) pulse.

  2. A 55-year-old man presents with exertional syncope. Physical exam reveals a harsh mid-systolic crescendo-decrescendo murmur at the right upper sternal border radiating to the carotids. Carotid upstroke is diminished and delayed (pulsus parvus et tardus). What is the most likely diagnosis?

    • A. Hypertrophic obstructive cardiomyopathy
    • B. Severe aortic stenosis
    • C. Pulmonary stenosis with right heart failure
    • D. Aortic regurgitation with wide pulse pressure

    Answer: B. Severe aortic stenosis

    Pulsus parvus et tardus (small, slow-rising carotid pulse) with a calcific mid-systolic murmur radiating to carotids and exertional syncope are classic findings of severe calcific aortic stenosis.

  3. A 40-year-old HIV-positive man (CD4 40) on antiretrovirals develops vision loss. Fundoscopic exam shows yellow-white perivascular exudates with hemorrhage ('pizza pie' appearance). What is the diagnosis and treatment?

    • A. Toxoplasma retinitis; pyrimethamine plus sulfadiazine
    • B. CMV retinitis; IV ganciclovir or oral valganciclovir
    • C. Ocular histoplasmosis; itraconazole
    • D. Cryptococcal chorioretinitis; fluconazole

    Answer: B. CMV retinitis; IV ganciclovir or oral valganciclovir

    CMV retinitis in advanced AIDS presents with the classic 'pizza pie' fundoscopic appearance and is treated with valganciclovir 900mg BID for induction followed by maintenance therapy.

  4. A 48-year-old man with no cardiac history presents with syncope preceded by dizziness while standing. On exam, systolic BP drops from 140 to 95 mmHg after 3 minutes of standing. Heart rate does not compensate appropriately. The most likely diagnosis is:

    • A. Autonomic dysfunction (orthostatic hypotension)
    • B. Vasovagal syncope
    • C. Cardiac arrhythmia
    • D. Hypovolemia

    Answer: A. Autonomic dysfunction (orthostatic hypotension)

    Orthostatic hypotension with inadequate heart rate response suggests autonomic neuropathy; common causes include diabetes, Parkinson's disease, and certain medications.

Take the full ITE - Internal Medicine In-Training Exam practice test

ITE Questions and Answers

What topics are covered on the ITE exam?

The ITE covers all major areas of internal medicine, including cardiology, pulmonology, gastroenterology, nephrology, endocrinology, hematology, oncology, infectious disease, rheumatology, neurology, and general internal medicine. The content blueprint mirrors the ABIM certification exam, with question distribution weighted toward the most commonly encountered clinical scenarios in residency training.

Who is eligible to take the ITE exam?

The ITE is administered to residents enrolled in ACGME-accredited internal medicine residency programs in the United States. All categorical and preliminary internal medicine residents typically take the exam annually. Program directors register their residents through ABIM, and participation is generally required by most training programs as part of their assessment process.

How is the ITE exam scored?

The ITE uses a norm-referenced scoring system that compares each resident's performance against peers at the same training level (PGY-1, PGY-2, PGY-3). Scores are reported as percentile ranks rather than a traditional pass/fail cutoff. Programs receive individual and aggregate score reports broken down by medical content category to identify knowledge gaps.

How do I register for the ITE exam?

Individual residents do not register for the ITE on their own. Program directors or designated program coordinators register all eligible residents through ABIM/ACP. For the 2026 IM-ITE, regular registration ran April 29 through July 13, 2026 (a $30 late fee applied from July 14), ahead of the August 13-September 4, 2026 testing window. Residents should confirm their enrollment with their program coordinator well before the registration deadline.

How often is the ITE exam administered?

The ITE is administered once per year during a multi-week summer testing window rather than a single fixed date; the 2026 IM-ITE runs August 13-September 4, 2026. Internal medicine residents take the exam annually throughout their training, so most residents will sit for the ITE three times during a standard three-year categorical residency. Programs schedule testing on one or more days inside that national window to maintain standardization.

What is a good score on the ITE exam?

Since the ITE is scored by percentile rank, a score at or above the 50th percentile means a resident performed better than half of peers at the same training level. Scores above the 70th percentile are generally considered strong. Research has shown that residents scoring consistently above the 60th percentile on the ITE have high pass rates on the ABIM certifying examination.

Does the ITE predict ABIM board exam performance?

Yes, ITE scores are one of the strongest predictors of performance on the ABIM Internal Medicine Certification Exam. Studies have demonstrated that PGY-3 residents scoring at or above the 60th to 70th percentile on the ITE have first-time board pass rates exceeding 95 percent. Programs often use ITE trends across all three years to identify residents who may need additional board preparation support.

What study strategies work best for ITE preparation?

Consistent use of question banks such as MKSAP and UWorld Internal Medicine throughout residency is the most effective preparation strategy. Reviewing ITE score reports to identify weak content areas allows for targeted studying. Many high-performing residents dedicate 30 to 60 minutes daily to board-style practice questions rather than cramming, as spaced repetition over months produces stronger knowledge retention than short-term intensive review.

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