Internal Medicine COMAT Review | 100% Correct
Answers | Verified | Latest 2024 Version
ECG leads representing anterior wall - ✔✔V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ✔✔II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall - ✔✔I, AVL, V5, & V6
When should you consider immediate diagnostic coronary angiography? - ✔✔order immediate
diagnostic coronary angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ✔✔Primary
In an acute inferior wall myocardial infarction, occlusion of which coronary artery is usually implicated? -
✔✔Right coronary artery
Difference in sounds between COPD and pulmonary edema/interstitial lung disease. - ✔✔Wheezing or
rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound - ✔✔CHF
What are S3 heart sounds - ✔✔S3 results from increased atrial pressure leading to increased flow rates,
as seen in congestive heart failure, which is the most common cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur - ✔✔High output states (anemia, fever, thyrotoxicosis,
pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
,Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ✔✔It's an early DIASTOLIC murmur heard in the 2nd LEFT-
upper sternal border.
Indications for ordering an echocardiogram - ✔✔1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE - ✔✔Hampton hump (shallow wedge-shaped opacity in the
periphery of the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of vessel) seen distal to a
PE. It's due to a combo of dilation of the pulmonary arteries proximal to the embolus & collapse of the
distal vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure - ✔✔Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in systolic heart failure - ✔✔-ACE inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
,Goal of treating hypertensive urgency - ✔✔BP reduction of 25% in the first few hours to day in order to
avoid reducing the BP too quickly.
Roth spots - ✔✔Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome - ✔✔Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for women (or on medical
therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy - ✔✔1. current ASCVD (atherosclerotic vascular
dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria - ✔✔Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3) asymmetric calf swelling
*Virchow's Triad - ✔✔Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient - ✔✔Arterial blood gases (ABGs) in pulmonary
thromboembolism usually reveal an acute respiratory alkalosis secondary to hyperventilation.
, Timeframe for acute vs chronic arthritis - ✔✔Acute <6 weeks
Chronic >6 weeks
Rhonchi - ✔✔Low-pitched, continuous sounds often described as similar to a snoring sound. Generated
by narrowing of larger airways due to mucus from bronchitis or narrowing from asthma or COPD
Wheezes - ✔✔High-pitched whistling sound during breathing when air flows through a narrowed airway,
most commonly heard in asthmatics.
Crackles - ✔✔Synonymous with rales. A discontinuous sound heard more often during inhalation caused
by airway opening. The sounds are often divided into dry or moist, with the dryness being caused by
disease processes such as fibrosis and the moistness or wetness being secondary to heart failure or
pneumonia.
Antibiotic of choice for uncomplicated pneumonia - ✔✔Azithromycin
What is neutropenic fever - ✔✔Neutropenic fever= temperature greater than 38.3 C (101 F) & an
absolute neutrophil count less than 500.
What antibiotics are appropriate for patients with neutropenic fever? - ✔✔Antibiotics used in
neutropenic fever need to treat for pseudomonas (since it can be lethal in septic patients if left
untreated)--> ceftazadime, cefepime, piperacillin-tazobactam, meropenem, imipenem.
For persistent neutropenic fevers, after giving broad spectrum antibiotics that cover for pseudomonas,
what should be added? - ✔✔For persistenet neutropenic fevers, add a broad spectrum anti-fungal agent
(like amphotericin B).
Centor Criteria for Strep Throat - ✔✔4 criteria= fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, absence of cough.
Score of 0/1= no test.
Score of 2= RADT (rapid antigen detection test)
Score of 3/4= not test.
Answers | Verified | Latest 2024 Version
ECG leads representing anterior wall - ✔✔V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ✔✔II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall - ✔✔I, AVL, V5, & V6
When should you consider immediate diagnostic coronary angiography? - ✔✔order immediate
diagnostic coronary angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ✔✔Primary
In an acute inferior wall myocardial infarction, occlusion of which coronary artery is usually implicated? -
✔✔Right coronary artery
Difference in sounds between COPD and pulmonary edema/interstitial lung disease. - ✔✔Wheezing or
rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound - ✔✔CHF
What are S3 heart sounds - ✔✔S3 results from increased atrial pressure leading to increased flow rates,
as seen in congestive heart failure, which is the most common cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur - ✔✔High output states (anemia, fever, thyrotoxicosis,
pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
,Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ✔✔It's an early DIASTOLIC murmur heard in the 2nd LEFT-
upper sternal border.
Indications for ordering an echocardiogram - ✔✔1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE - ✔✔Hampton hump (shallow wedge-shaped opacity in the
periphery of the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of vessel) seen distal to a
PE. It's due to a combo of dilation of the pulmonary arteries proximal to the embolus & collapse of the
distal vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure - ✔✔Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in systolic heart failure - ✔✔-ACE inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
,Goal of treating hypertensive urgency - ✔✔BP reduction of 25% in the first few hours to day in order to
avoid reducing the BP too quickly.
Roth spots - ✔✔Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome - ✔✔Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for women (or on medical
therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy - ✔✔1. current ASCVD (atherosclerotic vascular
dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria - ✔✔Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3) asymmetric calf swelling
*Virchow's Triad - ✔✔Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient - ✔✔Arterial blood gases (ABGs) in pulmonary
thromboembolism usually reveal an acute respiratory alkalosis secondary to hyperventilation.
, Timeframe for acute vs chronic arthritis - ✔✔Acute <6 weeks
Chronic >6 weeks
Rhonchi - ✔✔Low-pitched, continuous sounds often described as similar to a snoring sound. Generated
by narrowing of larger airways due to mucus from bronchitis or narrowing from asthma or COPD
Wheezes - ✔✔High-pitched whistling sound during breathing when air flows through a narrowed airway,
most commonly heard in asthmatics.
Crackles - ✔✔Synonymous with rales. A discontinuous sound heard more often during inhalation caused
by airway opening. The sounds are often divided into dry or moist, with the dryness being caused by
disease processes such as fibrosis and the moistness or wetness being secondary to heart failure or
pneumonia.
Antibiotic of choice for uncomplicated pneumonia - ✔✔Azithromycin
What is neutropenic fever - ✔✔Neutropenic fever= temperature greater than 38.3 C (101 F) & an
absolute neutrophil count less than 500.
What antibiotics are appropriate for patients with neutropenic fever? - ✔✔Antibiotics used in
neutropenic fever need to treat for pseudomonas (since it can be lethal in septic patients if left
untreated)--> ceftazadime, cefepime, piperacillin-tazobactam, meropenem, imipenem.
For persistent neutropenic fevers, after giving broad spectrum antibiotics that cover for pseudomonas,
what should be added? - ✔✔For persistenet neutropenic fevers, add a broad spectrum anti-fungal agent
(like amphotericin B).
Centor Criteria for Strep Throat - ✔✔4 criteria= fever, tonsillar exudates, tender anterior cervical
lymphadenopathy, absence of cough.
Score of 0/1= no test.
Score of 2= RADT (rapid antigen detection test)
Score of 3/4= not test.
