ABIM INTERNAL MEDICINE ITE EXAM
SCRIPT WITH VERIFIED QUESTIONS AND
ANSWERS
●● When to stop a stress test
Answer: St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
●● Stress test of choice with a LBBB or ventricular pacing?
Answer: Myocardial perfusion imaging with adenosine,
NOT exercising!
●● When to not use doutamine for stress
Answer: History of VT,
severe HTN,
Low BP,
poor echo images
,●● When to not use adenosine for stress
Answer: Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
●● Normals for PA catheter pressures
Answer: RA <8
RV 30/8
PCWP 3-12
PAP 12--12
●● Diastolic pressures
elevated & equalized
in all chambers,
low BP
Answer: tamponade
or restrictive pericarditis
●● Elevated RA and PA pressures,
,decreased or nl PCWP,
hypotension
Answer: RV MI
●● Elevated PCWP, RA pressure
decreased SBP/cardiac output
Answer: cardiogenic shock
●● high RA,
PA very elevated
high PCWP
nl SBP
Answer: mitral stenosis with RV failure
●● Elevated PAP, RAP
nl PCWP, SBP
Answer: pulmonary HTN
●● decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats
Answer: pulsus paradoxus:
, Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
●● What gives you pulsus bisferiens
(two systolic peaks per cycle)
Answer: Aortic regurgitation,
HOCM
●● What causes pulsus alternans
Answer: Severe LV dysfunction
●● What causes pulsus tardus
Answer: Aortic stenosis
●● How do positional maneuvers affect blood flow and murmurs
Answer: -standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
SCRIPT WITH VERIFIED QUESTIONS AND
ANSWERS
●● When to stop a stress test
Answer: St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
●● Stress test of choice with a LBBB or ventricular pacing?
Answer: Myocardial perfusion imaging with adenosine,
NOT exercising!
●● When to not use doutamine for stress
Answer: History of VT,
severe HTN,
Low BP,
poor echo images
,●● When to not use adenosine for stress
Answer: Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
●● Normals for PA catheter pressures
Answer: RA <8
RV 30/8
PCWP 3-12
PAP 12--12
●● Diastolic pressures
elevated & equalized
in all chambers,
low BP
Answer: tamponade
or restrictive pericarditis
●● Elevated RA and PA pressures,
,decreased or nl PCWP,
hypotension
Answer: RV MI
●● Elevated PCWP, RA pressure
decreased SBP/cardiac output
Answer: cardiogenic shock
●● high RA,
PA very elevated
high PCWP
nl SBP
Answer: mitral stenosis with RV failure
●● Elevated PAP, RAP
nl PCWP, SBP
Answer: pulmonary HTN
●● decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats
Answer: pulsus paradoxus:
, Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
●● What gives you pulsus bisferiens
(two systolic peaks per cycle)
Answer: Aortic regurgitation,
HOCM
●● What causes pulsus alternans
Answer: Severe LV dysfunction
●● What causes pulsus tardus
Answer: Aortic stenosis
●● How do positional maneuvers affect blood flow and murmurs
Answer: -standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
