IM - Dr. High Yield | Complete Practice Questions & Verified Answers
What does CHA2DS2-VASc stand for? C = CHF/LV dysfn
What is it used for? H = HTN
A2 = Age ≥75yo
D = Diabetes
S2 = Stroke/TIA/Thrombus
V = Vascular Dz
A = Age 65 - 74
S = Sex Female
If you have AFib & have a score 2+ then you start Anticoagulation (Warfarin)
Score <2 = treat w/aspirin
What is the Centor criteria? - No Cough
How to interpret? - Tonsilar Exudate
- Nodes: tender/swollen ant cervical
- Temp >38C
- Age 3 - 14
>4 treat empirically (w/pen)
2 - 3 do rapid strep
What is the Pound criteria? Migraine Headache
- Pulsatile
- One day duration
- Unilateral
- Nausea
- Debilitating
What is the CURB-65 criteria? Pneumonia
How to interpret? Confusion
Urea >7
RR >30
BP - sys <90, dia <60
Age ≥ 65
0-1 = low risk, outpt tx
2 = intermediate risk, consider inpt
>2 = high risk, ICU
1st line inpatient PNA Tx? Fluoroquinolone
1st line outpatient typical PNA Tx?
Amoxicillin
1st line outpatient atypical PNA Tx?
Azithromycin
What is the SIRS criteria? Temp ≥38 or ≤36
How to interpret? HR >90
RR >20 (or PaCO2 <32)
WBC >12000 or <4000
2+ = SIRS
2+ & source discovered = SEPSIS
2+ & source & end organ damage or HypoTN = SEVERE SEPSIS
2+ & source & HypoTN & Not responding to fluids = SEPTIC SHOCK
What is Light's criteria? Pleural Effusion
Common Causes of Exudate (7)? Exudative if:
Common Causes of Transudate (~4)? - Fluid protein >0.5 (pleural/serum)
- Fluid LDH >0.6 (or >2/3 ULN)
Transudative if opposite
Exudate: AI Dz, Esophageal Rupture, Infection, Malignancy, Pancreatitis, Post-
CABG, PE
Transudate: CHF, Constrictive Pericarditis, Hypoalbuminemia (cirrhosis,
nephrotic synd)
What is Well's Criteria? Pulmonary Embolism
- S&S of DVT (3)
How to interpret? - No Alternative Dx (3)
- HR >100 (1.5)
- Immobile ≥ 3 days or Surg in last 4wk (1.5)
- Previous DVT or PE (1.5)
- Hemoptysis (1)
- Malignancy w/active Tx in last 6mo or palliative care (1)
If the score is 4+ then get a CT angio
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
COPD - O2 sat <88
Long term oxygen therapy criteria? - PaO2 <55
Glasgow Coma Scale: if ≤ ___ then intubate? Glasgow Coma Scale: if ≤ 8 then intubate?
Ascites analysis: • 250+ Neutrophils
• ____+ Neutrophils = spontaneous bacterial
peritonitis • Cirrhosis + Ascites
• Usually seen in patients with which chronic condition?
• What other Symptoms usually seen? • Diffuse Abdominal Pain + Fever + Leukocytosis
What is the SAAG score? Serum to Ascites Albumin Gradient
How is it calculated? Subtract the ascites albumin concentration from the serum albumin concentration
How is it interpreted? >1.1 means that there is portal HTN
- TIMI score - Those with unstable angina or NSTEMI
For Whom?
How is it calculated? 1 point each:
How is it interpreted? • > 65 yo
• > 3 RF for CAD
• Use of ASA in last 7d
• Known CAD (w/stenosis ≥50%)
• > 1 episode of rest angina in <24hr
• ST segment deviation
• Elevated cardiac enzymes
Score 0-2: do a stress test
Score ≥ 3: High risk, treat aggressively (cath)
Stable angina If the pt has abnormalities on EKG.
When do you do echo or nuclear perfusion stress test?
1st line Tx for stable Angina (3)? • Nitro
• ASA
• BB
1st line Tx for unstable Angina (9)? Morphine
O2
Nitro
ASA (1st)
Clopedogril
BB
ACE-I
Statin
Hep
What do you call øSTΔ on EKG + Chest Pain + Unstable Angina
øelevated trops?
What do you do for someone w/chest pain, unstable still go to cath
vitals, you suspect MI but don't have proof?
2 indications for CABG? • 3 vessels Dz
• Proximal LAD w/70%+ occlusion
How do you test for prinzmetal angina? EKGΔ or angio spasm when given ergotomine or Ach
How do you treat prinzmetal angina? CCB or Nitro
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
In which kind of MI do you not give Nitro & why? Inferior MI (II, III, aVF) b/c this'll be a RV MI which will mean less blood to L
heart. So super hypoTN
(give fluids instead)
What is 1st line Tx for cardiogenic shock? dobutamine (β1 agonist inotrope)
What is 1st line Tx for cardiogenic shock d/t Inferior MI? atropine (b/c shock is d/t injury of SA node)
What is 1st line Tx for septic shock (3)? IV ABX + IV Fluids ± Vasopressors
Sx of Neurogenic Shock? Bradycardia (↓)
Tx? Hypotension (↓)
Neurologic Deficit (↓)
CO ↓
PCWP ↓
TPR ↓
JVD ↓
IV fluids
3 drugs shown to decrease mortality in MI? ACE-I
BB
ASA
3 drugs shown to decrease mortality in CHF? ACE-I
BB
Spironolactone (K sparing diuretic)
Tx of mobitz I No Tx
Tx of mobitz II
Pacemaker
Tx of complete Heart Block
Pacemaker
How do you treat dressler synd? NSAID + colchicine
(Dr. High Yield says ASA specifically)
How to treat viral pericarditis?
NSAIDs
What 3 cause restrictive cardiomyopathy Hemochromatosis
Amyloidosis
What kind of HF does this cause? Sarcoidosis
Diastolic w/ reduced EF, deposits in myocardium
symptoms of hemochromatosis - weakness
- chronic fatigue
- myalagias
- joint pain
- abdominal pain
- hapatomegaly
- elevated Hbg and liver enzymes
- bronze skin
- DM
- high ferritin, low TIBC, high serum Fe
Amyloidosis deposits where? A: heart, kidney, joints (+ proteinurea)
Sarcoidosis Sx seen?
S: b/l hilar LNs, dry cough, uveitis, erythema nodosum, restrictive
cardiomyopathy
Metformin is contraindicated in (4)? Why? • CHF
• liver failure (Cr >1.5)
• alcohol abuse
• renal insufficiency
(these are because it can cause lactic acidosis if not cleared properly)
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
Tx for CHF exacerbation? LMNOP
• Lasix
• Morphine
• Nitrates
• O2
• Position
(also Inotropes)
How to treat stable monomorphic vtach? Amioderone
How to treat stable supraventricular tachy? Adenosine (vagal maneuvers first - like carotid massage)
How to treat pulseless vtach? Defibrillation
(where other PEA = CPR)
How to treat torsades de pointes? IV Magnesium (stabilizes cardiac membranes)
2 common causes of constrictive pericarditis? TB or Lupus (look for calcifications)
Tx? Tx w/pericardectomy
Which virus is the major cause of acute pericarditis? Coxsackievirus
How to treat?
NSAID
Beck's triad is used for? Tamponade
Hypotension
What's the triad? JVD
Muffled heart sounds
Also assoc. with what unique findings? Electrical Alternans
Low Voltage QRS
Pulsus Paradoxis (systolic P dropping >10 on inspiration)
Kussumal Sign (JVD distends more on inhalation)
Major causes of Mitral Valve Stenosis are ___(4) 1. Rhematic Fever
2. Lupus
3. Rheumatoid heart disease
4. Calcification of Mitral ring
5 Major complications of Aortic Stenosis? • Angina (d/t less perfusion in coronaries)
What will you hear on auscultation? • Syncope (d/t less perfusion to brain)
• LV Hypertrophy (increased afterload)
• Dilated Cardiomyopathy
• CHF
Soft S2 (valve doesn't move well)
Treat w/valve replacement
2 associations with tricuspid valve complications? • IV drug use
• Carcinoid syndrome (serotonin producing tumor → bronchospasm, flushing,
diarrhea, R sided murmurs)
3 causes of holosystolic murmur? Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
What does CHA2DS2-VASc stand for? C = CHF/LV dysfn
What is it used for? H = HTN
A2 = Age ≥75yo
D = Diabetes
S2 = Stroke/TIA/Thrombus
V = Vascular Dz
A = Age 65 - 74
S = Sex Female
If you have AFib & have a score 2+ then you start Anticoagulation (Warfarin)
Score <2 = treat w/aspirin
What is the Centor criteria? - No Cough
How to interpret? - Tonsilar Exudate
- Nodes: tender/swollen ant cervical
- Temp >38C
- Age 3 - 14
>4 treat empirically (w/pen)
2 - 3 do rapid strep
What is the Pound criteria? Migraine Headache
- Pulsatile
- One day duration
- Unilateral
- Nausea
- Debilitating
What is the CURB-65 criteria? Pneumonia
How to interpret? Confusion
Urea >7
RR >30
BP - sys <90, dia <60
Age ≥ 65
0-1 = low risk, outpt tx
2 = intermediate risk, consider inpt
>2 = high risk, ICU
1st line inpatient PNA Tx? Fluoroquinolone
1st line outpatient typical PNA Tx?
Amoxicillin
1st line outpatient atypical PNA Tx?
Azithromycin
What is the SIRS criteria? Temp ≥38 or ≤36
How to interpret? HR >90
RR >20 (or PaCO2 <32)
WBC >12000 or <4000
2+ = SIRS
2+ & source discovered = SEPSIS
2+ & source & end organ damage or HypoTN = SEVERE SEPSIS
2+ & source & HypoTN & Not responding to fluids = SEPTIC SHOCK
What is Light's criteria? Pleural Effusion
Common Causes of Exudate (7)? Exudative if:
Common Causes of Transudate (~4)? - Fluid protein >0.5 (pleural/serum)
- Fluid LDH >0.6 (or >2/3 ULN)
Transudative if opposite
Exudate: AI Dz, Esophageal Rupture, Infection, Malignancy, Pancreatitis, Post-
CABG, PE
Transudate: CHF, Constrictive Pericarditis, Hypoalbuminemia (cirrhosis,
nephrotic synd)
What is Well's Criteria? Pulmonary Embolism
- S&S of DVT (3)
How to interpret? - No Alternative Dx (3)
- HR >100 (1.5)
- Immobile ≥ 3 days or Surg in last 4wk (1.5)
- Previous DVT or PE (1.5)
- Hemoptysis (1)
- Malignancy w/active Tx in last 6mo or palliative care (1)
If the score is 4+ then get a CT angio
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
COPD - O2 sat <88
Long term oxygen therapy criteria? - PaO2 <55
Glasgow Coma Scale: if ≤ ___ then intubate? Glasgow Coma Scale: if ≤ 8 then intubate?
Ascites analysis: • 250+ Neutrophils
• ____+ Neutrophils = spontaneous bacterial
peritonitis • Cirrhosis + Ascites
• Usually seen in patients with which chronic condition?
• What other Symptoms usually seen? • Diffuse Abdominal Pain + Fever + Leukocytosis
What is the SAAG score? Serum to Ascites Albumin Gradient
How is it calculated? Subtract the ascites albumin concentration from the serum albumin concentration
How is it interpreted? >1.1 means that there is portal HTN
- TIMI score - Those with unstable angina or NSTEMI
For Whom?
How is it calculated? 1 point each:
How is it interpreted? • > 65 yo
• > 3 RF for CAD
• Use of ASA in last 7d
• Known CAD (w/stenosis ≥50%)
• > 1 episode of rest angina in <24hr
• ST segment deviation
• Elevated cardiac enzymes
Score 0-2: do a stress test
Score ≥ 3: High risk, treat aggressively (cath)
Stable angina If the pt has abnormalities on EKG.
When do you do echo or nuclear perfusion stress test?
1st line Tx for stable Angina (3)? • Nitro
• ASA
• BB
1st line Tx for unstable Angina (9)? Morphine
O2
Nitro
ASA (1st)
Clopedogril
BB
ACE-I
Statin
Hep
What do you call øSTΔ on EKG + Chest Pain + Unstable Angina
øelevated trops?
What do you do for someone w/chest pain, unstable still go to cath
vitals, you suspect MI but don't have proof?
2 indications for CABG? • 3 vessels Dz
• Proximal LAD w/70%+ occlusion
How do you test for prinzmetal angina? EKGΔ or angio spasm when given ergotomine or Ach
How do you treat prinzmetal angina? CCB or Nitro
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
In which kind of MI do you not give Nitro & why? Inferior MI (II, III, aVF) b/c this'll be a RV MI which will mean less blood to L
heart. So super hypoTN
(give fluids instead)
What is 1st line Tx for cardiogenic shock? dobutamine (β1 agonist inotrope)
What is 1st line Tx for cardiogenic shock d/t Inferior MI? atropine (b/c shock is d/t injury of SA node)
What is 1st line Tx for septic shock (3)? IV ABX + IV Fluids ± Vasopressors
Sx of Neurogenic Shock? Bradycardia (↓)
Tx? Hypotension (↓)
Neurologic Deficit (↓)
CO ↓
PCWP ↓
TPR ↓
JVD ↓
IV fluids
3 drugs shown to decrease mortality in MI? ACE-I
BB
ASA
3 drugs shown to decrease mortality in CHF? ACE-I
BB
Spironolactone (K sparing diuretic)
Tx of mobitz I No Tx
Tx of mobitz II
Pacemaker
Tx of complete Heart Block
Pacemaker
How do you treat dressler synd? NSAID + colchicine
(Dr. High Yield says ASA specifically)
How to treat viral pericarditis?
NSAIDs
What 3 cause restrictive cardiomyopathy Hemochromatosis
Amyloidosis
What kind of HF does this cause? Sarcoidosis
Diastolic w/ reduced EF, deposits in myocardium
symptoms of hemochromatosis - weakness
- chronic fatigue
- myalagias
- joint pain
- abdominal pain
- hapatomegaly
- elevated Hbg and liver enzymes
- bronze skin
- DM
- high ferritin, low TIBC, high serum Fe
Amyloidosis deposits where? A: heart, kidney, joints (+ proteinurea)
Sarcoidosis Sx seen?
S: b/l hilar LNs, dry cough, uveitis, erythema nodosum, restrictive
cardiomyopathy
Metformin is contraindicated in (4)? Why? • CHF
• liver failure (Cr >1.5)
• alcohol abuse
• renal insufficiency
(these are because it can cause lactic acidosis if not cleared properly)
, IM - Dr. High Yield | Complete Practice Questions & Verified Answers
Tx for CHF exacerbation? LMNOP
• Lasix
• Morphine
• Nitrates
• O2
• Position
(also Inotropes)
How to treat stable monomorphic vtach? Amioderone
How to treat stable supraventricular tachy? Adenosine (vagal maneuvers first - like carotid massage)
How to treat pulseless vtach? Defibrillation
(where other PEA = CPR)
How to treat torsades de pointes? IV Magnesium (stabilizes cardiac membranes)
2 common causes of constrictive pericarditis? TB or Lupus (look for calcifications)
Tx? Tx w/pericardectomy
Which virus is the major cause of acute pericarditis? Coxsackievirus
How to treat?
NSAID
Beck's triad is used for? Tamponade
Hypotension
What's the triad? JVD
Muffled heart sounds
Also assoc. with what unique findings? Electrical Alternans
Low Voltage QRS
Pulsus Paradoxis (systolic P dropping >10 on inspiration)
Kussumal Sign (JVD distends more on inhalation)
Major causes of Mitral Valve Stenosis are ___(4) 1. Rhematic Fever
2. Lupus
3. Rheumatoid heart disease
4. Calcification of Mitral ring
5 Major complications of Aortic Stenosis? • Angina (d/t less perfusion in coronaries)
What will you hear on auscultation? • Syncope (d/t less perfusion to brain)
• LV Hypertrophy (increased afterload)
• Dilated Cardiomyopathy
• CHF
Soft S2 (valve doesn't move well)
Treat w/valve replacement
2 associations with tricuspid valve complications? • IV drug use
• Carcinoid syndrome (serotonin producing tumor → bronchospasm, flushing,
diarrhea, R sided murmurs)
3 causes of holosystolic murmur? Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
