FAMILY MEDICINE EOR EXAM ACTUAL EXAM
What are the 3 local vasodilators in the heart? - ANSWER: Nitric oxide, adenosine,
and oxygen
Vagal maneuvers _______ heart rate in tachyarrhythmias - ANSWER: decrease
During inspiration, left sided stroke volume __________ - ANSWER: decreases
Physiologic splitting of S2 - ANSWER: inspiration separates S2 into A2 followed by
P2; during inspiration, the decreased L-sided venous return results in an earlier A2
and increased right-sided flow with inspiration results in later P2
L-sided murmurs are best heard at end ___________; R-sided murmurs are best
heard at end __________ - ANSWER: expiration; inspiration
>10 mmHg decline in SBP with inspiration - ANSWER: pulsus paradoxus
Pulsus paradoxus is a sign of what conditions? - ANSWER: Cardiac tamponade,
tension pneumothorax
Gold standard diagnosis for CAD - ANSWER: Angiography
Gold standard diagnosis for PAD - ANSWER: Angiography
Gold standard diagnosis for AAA - ANSWER: Angiography
Most useful diagnostic study to diagnose heart failure - ANSWER: Echo
Primary noninvasive test for assessing cardiac anatomy and function - ANSWER:
Transthoracic echocardiogram (TTE)
Bruce protocol - ANSWER: Positive exercise stress test if ST depressions, exercise-
induced HTN or hypotension, arrhythmias, symptoms or HR abnormalities occur
during testing
Vasodilators used in pharmacologic stress testing - ANSWER: Adenosine or
Dipyridamole
Contraindications of pharmacologic stress testing - ANSWER: Bronchospastic disease
(e.g. severe asthma and COPD), 2nd/3rd degree heart block or sick sinus syndrome
Medication used in stress echocardiography - ANSWER: Dobutamine
MC cause of CAD - ANSWER: Atherosclerosis
,Most important modifiable risk factor for CAD - ANSWER: Smoking
Valvular diseases that may lead to CAD - ANSWER: Aortic stenosis
Aortic regurgitation
Substernal chest pain usually brought on by exertion - ANSWER: Angina pectoris
Radiation of angina pectoris - ANSWER: Arm (especially ulnar surfaces of forearm
and hand)
Teeth
Lower jaw
Back
Epigastrium
Shoulders
Duration of stable angina pectoris - ANSWER: Less than 30 minutes by definition but
typically 1-5 minutes
Angina pectoris is relieved with _______ or ________ - ANSWER: nitroglycerin or
rest
Classic EKG finding in ischemic heart disease - ANSWER: ST depression
Initial testing of angina pectoris - ANSWER: EKG
Gold standard diagnosis of angina pectoris - ANSWER: angiography
Most useful noninvasive screening tool for angina pectoris - ANSWER: Stress testing
Paroxysmal chest "squeezing" or pressure, often accompanied by a sensation of
smothering and a fear of impending death - ANSWER: Angina pectoris
Duration of unstable angina pectoris - ANSWER: More than 30 minutes
If stable angina is not completely resolved after ______ doses of nitro, unstable
angina, MI, or another diagnosis should be suspected - ANSWER: three doses
Sublingual nitro can be repeated every __ minutes up to __ times - ANSWER: every 5
minutes up to 3 times
Long-acting nitrate therapy should include a daily __-__ hour treatment-free interval
to prevent drug tolerance - ANSWER: 8-10 hours
Major adverse effects of nitro - ANSWER: Headache, nausea, light-headedness, and
hypotension
First-line therapy for chronic angina - ANSWER: BB
,Medication that prolongs exercise duration and time to angina - ANSWER:
Ranolozine
Indications for stress testing - ANSWER: Patients with baseline EKG abnormalities
Indications for PTCA - ANSWER: 1 or 2 vessel disease NOT involving the left main
coronary artery and in whom ventricular function is normal/near normal
Indications for CABG - ANSWER: Left main coronary artery disease, symptomatic or
critical stenotic (>70%) 3-vessel disease or decreased LVEF <40%
1st line drug for chronic management of angina pectoris - ANSWER: beta blocker
Treatment of choice for Prinzmetal angina - ANSWER: CCB
Classic outpatient regimen for angina pectoris - ANSWER: daily aspirin, sublingual
nitro, daily BB and statin
Cardioselective beta-blockers - ANSWER: Metoprolol and atenolol
Nonselective beta-blockers - ANSWER: Propranolol and Nadolol
Nondihydropyridines - ANSWER: Diltiazem and verapamil
Contraindications to nitro - ANSWER: SBP <90mmHg, RV infarction, use of sildenafil
an other PDE-5 inhibitors
>____% occlusion of coronary arteries can cause pain at rest - ANSWER: >90%
Pericarditis, fever, leukocytosis, and pericardial or pleural effusion usually 1 to 2
weeks post-MI - ANSWER: Dressler syndrome
PE findings of acute coronary syndrome - ANSWER: usually normal; +/- S4
Chest pain + bradycardia may be suggestive of a _________ wall MI - ANSWER:
inferior
ST elevations > or equal to 1mm in > or equal to 2 anatomically contiguous leads -
ANSWER: STEMI
A new ______ is considered a STEMI equivalent - ANSWER: LBBB
Natural STEMI progression on EKG - ANSWER: Peaked T waves -> ST elevations -> Q
waves -> ST depression
Anterior wall infarct:
, 1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. V1-V4
2. LAD
Lateral wall infarct:
1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. V5, V6, aVL, I
2. Circumflex
Inferior wall infarct:
1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. II, III, aVF
2. Right coronary artery
CK-MB
1. Appears?
2. Peaks?
3. Returns to baseline? - ANSWER: 1. 4-6 hours
2. 12-24 hours
3. 3-4 days
Troponin
1. Appears?
2. Peaks?
3. Returns to baseline? - ANSWER: 1. 4-8 hours
2. 12-24 hours
3. 7-10 days
Non cardiac differential diagnosis of angina pectoris - ANSWER: GERD,
musculoskeletal/costochondritis, pneumonia/pleuritis, anxiety
Best predictor of survival in STEMI - ANSWER: LVEF
Acute treatment of MI - ANSWER: Morphine
Oxygen
Nitro
Aspirin
EKG findings in posterior MI - ANSWER: ST depression in leads V1-V2
Most common complication and most common cause of death following acute MI -
ANSWER: Arrhythmia
In inferior wall MI, avoid ______ due to risk of severe hypotension - ANSWER:
nitrates
Dyslipidemia
What are the 3 local vasodilators in the heart? - ANSWER: Nitric oxide, adenosine,
and oxygen
Vagal maneuvers _______ heart rate in tachyarrhythmias - ANSWER: decrease
During inspiration, left sided stroke volume __________ - ANSWER: decreases
Physiologic splitting of S2 - ANSWER: inspiration separates S2 into A2 followed by
P2; during inspiration, the decreased L-sided venous return results in an earlier A2
and increased right-sided flow with inspiration results in later P2
L-sided murmurs are best heard at end ___________; R-sided murmurs are best
heard at end __________ - ANSWER: expiration; inspiration
>10 mmHg decline in SBP with inspiration - ANSWER: pulsus paradoxus
Pulsus paradoxus is a sign of what conditions? - ANSWER: Cardiac tamponade,
tension pneumothorax
Gold standard diagnosis for CAD - ANSWER: Angiography
Gold standard diagnosis for PAD - ANSWER: Angiography
Gold standard diagnosis for AAA - ANSWER: Angiography
Most useful diagnostic study to diagnose heart failure - ANSWER: Echo
Primary noninvasive test for assessing cardiac anatomy and function - ANSWER:
Transthoracic echocardiogram (TTE)
Bruce protocol - ANSWER: Positive exercise stress test if ST depressions, exercise-
induced HTN or hypotension, arrhythmias, symptoms or HR abnormalities occur
during testing
Vasodilators used in pharmacologic stress testing - ANSWER: Adenosine or
Dipyridamole
Contraindications of pharmacologic stress testing - ANSWER: Bronchospastic disease
(e.g. severe asthma and COPD), 2nd/3rd degree heart block or sick sinus syndrome
Medication used in stress echocardiography - ANSWER: Dobutamine
MC cause of CAD - ANSWER: Atherosclerosis
,Most important modifiable risk factor for CAD - ANSWER: Smoking
Valvular diseases that may lead to CAD - ANSWER: Aortic stenosis
Aortic regurgitation
Substernal chest pain usually brought on by exertion - ANSWER: Angina pectoris
Radiation of angina pectoris - ANSWER: Arm (especially ulnar surfaces of forearm
and hand)
Teeth
Lower jaw
Back
Epigastrium
Shoulders
Duration of stable angina pectoris - ANSWER: Less than 30 minutes by definition but
typically 1-5 minutes
Angina pectoris is relieved with _______ or ________ - ANSWER: nitroglycerin or
rest
Classic EKG finding in ischemic heart disease - ANSWER: ST depression
Initial testing of angina pectoris - ANSWER: EKG
Gold standard diagnosis of angina pectoris - ANSWER: angiography
Most useful noninvasive screening tool for angina pectoris - ANSWER: Stress testing
Paroxysmal chest "squeezing" or pressure, often accompanied by a sensation of
smothering and a fear of impending death - ANSWER: Angina pectoris
Duration of unstable angina pectoris - ANSWER: More than 30 minutes
If stable angina is not completely resolved after ______ doses of nitro, unstable
angina, MI, or another diagnosis should be suspected - ANSWER: three doses
Sublingual nitro can be repeated every __ minutes up to __ times - ANSWER: every 5
minutes up to 3 times
Long-acting nitrate therapy should include a daily __-__ hour treatment-free interval
to prevent drug tolerance - ANSWER: 8-10 hours
Major adverse effects of nitro - ANSWER: Headache, nausea, light-headedness, and
hypotension
First-line therapy for chronic angina - ANSWER: BB
,Medication that prolongs exercise duration and time to angina - ANSWER:
Ranolozine
Indications for stress testing - ANSWER: Patients with baseline EKG abnormalities
Indications for PTCA - ANSWER: 1 or 2 vessel disease NOT involving the left main
coronary artery and in whom ventricular function is normal/near normal
Indications for CABG - ANSWER: Left main coronary artery disease, symptomatic or
critical stenotic (>70%) 3-vessel disease or decreased LVEF <40%
1st line drug for chronic management of angina pectoris - ANSWER: beta blocker
Treatment of choice for Prinzmetal angina - ANSWER: CCB
Classic outpatient regimen for angina pectoris - ANSWER: daily aspirin, sublingual
nitro, daily BB and statin
Cardioselective beta-blockers - ANSWER: Metoprolol and atenolol
Nonselective beta-blockers - ANSWER: Propranolol and Nadolol
Nondihydropyridines - ANSWER: Diltiazem and verapamil
Contraindications to nitro - ANSWER: SBP <90mmHg, RV infarction, use of sildenafil
an other PDE-5 inhibitors
>____% occlusion of coronary arteries can cause pain at rest - ANSWER: >90%
Pericarditis, fever, leukocytosis, and pericardial or pleural effusion usually 1 to 2
weeks post-MI - ANSWER: Dressler syndrome
PE findings of acute coronary syndrome - ANSWER: usually normal; +/- S4
Chest pain + bradycardia may be suggestive of a _________ wall MI - ANSWER:
inferior
ST elevations > or equal to 1mm in > or equal to 2 anatomically contiguous leads -
ANSWER: STEMI
A new ______ is considered a STEMI equivalent - ANSWER: LBBB
Natural STEMI progression on EKG - ANSWER: Peaked T waves -> ST elevations -> Q
waves -> ST depression
Anterior wall infarct:
, 1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. V1-V4
2. LAD
Lateral wall infarct:
1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. V5, V6, aVL, I
2. Circumflex
Inferior wall infarct:
1. ST elevations in which leads?
2. Artery involved? - ANSWER: 1. II, III, aVF
2. Right coronary artery
CK-MB
1. Appears?
2. Peaks?
3. Returns to baseline? - ANSWER: 1. 4-6 hours
2. 12-24 hours
3. 3-4 days
Troponin
1. Appears?
2. Peaks?
3. Returns to baseline? - ANSWER: 1. 4-8 hours
2. 12-24 hours
3. 7-10 days
Non cardiac differential diagnosis of angina pectoris - ANSWER: GERD,
musculoskeletal/costochondritis, pneumonia/pleuritis, anxiety
Best predictor of survival in STEMI - ANSWER: LVEF
Acute treatment of MI - ANSWER: Morphine
Oxygen
Nitro
Aspirin
EKG findings in posterior MI - ANSWER: ST depression in leads V1-V2
Most common complication and most common cause of death following acute MI -
ANSWER: Arrhythmia
In inferior wall MI, avoid ______ due to risk of severe hypotension - ANSWER:
nitrates
Dyslipidemia
