INTERNAL MEDICINE EOR EXAMS SCRIPT QUESTIONS
AND ANSWERS 2025/2026 ALL RATED A+
✔✔What is the definition of HFrEF [systolic heart failure]? - ✔✔Heart failure with LVEF
</= 40%
✔✔What is the definition of HFpEF [diastolic heart failure]? - ✔✔Heart failure with LVEF
> 50%
✔✔What are some pharmacologic therapy options for a patient with Stage C HFrEF? -
✔✔Routine use:
Diuretic (if has fluid retention)
ACE-I
ARB (if ACE-I intolerant)
Aldosterone receptor antagonists (NYHA class II-IV with LVEF </= 35% or following an
acute MI with LVEF </= 40% w/sx of HF or DM)
Beta blocker
Selected patients:
Hydralazine and isosorbide dinitrate (For African Americans with NYHA class III-IV
HFrEF on GDMT)
Digoxin
Anticoagulants
✔✔What is the acute management of a patient with acute MI? - ✔✔Hospitalize
Possible cardioversion
Beta blocker (if no late stage heart failure)
Rate control
Morphine
ASA
Oxygen
Nitrates
✔✔What do you *NOT* do with a patient with unstable angina? - ✔✔Send home to treat
as outpatient
✔✔Most common organism causing endocarditis in an IVDU? - ✔✔Staph aureus (or
MRSA)
✔✔Which heart valve is most commonly affected in IVDU with endocarditis? -
✔✔Tricuspid
✔✔How do you treat an IVDU with endocarditis? - ✔✔IV Vancomycin
,✔✔How do you treat diabetic neuropathy? - ✔✔Amitriptyline/Nortriptyline
Gabapentin/pregabalin
Duloxetine
Venlafaxine
✔✔A patient presents with hemiparesis and conjugate gaze paresis. What is the initial
test you do? - ✔✔CT of the head
✔✔What are some signs/symptoms of a middle cerebral artery stroke? -
✔✔Contralateral hemiparesis (worse in the arm and face than in the leg), dysarthria,
hemianesthesia, contralateral homonymous hemianopia, aphasia (if the dominant
hemisphere is affected) or apraxia and sensory neglect (if the nondominant hemisphere
is affected)
✔✔What are some signs/symptoms of a posterior cerebral artery stroke? -
✔✔Contralateral homonymous hemianopia, unilateral cortical blindness, memory loss,
unilateral 3rd cranial nerve palsy, hemiballismus (chorea - flailing, ballistic, undesired
movements of the limbs)
✔✔What are some signs/symptoms of an anterior cerebral artery stroke? -
✔✔Contralateral hemiparesis (maximal in the leg), urinary incontinence, apathy,
confusion, poor judgment, mutism, grasp reflex, gait apraxia
✔✔What are some *absolute* contraindications to giving tPA? - ✔✔1) Acute intracranial
hemorrhage
2) History of ICH
3) Severe uncontrolled HTN (systolic >/= 185 mm Hg or diastolic >/=110 mm Hg )
4) Serious head trauma or stroke in previous 3 months
5) Platelet count <100 000/mm
6) Pts on anticoagulation therapy
✔✔Which diuretic causes *hyperkalemia*? - ✔✔Spironolactone
✔✔Which BP medication do you *NOT* give to a patient with heart failure? - ✔✔CCB
(diltiazem or verapamil)
- negative inotropic effects can exacerbate CHF
✔✔Which antihypertensive medications both slow heart rate and lower blood pressure?
- ✔✔Calcium channel blockers
Beta blockers
✔✔If a patient with HTN is on a beta blocker and a diuretic and their HR goes down to
50 bpm, what do you do? - ✔✔Stop the beta blocker
, ✔✔What is the first line HTN treatment for an African American woman with COPD? -
✔✔Thiazide diuretic
✔✔Which cardiac enzyme rises early and stays elevated for 7 days post MI? -
✔✔Troponin I
✔✔Cardiac enzymes - ✔✔
✔✔What are some side effects of digitalis toxicity? - ✔✔Bradycardia
Arrhythmia
Anorexia, nausea, vomiting, abdominal pain
Lethargy, fatigue, delirium, confusion, disorientation, and weakness
Hyperkalemia
Color vision (chromatopsia, most likely xanthopsia), diplopia, photophobia, decreased
visual acuity, photopsia, scotomas, or blindness
✔✔Which electrolyte abnormalities predispose a patient to digoxin toxicity arrhythmias?
- ✔✔Hypokalemia, hypomagnesemia, and hypercalcemia.
✔✔What are some EKG changes seen with digoxin toxicity? - ✔✔T wave changes
(flattening or inversion)
QT interval shortening
Scooped ST segments with ST depression in the lateral leads
Increased amplitude of the U waves
✔✔What are some arrhythmias seen in digoxin toxicity? - ✔✔#1 - PVCs
Bradycardia
Atrial tachyarrhythmias with AV block
Ventricular bigeminy
Junctional rhythms
Various degrees of AV nodal blockade
Ventricular tachycardia
Ventricular fibrillation
✔✔Does digoxin toxicity cause jaundice? - ✔✔NO
✔✔What side effect of thiazide and loop diuretics can worsen digoxin toxicity? -
✔✔Hypokalemia
✔✔What is the antidote for digoxin toxicity? - ✔✔Digoxin-specific antibody (Fab)
fragments [DigiFab]
✔✔What is the most sensitive and specific test for PE? - ✔✔CT angiogram
AND ANSWERS 2025/2026 ALL RATED A+
✔✔What is the definition of HFrEF [systolic heart failure]? - ✔✔Heart failure with LVEF
</= 40%
✔✔What is the definition of HFpEF [diastolic heart failure]? - ✔✔Heart failure with LVEF
> 50%
✔✔What are some pharmacologic therapy options for a patient with Stage C HFrEF? -
✔✔Routine use:
Diuretic (if has fluid retention)
ACE-I
ARB (if ACE-I intolerant)
Aldosterone receptor antagonists (NYHA class II-IV with LVEF </= 35% or following an
acute MI with LVEF </= 40% w/sx of HF or DM)
Beta blocker
Selected patients:
Hydralazine and isosorbide dinitrate (For African Americans with NYHA class III-IV
HFrEF on GDMT)
Digoxin
Anticoagulants
✔✔What is the acute management of a patient with acute MI? - ✔✔Hospitalize
Possible cardioversion
Beta blocker (if no late stage heart failure)
Rate control
Morphine
ASA
Oxygen
Nitrates
✔✔What do you *NOT* do with a patient with unstable angina? - ✔✔Send home to treat
as outpatient
✔✔Most common organism causing endocarditis in an IVDU? - ✔✔Staph aureus (or
MRSA)
✔✔Which heart valve is most commonly affected in IVDU with endocarditis? -
✔✔Tricuspid
✔✔How do you treat an IVDU with endocarditis? - ✔✔IV Vancomycin
,✔✔How do you treat diabetic neuropathy? - ✔✔Amitriptyline/Nortriptyline
Gabapentin/pregabalin
Duloxetine
Venlafaxine
✔✔A patient presents with hemiparesis and conjugate gaze paresis. What is the initial
test you do? - ✔✔CT of the head
✔✔What are some signs/symptoms of a middle cerebral artery stroke? -
✔✔Contralateral hemiparesis (worse in the arm and face than in the leg), dysarthria,
hemianesthesia, contralateral homonymous hemianopia, aphasia (if the dominant
hemisphere is affected) or apraxia and sensory neglect (if the nondominant hemisphere
is affected)
✔✔What are some signs/symptoms of a posterior cerebral artery stroke? -
✔✔Contralateral homonymous hemianopia, unilateral cortical blindness, memory loss,
unilateral 3rd cranial nerve palsy, hemiballismus (chorea - flailing, ballistic, undesired
movements of the limbs)
✔✔What are some signs/symptoms of an anterior cerebral artery stroke? -
✔✔Contralateral hemiparesis (maximal in the leg), urinary incontinence, apathy,
confusion, poor judgment, mutism, grasp reflex, gait apraxia
✔✔What are some *absolute* contraindications to giving tPA? - ✔✔1) Acute intracranial
hemorrhage
2) History of ICH
3) Severe uncontrolled HTN (systolic >/= 185 mm Hg or diastolic >/=110 mm Hg )
4) Serious head trauma or stroke in previous 3 months
5) Platelet count <100 000/mm
6) Pts on anticoagulation therapy
✔✔Which diuretic causes *hyperkalemia*? - ✔✔Spironolactone
✔✔Which BP medication do you *NOT* give to a patient with heart failure? - ✔✔CCB
(diltiazem or verapamil)
- negative inotropic effects can exacerbate CHF
✔✔Which antihypertensive medications both slow heart rate and lower blood pressure?
- ✔✔Calcium channel blockers
Beta blockers
✔✔If a patient with HTN is on a beta blocker and a diuretic and their HR goes down to
50 bpm, what do you do? - ✔✔Stop the beta blocker
, ✔✔What is the first line HTN treatment for an African American woman with COPD? -
✔✔Thiazide diuretic
✔✔Which cardiac enzyme rises early and stays elevated for 7 days post MI? -
✔✔Troponin I
✔✔Cardiac enzymes - ✔✔
✔✔What are some side effects of digitalis toxicity? - ✔✔Bradycardia
Arrhythmia
Anorexia, nausea, vomiting, abdominal pain
Lethargy, fatigue, delirium, confusion, disorientation, and weakness
Hyperkalemia
Color vision (chromatopsia, most likely xanthopsia), diplopia, photophobia, decreased
visual acuity, photopsia, scotomas, or blindness
✔✔Which electrolyte abnormalities predispose a patient to digoxin toxicity arrhythmias?
- ✔✔Hypokalemia, hypomagnesemia, and hypercalcemia.
✔✔What are some EKG changes seen with digoxin toxicity? - ✔✔T wave changes
(flattening or inversion)
QT interval shortening
Scooped ST segments with ST depression in the lateral leads
Increased amplitude of the U waves
✔✔What are some arrhythmias seen in digoxin toxicity? - ✔✔#1 - PVCs
Bradycardia
Atrial tachyarrhythmias with AV block
Ventricular bigeminy
Junctional rhythms
Various degrees of AV nodal blockade
Ventricular tachycardia
Ventricular fibrillation
✔✔Does digoxin toxicity cause jaundice? - ✔✔NO
✔✔What side effect of thiazide and loop diuretics can worsen digoxin toxicity? -
✔✔Hypokalemia
✔✔What is the antidote for digoxin toxicity? - ✔✔Digoxin-specific antibody (Fab)
fragments [DigiFab]
✔✔What is the most sensitive and specific test for PE? - ✔✔CT angiogram
