Internal Medicine COMAT Review
Questions and Answers Graded A
ECG leads representing anterior wall - ANS -V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ANS -II, III, and aVF (right coronary
artery)
ECG leads representing the lateral myocardial wall - ANS -I, AVL, V5, & V6
When should you consider immediate diagnostic coronary angiography? - ANS -order immediate
diagnostic coronary angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ANS -Primary
In an acute inferior wall myocardial infarction, occlusion of which coronary artery is usually
implicated? - ANS -Right coronary artery
Difference in sounds between COPD and pulmonary edema/interstitial lung disease. - ANS -
Wheezing or rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound - ANS -CHF
What are S3 heart sounds - ANS -S3 results from increased atrial pressure leading to increased
flow rates, as seen in congestive heart failure, which is the most common cause of an S3 heart
sound.
,causes of a mid-systolic non-radiating murmur - ANS -High output states (anemia, fever,
thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ANS -It's an early DIASTOLIC murmur heard in the
2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram - ANS -1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE - ANS -Hampton hump (shallow wedge-shaped
opacity in the periphery of the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of vessel) seen
distal to a PE. It's due to a combo of dilation of the pulmonary arteries proximal to the embolus
& collapse of the distal vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure - ANS -Severe hypothyroidism can cause
CHF.
,Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in systolic heart failure - ANS --ACE
inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency - ANS -BP reduction of 25% in the first few hours to day
in order to avoid reducing the BP too quickly.
Roth spots - ANS -Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome - ANS -Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for women (or
on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy - ANS -1. current ASCVD
(atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
, Well's Criteria - ANS -Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3) asymmetric calf
swelling
*Virchow's Triad - ANS -Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient - ANS -Arterial blood gases (ABGs) in pulmonary
thromboembolism usually reveal an acute respiratory alkalosis secondary to hyperventilation.
Timeframe for acute vs chronic arthritis - ANS -Acute <6 weeks
Chronic >6 weeks
Rhonchi - ANS -Low-pitched, continuous sounds often described as similar to a snoring sound.
Generated by narrowing of larger airways due to mucus from bronchitis or narrowing from
asthma or COPD
Wheezes - ANS -High-pitched whistling sound during breathing when air flows through a
narrowed airway, most commonly heard in asthmatics.
Crackles - ANS -Synonymous with rales. A discontinuous sound heard more often during
inhalation caused by airway opening. The sounds are often divided into dry or moist, with the
dryness being caused by disease processes such as fibrosis and the moistness or wetness being
secondary to heart failure or pneumonia.
Antibiotic of choice for uncomplicated pneumonia - ANS -Azithromycin
Questions and Answers Graded A
ECG leads representing anterior wall - ANS -V1-4 (LAD)
ECG leads representing the inferior portion of the heart - ANS -II, III, and aVF (right coronary
artery)
ECG leads representing the lateral myocardial wall - ANS -I, AVL, V5, & V6
When should you consider immediate diagnostic coronary angiography? - ANS -order immediate
diagnostic coronary angiography for a STEMI or new-onset Left BBB
Another name for angioplasty... - ANS -Primary
In an acute inferior wall myocardial infarction, occlusion of which coronary artery is usually
implicated? - ANS -Right coronary artery
Difference in sounds between COPD and pulmonary edema/interstitial lung disease. - ANS -
Wheezing or rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound - ANS -CHF
What are S3 heart sounds - ANS -S3 results from increased atrial pressure leading to increased
flow rates, as seen in congestive heart failure, which is the most common cause of an S3 heart
sound.
,causes of a mid-systolic non-radiating murmur - ANS -High output states (anemia, fever,
thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? - ANS -It's an early DIASTOLIC murmur heard in the
2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram - ANS -1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE - ANS -Hampton hump (shallow wedge-shaped
opacity in the periphery of the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of vessel) seen
distal to a PE. It's due to a combo of dilation of the pulmonary arteries proximal to the embolus
& collapse of the distal vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure - ANS -Severe hypothyroidism can cause
CHF.
,Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in systolic heart failure - ANS --ACE
inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency - ANS -BP reduction of 25% in the first few hours to day
in order to avoid reducing the BP too quickly.
Roth spots - ANS -Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome - ANS -Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for women (or
on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy - ANS -1. current ASCVD
(atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
, Well's Criteria - ANS -Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3) asymmetric calf
swelling
*Virchow's Triad - ANS -Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient - ANS -Arterial blood gases (ABGs) in pulmonary
thromboembolism usually reveal an acute respiratory alkalosis secondary to hyperventilation.
Timeframe for acute vs chronic arthritis - ANS -Acute <6 weeks
Chronic >6 weeks
Rhonchi - ANS -Low-pitched, continuous sounds often described as similar to a snoring sound.
Generated by narrowing of larger airways due to mucus from bronchitis or narrowing from
asthma or COPD
Wheezes - ANS -High-pitched whistling sound during breathing when air flows through a
narrowed airway, most commonly heard in asthmatics.
Crackles - ANS -Synonymous with rales. A discontinuous sound heard more often during
inhalation caused by airway opening. The sounds are often divided into dry or moist, with the
dryness being caused by disease processes such as fibrosis and the moistness or wetness being
secondary to heart failure or pneumonia.
Antibiotic of choice for uncomplicated pneumonia - ANS -Azithromycin
