A comprehensive Internal Medicine Blueprint study guide featuring high-yield exam questions and verified correct answers. Covers core internal medicine topics including cardiology, pulmonology, gastroenterology, endocrinology, infectious diseases, nephrol

INTERNNAL MEDICINE BLUEPRINT
WITH QUESTIONS AND ANSWERS



Describe what the heart is like during diastolic heart failure - correct
answer.💖💖💖💖✔<<<<<Normal/increased EF

thick ventricular walls

small LV chamber

S4 on auscultation



Describe what the heart is like during systolic heart failure - correct
answer.💖💖💖💖✔<<<<<decreased EF

thin ventricular walls

dilated chamber

S3 on auscultation



NYHA classifications of heart failure - correct answer.💖💖💖💖✔<<<<<I - no symptoms or
limitation

II - mild symptoms, slight limitation

III - comfort only at rest, marked limitation of activity

IV - symptoms at rest and inability of physical activity



S/S of L sided Heart failure - correct answer.💖💖💖💖✔<<<<<dyspnea

pulmonary congestion

hypertension - cheyenne stokes breathing

INC adrenergic activation - tachy, pale, diaphoretic

,S/S of R sided heart failure - correct answer.💖💖💖💖✔<<<<<edema

JVD

hepatosplenomegaly



Best way to DX heart failure - correct answer.💖💖💖💖✔<<<<<echo

BNP >100

xray



At what ejection fraction with heart failure should defibrillator placement be made to reduce mortality -
correct answer.💖💖💖💖✔<<<<<<35 %



1st line treatment in outpatient management of heart failure - correct
answer.💖💖💖💖✔<<<<<ACE inhibitor



What medication usually added after ACE Inhibitor in managemnt of heart failure - correct
answer.💖💖💖💖✔<<<<<BBlocker



Most effective initial treatment for symptoms of heart failure - correct
answer.💖💖💖💖✔<<<<<Lasix



Novel Medications for systolic heart failure (2) - correct answer.💖💖💖💖✔<<<<<Entresto

Ivabradine - sinus node inhibitor



Management of Acute Pulmonary Edema/Cong heart failure - correct
answer.💖💖💖💖✔<<<<<LMNOP

Lasix

Morphine

Nitrates

O2

Position - upright to decrease venous return

,Most common cause of secondary hypertension - correct answer.💖💖💖💖✔<<<<<Renovascular -
Renal artery stenois/ fibromuscular dysplasia



Goal BP in general population and diabetics - correct answer.💖💖💖💖✔<<<<<<140/90



Lifestyle modifications decrease systolic blood pressure by how much? - correct
answer.💖💖💖💖✔<<<<<Dec by 5 mm Hg per modication:

weight loss

dash diet

exercise

limit alcohol



First line HTN meds in non-aftrican - correct answer.💖💖💖💖✔<<<<<ACE/ARB

CCB

Thiazide



Management of HTN with comorbidities:

AFib

Angina

Post MI

Sys Heart failure

DM/CKD

BPH

africans

young, caucasion males

Gout - correct answer.💖💖💖💖✔<<<<<AFib - BB or CCB

Angina - BB or CCB

Post MI - BB or ACE

, Sys Heart failure - ACE/ARB , BB, diuretic

DM/CKD - ACE

BPH - alpha blocker

africans - thiazide/CCB

young, caucasion males - thiazide

Gout - Losartan(only ARB that doesnt cause hyperuricemia, CCB



systolic ejctection crescendo descrescendo murmer heard best at RUSB - correct
answer.💖💖💖💖✔<<<<<aortic stenosis



Diastolic rumble murmer heard best at the apex in left lateral decubitus position that may be preceded
by opening snap - correct answer.💖💖💖💖✔<<<<<Mitral Stenosis



Disastolic blowing decrescendo murmer herad best at left upper sternal border

increases with handgrip

descreases with nitrate - correct answer.💖💖💖💖✔<<<<<Aortic Regurgitation



Blowing holosytolic murmer heard best at the apex - correct answer.💖💖💖💖✔<<<<<Mitral
Regurgitation



Mid - Late systolic ejection click heard best at the apex that is accentuated by valsalve maneuver -
correct answer.💖💖💖💖✔<<<<<Mitral Valve prolapse



Harsh midsystolic ejection crescendo decrescendo murmuer heard best at LUSB that radiates to the
neck - correct answer.💖💖💖💖✔<<<<<Pulmonic Stenosis



Graham Steell Murmer - brief decrescendo early diastolic murmuer heard best at LUSB if with full
inspiration - correct answer.💖💖💖💖✔<<<<<Pulmonic Regurgitation



Mid diastolic murmur heard best at left lower sternal border - correct
answer.💖💖💖💖✔<<<<<Tricuspid stenosis