PAEA INTERNAL MEDICINE EOR UPDATED EXAM
QUESTIONS AND ANSWERS GRADED A+
✔✔what do alpha blockers do? - ✔✔lower peripheral vascular resistance
may be initial drug of choice in men w/ symptomatic BPH
✔✔tetralogy of fallot
1.
2.
3.
4. - ✔✔1. ventricular septal defect
2. aorta arising out of both ventricles (overriding aorta)
3. right ventricular outflow obstruction
(pulmonary stenosis)
4. right ventricular hypertrophy
✔✔tetralogy of fallot
murmur - ✔✔crescendo-decrescendo
holosystolic murmur
left sternal border (LSB)
radiates to back
✔✔tetralogy of fallot
Sx - ✔✔cyanosis
clubbing
loud S2
tet (hypercyanotic) spells
✔✔pulmonary atresia
characteristics - ✔✔usually intact ventricular septum
pulmonary valve is closed
atrial septal opening
patent ductus arteriosus
✔✔pulmonary atresia
Sx - ✔✔cyanosis w/ tachynpea at birth
tachypea w/out dyspnea
hyperdynamic apical impulse
single S1 and S2
✔✔atrial septal defect
murmur - ✔✔systolic ejection murmur at 2nd left intercostal space (early to middle
systolic rumble)
,✔✔atrial septal defect
Sx - ✔✔failure to thrive
fatigability
RV heave
wide fixed split S2
✔✔most common congenital heart defect - ✔✔ventral septal defect
✔✔ventricular septal defect
murmur - ✔✔systolic murmur at LLSB
(lower left sternal border)
✔✔AV septal defect
characeristics - ✔✔common in down syndrome
murmur variable w/ degree of defect
maybe cyanosis
infants present w/ CHF
✔✔patent ductus arteriosus
murmur - ✔✔continuous (machinery) murmur
✔✔patent ductus arteriosus
Tx - ✔✔unlike other congenital anomalies, surgical tx is NOT indicated as many pts
respond to IV indomethacin
✔✔coarctation of the aorta
murmur - ✔✔systolic murmur LUSB and left interscapular area
(left upper sternal border)
murmur maybe continuous
✔✔in pts w/ myocardial infarction, which 3 drugs have been shown to decrease
mortality? - ✔✔aspirin
beta blockers
ace-inhibitors
✔✔prinzmetal/variant angina
Sx - ✔✔chest pain
occurs at rest
typically early morning
may wake pt up from sleep
no correlation w/ exertion/emotional stress
, *often affects women < 50 yo
*may be associated with other vasospastic disease
-migraines
-Raynaud's
✔✔which agent can be used for rhythm control in hemodynamically stable atrial
fibrillation w/ concomitant Wolff-Parkinson-White Syndrome? - ✔✔ibutilide
-prolongs refractoriness of AV node
-if concern for prolong QT interval or PVC, can use procainamide
-if use AV nodal blockers like BB, CCB, adenosine, or digoxin...may go into VTACH
✔✔endocarditis
Duke Major criteria - ✔✔2 positive blood cultures of a typically causative microorganism
evidence of endocardial involvement on echo
development of a new regurgitant murmur
✔✔endocarditis
Duke Minor criteria - ✔✔predisposing factor
fever > 100.48 F (38.8 C)
vascular phenomena
(embolic dz or pulmonary infarc)
immunologic phenomena
(glomerunephritis, osler nodes, roth spots)
positive blood culture not meeting major criteria
✔✔hyperlidemia
Tx - ✔✔lifestyle changes 1st line
-smoking cessation
-modest alcohol
-daily exercise
-mediterranean diet
-reduce LDL: soluble fiber, garlic, soy, pecans, plant sterols, vit C
Rx
STATINS
Niacin (SE: flushing)
bile acid sequestrants
QUESTIONS AND ANSWERS GRADED A+
✔✔what do alpha blockers do? - ✔✔lower peripheral vascular resistance
may be initial drug of choice in men w/ symptomatic BPH
✔✔tetralogy of fallot
1.
2.
3.
4. - ✔✔1. ventricular septal defect
2. aorta arising out of both ventricles (overriding aorta)
3. right ventricular outflow obstruction
(pulmonary stenosis)
4. right ventricular hypertrophy
✔✔tetralogy of fallot
murmur - ✔✔crescendo-decrescendo
holosystolic murmur
left sternal border (LSB)
radiates to back
✔✔tetralogy of fallot
Sx - ✔✔cyanosis
clubbing
loud S2
tet (hypercyanotic) spells
✔✔pulmonary atresia
characteristics - ✔✔usually intact ventricular septum
pulmonary valve is closed
atrial septal opening
patent ductus arteriosus
✔✔pulmonary atresia
Sx - ✔✔cyanosis w/ tachynpea at birth
tachypea w/out dyspnea
hyperdynamic apical impulse
single S1 and S2
✔✔atrial septal defect
murmur - ✔✔systolic ejection murmur at 2nd left intercostal space (early to middle
systolic rumble)
,✔✔atrial septal defect
Sx - ✔✔failure to thrive
fatigability
RV heave
wide fixed split S2
✔✔most common congenital heart defect - ✔✔ventral septal defect
✔✔ventricular septal defect
murmur - ✔✔systolic murmur at LLSB
(lower left sternal border)
✔✔AV septal defect
characeristics - ✔✔common in down syndrome
murmur variable w/ degree of defect
maybe cyanosis
infants present w/ CHF
✔✔patent ductus arteriosus
murmur - ✔✔continuous (machinery) murmur
✔✔patent ductus arteriosus
Tx - ✔✔unlike other congenital anomalies, surgical tx is NOT indicated as many pts
respond to IV indomethacin
✔✔coarctation of the aorta
murmur - ✔✔systolic murmur LUSB and left interscapular area
(left upper sternal border)
murmur maybe continuous
✔✔in pts w/ myocardial infarction, which 3 drugs have been shown to decrease
mortality? - ✔✔aspirin
beta blockers
ace-inhibitors
✔✔prinzmetal/variant angina
Sx - ✔✔chest pain
occurs at rest
typically early morning
may wake pt up from sleep
no correlation w/ exertion/emotional stress
, *often affects women < 50 yo
*may be associated with other vasospastic disease
-migraines
-Raynaud's
✔✔which agent can be used for rhythm control in hemodynamically stable atrial
fibrillation w/ concomitant Wolff-Parkinson-White Syndrome? - ✔✔ibutilide
-prolongs refractoriness of AV node
-if concern for prolong QT interval or PVC, can use procainamide
-if use AV nodal blockers like BB, CCB, adenosine, or digoxin...may go into VTACH
✔✔endocarditis
Duke Major criteria - ✔✔2 positive blood cultures of a typically causative microorganism
evidence of endocardial involvement on echo
development of a new regurgitant murmur
✔✔endocarditis
Duke Minor criteria - ✔✔predisposing factor
fever > 100.48 F (38.8 C)
vascular phenomena
(embolic dz or pulmonary infarc)
immunologic phenomena
(glomerunephritis, osler nodes, roth spots)
positive blood culture not meeting major criteria
✔✔hyperlidemia
Tx - ✔✔lifestyle changes 1st line
-smoking cessation
-modest alcohol
-daily exercise
-mediterranean diet
-reduce LDL: soluble fiber, garlic, soy, pecans, plant sterols, vit C
Rx
STATINS
Niacin (SE: flushing)
bile acid sequestrants
