MCCQE1 Internal Medicine All Possible Questions and Answers with complete solution

STABLE angina definiton - substernal "gripping" chest pain or pressure on exertion, relieved w/ rest or NTG One vessel disease treatment - Tx β-blocker + aspirin + nitrates two vessel treatment - Tx β-blocker + aspirin + nitrates vs PTCA OR CABG three vessel disease - Tx CABG what is involved in a pharmacological stress test - : IV adenosine, dipyridamole, or dobutamine can stress the heart in place of exercise The cardiac markers- when do they pick which is most specific? - CK-MB: peaks in 24 hrs and lasts 2-3 days, good for recurrence Troponin I: peaks in 24 hrs and lasts 1-2 weeks, most specific Difference between left-sided and right-sided CHF? - Left-sided CHF: dyspnea, orthopnea, PND Right-sided CHF: pitting edema, hepatic congestion, JVD, ascites NYHA classificaitons in order - NYHA class I: sx only w/ vigorous activity (e.g. sports) NYHA class II: sx w/ moderate activity (e.g. stairs) NYHA class III: sx w/ ADLs NYHA class IV: sx at rest CHF classes and treatment - class I → Tx loop diuretic + ACE inhibitor • class II-III → add β- blocker • class IV → add digoxin what is PAC and how do we treat? - early P wave that looks differently than other P waves, tx is reassuranceAfib - acute, stable → anticoagulate + • rate control w/ Ca-blockers • then cardioversion MAT - ooks like AFib but the P waves are variable, need 3 different P waves for dx ETIOLOGY OF MAT - Etiology: end-stage COPD (MCC) wpw, what is the characteristic wave and how do we treat - "delta wave" reflects accessory conduction pathway from atria to ventricles, tx is ablation VTACH TRAETMENT - Sustained VTach: lasts 30 sec, always symptomatic Nonsustained VTach: lasts 30 sec, usually asx Torsades de pointes: rapid, polymorphic VTach due to QT prolongation sustained → Tx IV amiodarone • nonsustained → reassurance • torsades → Tx IV mag sulfate VFIB tx - • Tx immediate defib + CPR, then • continue IV amiodarone sinus brady tx - usually insignificant; if sx → Tx • atropine (blocks vagus nerve) first degree meaning and tx - PR interval 0.2 .. needs reassurance DCM management - echo and CXR to diagnose and tx for CHF AN HEART TXP