MCCQE1 Internal Medicine UPDATED
ACTUAL Exam Questions and CORRECT
Answers
STABLE angina definiton - CORRECT ANSWER - substernal "gripping" chest pain or
pressure on exertion, relieved w/ rest or NTG
One vessel disease treatment - CORRECT ANSWER - Tx β-blocker + aspirin + nitrates
two vessel treatment - CORRECT ANSWER - Tx β-blocker + aspirin + nitrates vs PTCA
OR CABG
three vessel disease - CORRECT ANSWER - Tx CABG
what is involved in a pharmacological stress test - CORRECT ANSWER - : IV adenosine,
dipyridamole, or dobutamine can stress the heart in place of exercise
The cardiac markers- when do they pick which is most specific? - CORRECT ANSWER -
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? - CORRECT ANSWER - Left-sided
CHF: dyspnea, orthopnea, PND
Right-sided CHF: pitting edema, hepatic congestion, JVD, ascites
NYHA classificaitons in order - CORRECT ANSWER - 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 - CORRECT ANSWER - 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? - CORRECT ANSWER - early P wave that looks
differently than other P waves, tx is reassurance
Afib - CORRECT ANSWER - acute, stable → anticoagulate + • rate control w/ Ca-
blockers
• then cardioversion
MAT - CORRECT ANSWER - ooks like AFib but the P waves are variable, need 3
different P waves for dx
ETIOLOGY OF MAT - CORRECT ANSWER - Etiology: end-stage COPD (MCC)
wpw, what is the characteristic wave and how do we treat - CORRECT ANSWER - "delta
wave" reflects accessory conduction pathway from atria to ventricles, tx is ablation
VTACH TRAETMENT - CORRECT ANSWER - 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 - CORRECT ANSWER - • Tx immediate defib + CPR, then • continue IV
amiodarone
ACTUAL Exam Questions and CORRECT
Answers
STABLE angina definiton - CORRECT ANSWER - substernal "gripping" chest pain or
pressure on exertion, relieved w/ rest or NTG
One vessel disease treatment - CORRECT ANSWER - Tx β-blocker + aspirin + nitrates
two vessel treatment - CORRECT ANSWER - Tx β-blocker + aspirin + nitrates vs PTCA
OR CABG
three vessel disease - CORRECT ANSWER - Tx CABG
what is involved in a pharmacological stress test - CORRECT ANSWER - : IV adenosine,
dipyridamole, or dobutamine can stress the heart in place of exercise
The cardiac markers- when do they pick which is most specific? - CORRECT ANSWER -
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? - CORRECT ANSWER - Left-sided
CHF: dyspnea, orthopnea, PND
Right-sided CHF: pitting edema, hepatic congestion, JVD, ascites
NYHA classificaitons in order - CORRECT ANSWER - 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 - CORRECT ANSWER - 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? - CORRECT ANSWER - early P wave that looks
differently than other P waves, tx is reassurance
Afib - CORRECT ANSWER - acute, stable → anticoagulate + • rate control w/ Ca-
blockers
• then cardioversion
MAT - CORRECT ANSWER - ooks like AFib but the P waves are variable, need 3
different P waves for dx
ETIOLOGY OF MAT - CORRECT ANSWER - Etiology: end-stage COPD (MCC)
wpw, what is the characteristic wave and how do we treat - CORRECT ANSWER - "delta
wave" reflects accessory conduction pathway from atria to ventricles, tx is ablation
VTACH TRAETMENT - CORRECT ANSWER - 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 - CORRECT ANSWER - • Tx immediate defib + CPR, then • continue IV
amiodarone
