PAEA INTERNAL MEDICINE EOR COMPREHENSIVE
UPDATED EXAM QUESTIONS AND ANSWERS GRADED A+
✔✔Coronary vascular disease Major Risk factors - ✔✔Male gender, ↑LDL , ↓HDL, DM,
hypertension, a family history, smoking, and peripheral arterial disease.
✔✔Valvular Disease: Aortic Aneurysm - ✔✔Aortic aneurysms are most commonly
associated with atherosclerosis. Most are abdominal, and > 90% originate below the
renal arteries.
✔✔Valvular Disease: Aortic Aneurysm Dx - ✔✔Abdominal ultrasound. Risk Factor:
HTN, Smoking, FH, LDL
✔✔Aortic Aneurysm vs Aortic dissection - ✔✔Aortic aneurysm is most often associated
with atherosclerosis, while aortic dissection is commonly linked to hypertension.
✔✔Valvular Disease: Aortic Aneurysm Tx - ✔✔In asymptomatic patients, monitoring is
appropriate for lesions < 5 cm.
■ Surgical repair is indicated if the lesion is > 5.5 cm (abdominal), > 6 cm (thoracic), or
smaller but rapidly enlarging.
■ Emergent surgery for symptomatic or ruptured aneurysms.
✔✔Valvular Disease: Aortic Dissection - ✔✔A transverse tear in the intima of a vessel
that results in blood entering the media, creating a false lumen and leading to a
hematoma that propagates longitudinally.
Most commonly 2° to hypertension. The most common sites of origin are above the
aortic valve and distal to the left subclavian artery. Most often occurs at 40-60 years of
age, with a greater frequency in males than in females.
✔✔Valvular Disease: Aortic Dissection H/P = - ✔✔acute, "ripping" chest pain, syncope;
decreased peripheral pulses, normal or increased blood pressure
✔✔Valvular Disease: Aortic Dissection classification - ✔✔Stanford classification—
Stanford A aortic dissection involves ascending aorta; Stanford B is distal to left
subclavian artery
✔✔Valvular Disease: Aortic Dissection Dx - ✔✔ECG, CXR (shows widening of the
mediastinum, cardiomegaly, or new left pleural effusion). *CT angiography is the gold
standard of imaging.*
✔✔Valvular Disease: Aortic Dissection Tx - ✔✔stabilize blood pressure (e.g.,
nitroprusside, β-blockers) if unstable; Stanford A dissections need emergency surgery;
Stanford B dissections can be treated medically unless rupture or occlusion develops
,✔✔Valvular Disease: Lymphedema - ✔✔Disruption of the lymphatic circulation that
results in peripheral edema and chronic infection of the extremities. Often a
complication of surgery involving
lymph node dissection. In underdeveloped countries, parasitic infection can lead to
lymphatic obstruction, resulting in edema. Congenital malformations of the lymphatic
system, such as Milroy's disease, can present with lymphedema in childhood.
✔✔Valvular Disease: Lymphedema Hx/PE - ✔✔Postmastectomy patients present with
unexplained swelling of the upper extremity.
■ Immigrants present with progressive swelling of the lower extremities bilaterally with
no cardiac abnormalities (i.e., fi lariasis).
✔✔Valvular Disease: Lymphedema Dx - ✔✔Diagnosis is clinical. Rule out other causes
of edema, such as cardiac and metabolic disorders.
✔✔Valvular Disease: Lymphedema Tx - ✔✔Directed at symptom management, as no
curative treatment exists. Exercise, massage therapy, and pressure garments to
mobilize and limit fluid accumulation may be of help.
✔✔Digoxin Toxicity includes - ✔✔Anorexia, N/V, change in visual perception.
✔✔Thyroiditis: Hashimoto's - ✔✔∙Hypothyroidism
∙>women
∙Antibodies destroy the thyroid cells.
→causing decreased production of hormones.
∙Treatment.
→Thyroid replacement.
✔✔Thyroiditis: Graves Disease - ✔✔∙Hyperthyroidism
∙>women
∙Antibodies stimulated the TSH receptor causing.
→Increased size of the gland.
→Increased production of thyroid hormone.
∙Treatment.
→I₁₃₁
→Antithyroid hormones: PTU
→Thyroidectomy.
✔✔Second Generation Antihistamines: - ✔✔∙Certrizine: (Zyrtec)
∙Desloratadine (Clarinex)
∙Fexofenadine (Allegra)
∙Levocertirizine (Xyzal)
∙Loratadine (Claritin)
✔✔Angina Symptoms: - ✔✔∙Chest Pain-substernal
,→Increased with exercise
→decreased with rest
→radiated to jaw or left arm
∙Shortness of Breath
∙Diaphoresis
∙Nausea/indigestion
∙Fatigue
∙Palpitations
∙Syncope
✔✔Inducers of Angina: - ✔✔∙Excercise
∙Cold weather
∙Extreme Moods: anger, stress, excitement
∙Large Meal
✔✔Associated Symptoms of Chest Pain: - ✔✔∙Dyspnea
∙Diaphoresis
∙Palpitations
∙Syncope
∙Edema
∙Cyanosis
✔✔Non-controllable or modifiable risk factors for heart disease: - ✔✔∙Heredity
∙Gender: Male>female
∙Age: >55 men>65 women
✔✔Controllable or modifiable risk factors for heart disease: - ✔✔∙Smoking
∙Hypertension
∙Elevated cholesterol (Low HDL and high Lipoprotein a)
∙Obesity
∙Physical Inactivity
∙Type A personality
∙Diabetes Mellitus
∙Elevated homocystine
∙Elevated C reactive Protien
∙Cocaine use
✔✔Treatment: Angina - ✔✔∙Lifestyle Modification
∙Pharmacotherapy to improve symptoms.
∙Antiplatelet therapy
∙MONA B:
→*M*orphine
→*O*xygen
→*N*itroglycerin
→*A*spirin
→*B*eta-blocker
, ✔✔Prinzmetal Angina: - ✔✔∙Variant Angina
∙Pain at rest
∙*ECG with chest pain shows ST elevation* and not depression.
∙Often do not have the risk factors.
∙During cath can be provoked by acetylcholine or methacholine.
∙*Treat with Calcium Channel blockers and nitrites* not B-blockers.
✔✔Causes of Heart Failure: Systolic dyfunction - ✔✔∙Most common
*∙66% associated with CAD*
∙Also longstanding hypertension
∙Alcohol abuse
✔✔Causes of Heart Failure: Diastolic dysfunction - ✔✔∙20 to 60% of HF cases.
*∙Occurs when LV all thickness and LV compliance decreases.*
∙This impairs LV filling and CO
∙Due to hypertension, AS inflitrative cardiomyopathy.
✔✔Paroxysmal Nocturnal Dyspnea: - ✔✔awakening from sleep with SOB and needing
to be upright to achieve comfort
✔✔EKG Cardiomyopathy - ✔✔∙Going of the chart because the leads have thicker
muscle to go through.
✔✔Dilated Cardiomyopathy: - ✔✔∙Ventricular dilation and impaired contraction.
∙Left or right ventricles.
∙Develops as a result of infection, toxins, cardiac problems or systemic problems.
→ETOH
→Chemotherapy-Adriamycin
→Cocaine
∙Symptoms:
→Atypical chest pain
→Decompensation
✔✔Atrial Fibrillation (A. Fib): - ✔✔∙Irregular irregularity
∙Problems with atrial conduction.
∙Can cause emboli to brain-stroke.
∙Treat with medication or cardiovert.
✔✔The four major determinant of systolic function of the heart: - ✔✔1. The contractile
state of the myocardium
2. The preload of the ventricle
3. The afterload applied to the ventricles
4. The heart rate
UPDATED EXAM QUESTIONS AND ANSWERS GRADED A+
✔✔Coronary vascular disease Major Risk factors - ✔✔Male gender, ↑LDL , ↓HDL, DM,
hypertension, a family history, smoking, and peripheral arterial disease.
✔✔Valvular Disease: Aortic Aneurysm - ✔✔Aortic aneurysms are most commonly
associated with atherosclerosis. Most are abdominal, and > 90% originate below the
renal arteries.
✔✔Valvular Disease: Aortic Aneurysm Dx - ✔✔Abdominal ultrasound. Risk Factor:
HTN, Smoking, FH, LDL
✔✔Aortic Aneurysm vs Aortic dissection - ✔✔Aortic aneurysm is most often associated
with atherosclerosis, while aortic dissection is commonly linked to hypertension.
✔✔Valvular Disease: Aortic Aneurysm Tx - ✔✔In asymptomatic patients, monitoring is
appropriate for lesions < 5 cm.
■ Surgical repair is indicated if the lesion is > 5.5 cm (abdominal), > 6 cm (thoracic), or
smaller but rapidly enlarging.
■ Emergent surgery for symptomatic or ruptured aneurysms.
✔✔Valvular Disease: Aortic Dissection - ✔✔A transverse tear in the intima of a vessel
that results in blood entering the media, creating a false lumen and leading to a
hematoma that propagates longitudinally.
Most commonly 2° to hypertension. The most common sites of origin are above the
aortic valve and distal to the left subclavian artery. Most often occurs at 40-60 years of
age, with a greater frequency in males than in females.
✔✔Valvular Disease: Aortic Dissection H/P = - ✔✔acute, "ripping" chest pain, syncope;
decreased peripheral pulses, normal or increased blood pressure
✔✔Valvular Disease: Aortic Dissection classification - ✔✔Stanford classification—
Stanford A aortic dissection involves ascending aorta; Stanford B is distal to left
subclavian artery
✔✔Valvular Disease: Aortic Dissection Dx - ✔✔ECG, CXR (shows widening of the
mediastinum, cardiomegaly, or new left pleural effusion). *CT angiography is the gold
standard of imaging.*
✔✔Valvular Disease: Aortic Dissection Tx - ✔✔stabilize blood pressure (e.g.,
nitroprusside, β-blockers) if unstable; Stanford A dissections need emergency surgery;
Stanford B dissections can be treated medically unless rupture or occlusion develops
,✔✔Valvular Disease: Lymphedema - ✔✔Disruption of the lymphatic circulation that
results in peripheral edema and chronic infection of the extremities. Often a
complication of surgery involving
lymph node dissection. In underdeveloped countries, parasitic infection can lead to
lymphatic obstruction, resulting in edema. Congenital malformations of the lymphatic
system, such as Milroy's disease, can present with lymphedema in childhood.
✔✔Valvular Disease: Lymphedema Hx/PE - ✔✔Postmastectomy patients present with
unexplained swelling of the upper extremity.
■ Immigrants present with progressive swelling of the lower extremities bilaterally with
no cardiac abnormalities (i.e., fi lariasis).
✔✔Valvular Disease: Lymphedema Dx - ✔✔Diagnosis is clinical. Rule out other causes
of edema, such as cardiac and metabolic disorders.
✔✔Valvular Disease: Lymphedema Tx - ✔✔Directed at symptom management, as no
curative treatment exists. Exercise, massage therapy, and pressure garments to
mobilize and limit fluid accumulation may be of help.
✔✔Digoxin Toxicity includes - ✔✔Anorexia, N/V, change in visual perception.
✔✔Thyroiditis: Hashimoto's - ✔✔∙Hypothyroidism
∙>women
∙Antibodies destroy the thyroid cells.
→causing decreased production of hormones.
∙Treatment.
→Thyroid replacement.
✔✔Thyroiditis: Graves Disease - ✔✔∙Hyperthyroidism
∙>women
∙Antibodies stimulated the TSH receptor causing.
→Increased size of the gland.
→Increased production of thyroid hormone.
∙Treatment.
→I₁₃₁
→Antithyroid hormones: PTU
→Thyroidectomy.
✔✔Second Generation Antihistamines: - ✔✔∙Certrizine: (Zyrtec)
∙Desloratadine (Clarinex)
∙Fexofenadine (Allegra)
∙Levocertirizine (Xyzal)
∙Loratadine (Claritin)
✔✔Angina Symptoms: - ✔✔∙Chest Pain-substernal
,→Increased with exercise
→decreased with rest
→radiated to jaw or left arm
∙Shortness of Breath
∙Diaphoresis
∙Nausea/indigestion
∙Fatigue
∙Palpitations
∙Syncope
✔✔Inducers of Angina: - ✔✔∙Excercise
∙Cold weather
∙Extreme Moods: anger, stress, excitement
∙Large Meal
✔✔Associated Symptoms of Chest Pain: - ✔✔∙Dyspnea
∙Diaphoresis
∙Palpitations
∙Syncope
∙Edema
∙Cyanosis
✔✔Non-controllable or modifiable risk factors for heart disease: - ✔✔∙Heredity
∙Gender: Male>female
∙Age: >55 men>65 women
✔✔Controllable or modifiable risk factors for heart disease: - ✔✔∙Smoking
∙Hypertension
∙Elevated cholesterol (Low HDL and high Lipoprotein a)
∙Obesity
∙Physical Inactivity
∙Type A personality
∙Diabetes Mellitus
∙Elevated homocystine
∙Elevated C reactive Protien
∙Cocaine use
✔✔Treatment: Angina - ✔✔∙Lifestyle Modification
∙Pharmacotherapy to improve symptoms.
∙Antiplatelet therapy
∙MONA B:
→*M*orphine
→*O*xygen
→*N*itroglycerin
→*A*spirin
→*B*eta-blocker
, ✔✔Prinzmetal Angina: - ✔✔∙Variant Angina
∙Pain at rest
∙*ECG with chest pain shows ST elevation* and not depression.
∙Often do not have the risk factors.
∙During cath can be provoked by acetylcholine or methacholine.
∙*Treat with Calcium Channel blockers and nitrites* not B-blockers.
✔✔Causes of Heart Failure: Systolic dyfunction - ✔✔∙Most common
*∙66% associated with CAD*
∙Also longstanding hypertension
∙Alcohol abuse
✔✔Causes of Heart Failure: Diastolic dysfunction - ✔✔∙20 to 60% of HF cases.
*∙Occurs when LV all thickness and LV compliance decreases.*
∙This impairs LV filling and CO
∙Due to hypertension, AS inflitrative cardiomyopathy.
✔✔Paroxysmal Nocturnal Dyspnea: - ✔✔awakening from sleep with SOB and needing
to be upright to achieve comfort
✔✔EKG Cardiomyopathy - ✔✔∙Going of the chart because the leads have thicker
muscle to go through.
✔✔Dilated Cardiomyopathy: - ✔✔∙Ventricular dilation and impaired contraction.
∙Left or right ventricles.
∙Develops as a result of infection, toxins, cardiac problems or systemic problems.
→ETOH
→Chemotherapy-Adriamycin
→Cocaine
∙Symptoms:
→Atypical chest pain
→Decompensation
✔✔Atrial Fibrillation (A. Fib): - ✔✔∙Irregular irregularity
∙Problems with atrial conduction.
∙Can cause emboli to brain-stroke.
∙Treat with medication or cardiovert.
✔✔The four major determinant of systolic function of the heart: - ✔✔1. The contractile
state of the myocardium
2. The preload of the ventricle
3. The afterload applied to the ventricles
4. The heart rate
