Internal Medicine EOR Exam
Questions and Answers47
From the hospital: What is a single antibiotic that can be used for colitis that covers all bacteria?
It is NOT levofloxacin and metronidazole. What is a bad side effect of levo? - ANSWERS-zosyn ie.
piperacillin/tazobactam
QT prolongation
CARDIOLOGY: EKG should be obtained if CP appears cardiac in nature. CXR is initial step to rule
out pneumothorax, pulmonary infiltrates, and rib fractures. ____should be done for patients w
worrisome histories for aortic dissection regardless of CXR or EKG results. - ANSWERS-CT
_____is minimally invasive and rapid for detecting aortic dissection at the bedside. - ANSWERS-
TEE - transesophageal echocardiogram
A ____ is used for pleuritic pain w normal CXR when a PE is suspected. - ANSWERS-V/Q scan -
but not good for a small PE
A _____is sensitive for small PE and may detect other chest abnormalities leading to pain. -
ANSWERS-helical chest CT
____is used when CP is esophageal in origin. - ANSWERS-Esophageal pH monitoring
EKG: A ______suggests underlying heart disease (ischemic, hypertensive). - ANSWERS-left
bundle branch block
A _____may be indicative of right heart strain (as in pulmonary embolus). - ANSWERS-right
bundle branch block
,____is a term used to describe decreased perfusion and oxygen delivery to the body. This is best
defined by BP = CO x SVR. What are the three main types? - ANSWERS-Shock; hypovolemic,
cardiogenic, distributive
______shock can be from pump failure from infarction, cardiomyopathy, or tamponade,
arrhythmia, valve failure, obstructed outflow from tension pneumothorax or massive PE. -
ANSWERS-Cardiogenic
______shock can be from hemorrhage, diarrhea, heat stroke, or third spacing. - ANSWERS-
Hypovolemic
______shock can be from sepsis, anaphylaxis, adrenal crisis, or myxedema coma. - ANSWERS-
Distributive
The formation of _______occurs via:
a. endothelial dysfunction & formation of fatty streak
b. LDL enters fatty streak and attracts macrophages
c. proliferating smooth muscle cells, connective tissue, & lipids become incorporated into
plaque
d. "fibrous cap" forms - ANSWERS-atherosclerotic plaque
Name some risk factors for CHD. - ANSWERS-Diabetes Mellitus
Patient Age
Peripheral Vascular disease
Chronic Renal Failure
Elevated homocysteine level
elevated inflammatory markers like CRP
,Low Activity Level
Low intake of fruits and vegetables
lack of moderate alcohol intake
_____is insufficiently specific for assessment of patients with low (<10%) pretest probability of
CHD. It is best reserved for patients with intermediate pretest probability. Sensitivity and
specificity can be increased with imaging studies such as radionuclide imaging or
echocardiography. What is the gold standard to diagnose coronary artery disease? - ANSWERS-
Exercise stress testing; coronary angiography
The AHA suggests the following mnemonic for the important elements in treatment of stable
angina: - ANSWERS-A: aspirin, ACEi, antianginals - nitrates/CCB
B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
CCB: Short acting dihydropyridine CCBs ie ____ have been shown to increase cardiac risk
therefore nondihydropyridines are recommended. They are ___or___. Second generation
dihydropyridines have fewer negative inotropic effects and can be used in settings of reduced
ejection fraction. (ie. ___or___) - ANSWERS-Nifedipine
verapamil or diltiazem
amlodipine or nicardipine
Patients with stenosis of left anterior descending, left main coronary disease, three vessel
disease, or survivors of sudden cardiac death or sustained VF/VT would benefit from
_________. - ANSWERS-coronary artery bypass grafting (CABG)
, _______can be used to relieve symptoms in patients who fail medical therapy but who do not
have significant enough disease to require CABG. - ANSWERS-PCI - percutaneous coronary
intervention
What are some physical exam findings in an acute MI? - ANSWERS-entirely normal, fourth heart
sound, third heart sound, systolic murmur of acute mitral regurgitation -- physical exam should
focus on signs of PVD which may increase the suspicion for coronary disease
What is the typical evolution of the EKG in the setting of a STEMI? - ANSWERS-1. increase in
amplitude of the T wave
2. ST segment elevation
3. development of Q waves (hours to days)
4. resolution of ST-segment elevation
Cardiac-specific ____is drawn to detect damaged myocardium. It begins to rise is 6-9 hours,
peaks at approximately 20 hours, and remains in the circulation for 7-10 days. - ANSWERS-
troponin
For patients with UA or NSTEMI to assess risk.
TIMI SCORE - 7 point system, more points, higher risk - ANSWERS-Age >65
at least 3 risk factors
known coronary artery disease w at least 50% stenosis
ST segment changes
2 episodes of angina in past 24 hours
aspirin use in past week
elevated CK-MB or troponin
What are the absolute contraindications to thrombolytic therapy? BHTASC - ANSWERS-BHTASC
Questions and Answers47
From the hospital: What is a single antibiotic that can be used for colitis that covers all bacteria?
It is NOT levofloxacin and metronidazole. What is a bad side effect of levo? - ANSWERS-zosyn ie.
piperacillin/tazobactam
QT prolongation
CARDIOLOGY: EKG should be obtained if CP appears cardiac in nature. CXR is initial step to rule
out pneumothorax, pulmonary infiltrates, and rib fractures. ____should be done for patients w
worrisome histories for aortic dissection regardless of CXR or EKG results. - ANSWERS-CT
_____is minimally invasive and rapid for detecting aortic dissection at the bedside. - ANSWERS-
TEE - transesophageal echocardiogram
A ____ is used for pleuritic pain w normal CXR when a PE is suspected. - ANSWERS-V/Q scan -
but not good for a small PE
A _____is sensitive for small PE and may detect other chest abnormalities leading to pain. -
ANSWERS-helical chest CT
____is used when CP is esophageal in origin. - ANSWERS-Esophageal pH monitoring
EKG: A ______suggests underlying heart disease (ischemic, hypertensive). - ANSWERS-left
bundle branch block
A _____may be indicative of right heart strain (as in pulmonary embolus). - ANSWERS-right
bundle branch block
,____is a term used to describe decreased perfusion and oxygen delivery to the body. This is best
defined by BP = CO x SVR. What are the three main types? - ANSWERS-Shock; hypovolemic,
cardiogenic, distributive
______shock can be from pump failure from infarction, cardiomyopathy, or tamponade,
arrhythmia, valve failure, obstructed outflow from tension pneumothorax or massive PE. -
ANSWERS-Cardiogenic
______shock can be from hemorrhage, diarrhea, heat stroke, or third spacing. - ANSWERS-
Hypovolemic
______shock can be from sepsis, anaphylaxis, adrenal crisis, or myxedema coma. - ANSWERS-
Distributive
The formation of _______occurs via:
a. endothelial dysfunction & formation of fatty streak
b. LDL enters fatty streak and attracts macrophages
c. proliferating smooth muscle cells, connective tissue, & lipids become incorporated into
plaque
d. "fibrous cap" forms - ANSWERS-atherosclerotic plaque
Name some risk factors for CHD. - ANSWERS-Diabetes Mellitus
Patient Age
Peripheral Vascular disease
Chronic Renal Failure
Elevated homocysteine level
elevated inflammatory markers like CRP
,Low Activity Level
Low intake of fruits and vegetables
lack of moderate alcohol intake
_____is insufficiently specific for assessment of patients with low (<10%) pretest probability of
CHD. It is best reserved for patients with intermediate pretest probability. Sensitivity and
specificity can be increased with imaging studies such as radionuclide imaging or
echocardiography. What is the gold standard to diagnose coronary artery disease? - ANSWERS-
Exercise stress testing; coronary angiography
The AHA suggests the following mnemonic for the important elements in treatment of stable
angina: - ANSWERS-A: aspirin, ACEi, antianginals - nitrates/CCB
B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
CCB: Short acting dihydropyridine CCBs ie ____ have been shown to increase cardiac risk
therefore nondihydropyridines are recommended. They are ___or___. Second generation
dihydropyridines have fewer negative inotropic effects and can be used in settings of reduced
ejection fraction. (ie. ___or___) - ANSWERS-Nifedipine
verapamil or diltiazem
amlodipine or nicardipine
Patients with stenosis of left anterior descending, left main coronary disease, three vessel
disease, or survivors of sudden cardiac death or sustained VF/VT would benefit from
_________. - ANSWERS-coronary artery bypass grafting (CABG)
, _______can be used to relieve symptoms in patients who fail medical therapy but who do not
have significant enough disease to require CABG. - ANSWERS-PCI - percutaneous coronary
intervention
What are some physical exam findings in an acute MI? - ANSWERS-entirely normal, fourth heart
sound, third heart sound, systolic murmur of acute mitral regurgitation -- physical exam should
focus on signs of PVD which may increase the suspicion for coronary disease
What is the typical evolution of the EKG in the setting of a STEMI? - ANSWERS-1. increase in
amplitude of the T wave
2. ST segment elevation
3. development of Q waves (hours to days)
4. resolution of ST-segment elevation
Cardiac-specific ____is drawn to detect damaged myocardium. It begins to rise is 6-9 hours,
peaks at approximately 20 hours, and remains in the circulation for 7-10 days. - ANSWERS-
troponin
For patients with UA or NSTEMI to assess risk.
TIMI SCORE - 7 point system, more points, higher risk - ANSWERS-Age >65
at least 3 risk factors
known coronary artery disease w at least 50% stenosis
ST segment changes
2 episodes of angina in past 24 hours
aspirin use in past week
elevated CK-MB or troponin
What are the absolute contraindications to thrombolytic therapy? BHTASC - ANSWERS-BHTASC
