Aquifer IM Exam
In a patient presenting with possible ACS, what are the next steps in management? (3)
correct answersEKG, aspirin, troponins
Most likely diagnoses for chest pain? (5) correct answersGERD, muscular strain,
NSTEMI, PE, unstable angina
What management for a patient with ongoing chest pain due to unstable angina? (6)
correct answersAngiography with PCI; aspirin; beta blocker; heparin; statin; sublingual
nitroglycerin
Appropriate admission orders for unstable angina? (4) correct answersBed rest, PO
metoprolol, telemetry monitoring, LMWH
What are the absolute contraindications for thrombolytics? (3) correct answersactive
internal bleeding, prior hemorrhagic stroke, recent head trauma
Patient with STEMI should go home on what drugs? (6) correct answersACE inhibitor,
aspirin, beta blocker, clopidogrel, statin, sublingual nitro PRN
What are the top differential diagnoses for intermittent exertional chest pain and SOB?
(2) correct answersangina, GERD
What are risk factors for coronary artery disease? (8) correct answersage > 55 in
females, DM, dyslipidemia, family history of sudden death or premature CAD, HTN,
male sex, obesity, smoking
How to evaluate suspected angina? (4) correct answersBMP, CBC, fasting lipid panel,
TSH
What is first-line imaging for suspected angina? correct answersCXR
What is the next step after an abnormal treadmill stress test? correct answerscoronary
angiogram
What are the drug classes for angina? (3) correct answersbeta blockers, calcium
channel blockers, nitrates
Most likely diagnoses for syncope? (4) correct answersValvular cardiac disease;
arrhythmia; neurocardiogenic syncope; ACS
Recommended evaluation of syncope? (4) correct answersEKG, CXR, cardiac
enzymes, TSH
, What meds control the ventricular rate in afib? (3) correct answersBeta blocker,
calcium channel blocker, digoxin
What anticoagulation is most appropriate for afib? correct answersWarfarin po daily (or
heparin)
What is on the differential of dyspnea with lower extremity edema? (6) correct
answersCHF, PE, angina, interstitial lung disease, pulmonary HTN, CKD
What are causes of 2/6 mid systolic murmur at aortic area? (4) correct answersanemia,
aortic sclerosis, aortic stenosis, fever
What are recommendations for HFrEF? (6) correct answersadhere to medicines, check
weight daily, exercise training, immunizations, risk factor control, salt and fluid restriction
What are meds for systolic heart failure shown to decrease mortality?(6) correct
answersACE inhibitors, aldosterone blockers, ARBs, beta blockers, hydralazine and
nitrates, sacubitril & valsartan
What are the two most likely causes of heart failure? correct answersCAD and HTN
What to look for on HTN PE? (6) correct answersdisplaced PMI, discrepant BP b/w
arms & legs, pulsatile abdominal mass, renal artery bruit, retinopathy, thyromegaly
What tests to get on initial evaluation of HTN? In addition to EKG, electrolytes (4)
correct answersdiabetes screening, fasting lipid panel, hematocrit, TSH, urinalysis
When to follow up on BP that is 125/76? correct answerssix months
What are potential side effects of lisinopril? (6) correct answersangioedema, cough,
fatigue, hyperkalemia, hypotension, worsening renal insufficiency
What is the goal BP for hypertensive urgency? correct answers180/90
What is on the differential of hypotension, polyuria, nausea, vomiting, diarrhea? (5)
correct answersacute hyperglycemia, adrenal insufficiency, gastroenteritis, pregnancy,
urosepsis
What is a classic sign of hyperglycemia in DKA? correct answersKussumal breathing
What is the first step in management of HHS? correct answersnormal saline
In a patient with DKA, when is it safe to start the insulin drip? correct answersAfter the
patient has had a dose of long-acting insulin; has had two successive panels showing
an anion gap; when the patient can take food PO
In a patient presenting with possible ACS, what are the next steps in management? (3)
correct answersEKG, aspirin, troponins
Most likely diagnoses for chest pain? (5) correct answersGERD, muscular strain,
NSTEMI, PE, unstable angina
What management for a patient with ongoing chest pain due to unstable angina? (6)
correct answersAngiography with PCI; aspirin; beta blocker; heparin; statin; sublingual
nitroglycerin
Appropriate admission orders for unstable angina? (4) correct answersBed rest, PO
metoprolol, telemetry monitoring, LMWH
What are the absolute contraindications for thrombolytics? (3) correct answersactive
internal bleeding, prior hemorrhagic stroke, recent head trauma
Patient with STEMI should go home on what drugs? (6) correct answersACE inhibitor,
aspirin, beta blocker, clopidogrel, statin, sublingual nitro PRN
What are the top differential diagnoses for intermittent exertional chest pain and SOB?
(2) correct answersangina, GERD
What are risk factors for coronary artery disease? (8) correct answersage > 55 in
females, DM, dyslipidemia, family history of sudden death or premature CAD, HTN,
male sex, obesity, smoking
How to evaluate suspected angina? (4) correct answersBMP, CBC, fasting lipid panel,
TSH
What is first-line imaging for suspected angina? correct answersCXR
What is the next step after an abnormal treadmill stress test? correct answerscoronary
angiogram
What are the drug classes for angina? (3) correct answersbeta blockers, calcium
channel blockers, nitrates
Most likely diagnoses for syncope? (4) correct answersValvular cardiac disease;
arrhythmia; neurocardiogenic syncope; ACS
Recommended evaluation of syncope? (4) correct answersEKG, CXR, cardiac
enzymes, TSH
, What meds control the ventricular rate in afib? (3) correct answersBeta blocker,
calcium channel blocker, digoxin
What anticoagulation is most appropriate for afib? correct answersWarfarin po daily (or
heparin)
What is on the differential of dyspnea with lower extremity edema? (6) correct
answersCHF, PE, angina, interstitial lung disease, pulmonary HTN, CKD
What are causes of 2/6 mid systolic murmur at aortic area? (4) correct answersanemia,
aortic sclerosis, aortic stenosis, fever
What are recommendations for HFrEF? (6) correct answersadhere to medicines, check
weight daily, exercise training, immunizations, risk factor control, salt and fluid restriction
What are meds for systolic heart failure shown to decrease mortality?(6) correct
answersACE inhibitors, aldosterone blockers, ARBs, beta blockers, hydralazine and
nitrates, sacubitril & valsartan
What are the two most likely causes of heart failure? correct answersCAD and HTN
What to look for on HTN PE? (6) correct answersdisplaced PMI, discrepant BP b/w
arms & legs, pulsatile abdominal mass, renal artery bruit, retinopathy, thyromegaly
What tests to get on initial evaluation of HTN? In addition to EKG, electrolytes (4)
correct answersdiabetes screening, fasting lipid panel, hematocrit, TSH, urinalysis
When to follow up on BP that is 125/76? correct answerssix months
What are potential side effects of lisinopril? (6) correct answersangioedema, cough,
fatigue, hyperkalemia, hypotension, worsening renal insufficiency
What is the goal BP for hypertensive urgency? correct answers180/90
What is on the differential of hypotension, polyuria, nausea, vomiting, diarrhea? (5)
correct answersacute hyperglycemia, adrenal insufficiency, gastroenteritis, pregnancy,
urosepsis
What is a classic sign of hyperglycemia in DKA? correct answersKussumal breathing
What is the first step in management of HHS? correct answersnormal saline
In a patient with DKA, when is it safe to start the insulin drip? correct answersAfter the
patient has had a dose of long-acting insulin; has had two successive panels showing
an anion gap; when the patient can take food PO
