ABIM Complete Examination For Internal Medicine With Correct Solutions 2023

ABIM Complete Examination For Internal Medicine With Correct Solutions 2023 exam of mitral stenosis - CORRECT ANSWER-low pitched rumble heard best at apex No radiation heard best in left lateral decubitis position opening snap palpable P2 mitral stenosis tx. preferred repair method? - CORRECT ANSWER-balloon valvoplasty works well if there is not very much MR and no LA appendage clot. (If either present, go to MR replacement). mitral stenosis tx. when to repair? - CORRECT ANSWER-Repair if either of the following are present: a) patient symptomatic b) abnormal hemodynamic response to exercise (PAP increases by 25mmHg) aortic stenosis repair. Timing of intervention? - CORRECT ANSWER-Repair by AV replacement if either is present: a) patient symptomatic b) EF less than 50% c) pt needs thoracic surgery for other reason (e. g. CABG) aortic regurg. timing of repair? - CORRECT ANSWER-Repair by AV replacement (+/- aortic root replacement) if either is present: a) patient syptomatic b) EF less than 50% c) end-systolic dimension is less than 55mm or end-diastolic dimension is less than 70mm d) abnormal response to exercise (PAP increases by 25mmHg). indications for spironolactone in CHF - CORRECT ANSWER-NYHA class III-IV pts with acceptable serum K+ levels Indication for ICD in CHF - CORRECT ANSWER-Must meet all below criteria: a) NYHA class II-III symptoms while on optimal medication regimen b) expected to survive longer then 1 yr c) Either of the following: - EF under 35% OR - history of ventricular arrthymia or cardiac arrest (2ndary prevention) aortic regurg exam - CORRECT ANSWER-diastolic decresendo murmur heard best in LLSB enlarged apical impulse widened pulse pressure with bounding carotid pulses murmur heard best upright and leaning forward and at end-expiration mitral regurg exam - CORRECT ANSWER-holosystolic murmur heard best at apex radiates to back of axilla may eventually develop an S3 and laterally displaced apex due to pulmonary congestion mitral regurg repair - timing - CORRECT ANSWER-repair by mitral valve replacement if either is present a) symptomatic pt (NYHA class II-IV) b) end diastolic LV diameter below 40mm List the HACEK organisms - CORRECT ANSWER-Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella Indications for endocarditis prophylaxisfor dental procedures - CORRECT ANSWER-If any of the below are present: a) prosthetic valves or prosthetic material b) prior endocarditis c) congenital heart disease (that is unrepaired cyanotic or repaired) d) valve disease in heart transplant pts exam findings in ASD - CORRECT ANSWER-** fixed split S2 associated with Down syndrome RV heave if large L->R shunt is present, can also have diastolic rumble over tricuspid valve and a midsystolic murmur over pulmonic valve absence of physiologic sinus arrthymia when to repair ASDs? - CORRECT ANSWER-if there is either a) symptoms secondary to ASD b) evidence of right-sided volume overload When should a pt with CHF get a CRT+ ICD instead of a plain old ICD? - CORRECT ANSWER-Pt must have all of the following: - NYHA class III-IV symptoms - EF under 35% - QRS longer than 120msec or LBBB NYHA classes - CORRECT ANSWER-I - no symptoms II - slight limitation in physical activity III - marked limitation in physical acticity IV - inability to preform any physical activity without symptoms Indications for adding hydralazine/isodril to CHF regimen - CORRECT ANSWER-- black pts with NYHA class III-IV CHF chemo agents associated with cardiotoxicity - CORRECT ANSWER-anthracyclines (doxirubicin) trastuzumab (ab against her2 neu) compare 3 types of event recorders and indications in diagnosing arrthymias - CORRECT ANSWER-1) event monitor - held to the chest when symptoms start. Do not get start of arrthymia. not useful for syncope 2) loop recorder - continuous EKG leads worn. Starts recording only when activated by pt, but can go back and get rhythm 30 seconds prior to activation. Good for symptomatic infrequent arrthymias and syncope 3) implanted recorder. Device start recording when rate of rhythm is abnormal (not pt triggered). invasive. Good for asymptomatic arrthymias. role of plavix in chronic stable angina? - CORRECT ANSWER-Controversial Duration of plavix following stent placement - CORRECT ANSWER-DES - at least one year BMS - at least 1 month therapy for NSTEMI or UA? - CORRECT ANSWER-Therapy based on TIMI score a) low risk (TIMI 0-2): MONAB + plavix, statin. Consider heparin and pre-discharge stress test b) intermediate or high risk (TIMI 3-7); above + GP IIb/IIIa inhibitor RV MI - what leads will be +? classic presentation> therapy? - CORRECT ANSWER-ST elevation in II, II and aVF. Right sided EKG will show STEMI in v3, v4 classic presentaion = hypotension, clear lung fields and +JVD therapy - volume and avoid nitrates TIMI score components - CORRECT ANSWER-age over 65 3+ CV risk factors recent aspirin use documented CAD (+ 50% stenosis) ST segment deviation elevated biomarkers 2+ angina episodes in last 24hrs Name the 3 glycoprotein IIIb/IIa inhibitors - CORRECT ANSWER-tirofiban eptifibatide abciximab Name the 3 thrombolytics used in STEMI - CORRECT ANSWER-alteplase retetenecte