Internal Medicine Review-1928 Questions with Complete Solutions

Internal Medicine Review-1928 Questions with Complete Solutions EKG diagnosis of an MI? - CORRECT ANSWER ST elevation - immediately T wave inversion - 6 hrs - 1 day Q wave - lasts forever ECG leads corresponding to areas of MI? - CORRECT ANSWER Anterior wall - LAD artery - V1-V4 Lateral wall - circumflex artery - Lead I, aVL Inferior wall - RCA - Lead II, III, aVF Best first and second test for chest pain? - CORRECT ANSWER 1. EKG 2. Cardiac enzymes Cardiac enzymes? - CORRECT ANSWER 1. Myoglobin - rises 1st, peaks in 2 hrs, normal by 24 hrs 2. CKMB - rises in 3-5 hrs, peaks 24 hrs, normal by 72 hrs. 3. Troponin I - rises in 3-5 hrs, peaks 24 hrs, normal by 7-10 days CKMB best for diagnosis of reinfarction How often to draw cardiac enzymes? - CORRECT ANSWER Draw cardiac enzymes once on admission and every 8 hours until 3 samples are obtained Post MI complications? (3) MCC of death? New systolic murmur? Acute severe hypotension? VSD? Persistent ST elevation? 1-2 months later - friction rub? - CORRECT ANSWER Most common complications: 1. Arrhythmia 2. LV failure 3. Cardiogenic shock MCC death - V fib Papillary muscle rupture Free wall Cardiac tamponade Interventricular wall rupture Ventricular wall aneurysm Dressler's syndrome (autoimmune pericarditis) Cardiac Tamponade signs/symptoms? - CORRECT ANSWER Beck's triad: Hypotension JVD Muffled heart sounds Pulsus paradoxus (decrease in systolic BP > 10 mmHg during inspiration) ECG shows low voltage QRS and electrical alterans due to "swinging" movement of heart in large effusion Acute pericarditis pain - CORRECT ANSWER Worse with inspiration Better w/ leaning forward Friction rub Diffuse ST elevation