INTERNNAL MEDICINE BLUEPRINT
WITH QUESTIONS AND ANSWERS
Describe what the heart is like during diastolic heart failure - correct
answer.💖💖💖💖✔<<<<<Normal/increased EF
thick ventricular walls
small LV chamber
S4 on auscultation
Describe what the heart is like during systolic heart failure - correct
answer.💖💖💖💖✔<<<<<decreased EF
thin ventricular walls
dilated chamber
S3 on auscultation
NYHA classifications of heart failure - correct answer.💖💖💖💖✔<<<<<I - no symptoms or
limitation
II - mild symptoms, slight limitation
III - comfort only at rest, marked limitation of activity
IV - symptoms at rest and inability of physical activity
S/S of L sided Heart failure - correct answer.💖💖💖💖✔<<<<<dyspnea
pulmonary congestion
hypertension - cheyenne stokes breathing
INC adrenergic activation - tachy, pale, diaphoretic
,S/S of R sided heart failure - correct answer.💖💖💖💖✔<<<<<edema
JVD
hepatosplenomegaly
Best way to DX heart failure - correct answer.💖💖💖💖✔<<<<<echo
BNP >100
xray
At what ejection fraction with heart failure should defibrillator placement be made to reduce mortality -
correct answer.💖💖💖💖✔<<<<<<35 %
1st line treatment in outpatient management of heart failure - correct
answer.💖💖💖💖✔<<<<<ACE inhibitor
What medication usually added after ACE Inhibitor in managemnt of heart failure - correct
answer.💖💖💖💖✔<<<<<BBlocker
Most effective initial treatment for symptoms of heart failure - correct
answer.💖💖💖💖✔<<<<<Lasix
Novel Medications for systolic heart failure (2) - correct answer.💖💖💖💖✔<<<<<Entresto
Ivabradine - sinus node inhibitor
Management of Acute Pulmonary Edema/Cong heart failure - correct
answer.💖💖💖💖✔<<<<<LMNOP
Lasix
Morphine
Nitrates
O2
Position - upright to decrease venous return
,Most common cause of secondary hypertension - correct answer.💖💖💖💖✔<<<<<Renovascular -
Renal artery stenois/ fibromuscular dysplasia
Goal BP in general population and diabetics - correct answer.💖💖💖💖✔<<<<<<140/90
Lifestyle modifications decrease systolic blood pressure by how much? - correct
answer.💖💖💖💖✔<<<<<Dec by 5 mm Hg per modication:
weight loss
dash diet
exercise
limit alcohol
First line HTN meds in non-aftrican - correct answer.💖💖💖💖✔<<<<<ACE/ARB
CCB
Thiazide
Management of HTN with comorbidities:
AFib
Angina
Post MI
Sys Heart failure
DM/CKD
BPH
africans
young, caucasion males
Gout - correct answer.💖💖💖💖✔<<<<<AFib - BB or CCB
Angina - BB or CCB
Post MI - BB or ACE
, Sys Heart failure - ACE/ARB , BB, diuretic
DM/CKD - ACE
BPH - alpha blocker
africans - thiazide/CCB
young, caucasion males - thiazide
Gout - Losartan(only ARB that doesnt cause hyperuricemia, CCB
systolic ejctection crescendo descrescendo murmer heard best at RUSB - correct
answer.💖💖💖💖✔<<<<<aortic stenosis
Diastolic rumble murmer heard best at the apex in left lateral decubitus position that may be preceded
by opening snap - correct answer.💖💖💖💖✔<<<<<Mitral Stenosis
Disastolic blowing decrescendo murmer herad best at left upper sternal border
increases with handgrip
descreases with nitrate - correct answer.💖💖💖💖✔<<<<<Aortic Regurgitation
Blowing holosytolic murmer heard best at the apex - correct answer.💖💖💖💖✔<<<<<Mitral
Regurgitation
Mid - Late systolic ejection click heard best at the apex that is accentuated by valsalve maneuver -
correct answer.💖💖💖💖✔<<<<<Mitral Valve prolapse
Harsh midsystolic ejection crescendo decrescendo murmuer heard best at LUSB that radiates to the
neck - correct answer.💖💖💖💖✔<<<<<Pulmonic Stenosis
Graham Steell Murmer - brief decrescendo early diastolic murmuer heard best at LUSB if with full
inspiration - correct answer.💖💖💖💖✔<<<<<Pulmonic Regurgitation
Mid diastolic murmur heard best at left lower sternal border - correct
answer.💖💖💖💖✔<<<<<Tricuspid stenosis
WITH QUESTIONS AND ANSWERS
Describe what the heart is like during diastolic heart failure - correct
answer.💖💖💖💖✔<<<<<Normal/increased EF
thick ventricular walls
small LV chamber
S4 on auscultation
Describe what the heart is like during systolic heart failure - correct
answer.💖💖💖💖✔<<<<<decreased EF
thin ventricular walls
dilated chamber
S3 on auscultation
NYHA classifications of heart failure - correct answer.💖💖💖💖✔<<<<<I - no symptoms or
limitation
II - mild symptoms, slight limitation
III - comfort only at rest, marked limitation of activity
IV - symptoms at rest and inability of physical activity
S/S of L sided Heart failure - correct answer.💖💖💖💖✔<<<<<dyspnea
pulmonary congestion
hypertension - cheyenne stokes breathing
INC adrenergic activation - tachy, pale, diaphoretic
,S/S of R sided heart failure - correct answer.💖💖💖💖✔<<<<<edema
JVD
hepatosplenomegaly
Best way to DX heart failure - correct answer.💖💖💖💖✔<<<<<echo
BNP >100
xray
At what ejection fraction with heart failure should defibrillator placement be made to reduce mortality -
correct answer.💖💖💖💖✔<<<<<<35 %
1st line treatment in outpatient management of heart failure - correct
answer.💖💖💖💖✔<<<<<ACE inhibitor
What medication usually added after ACE Inhibitor in managemnt of heart failure - correct
answer.💖💖💖💖✔<<<<<BBlocker
Most effective initial treatment for symptoms of heart failure - correct
answer.💖💖💖💖✔<<<<<Lasix
Novel Medications for systolic heart failure (2) - correct answer.💖💖💖💖✔<<<<<Entresto
Ivabradine - sinus node inhibitor
Management of Acute Pulmonary Edema/Cong heart failure - correct
answer.💖💖💖💖✔<<<<<LMNOP
Lasix
Morphine
Nitrates
O2
Position - upright to decrease venous return
,Most common cause of secondary hypertension - correct answer.💖💖💖💖✔<<<<<Renovascular -
Renal artery stenois/ fibromuscular dysplasia
Goal BP in general population and diabetics - correct answer.💖💖💖💖✔<<<<<<140/90
Lifestyle modifications decrease systolic blood pressure by how much? - correct
answer.💖💖💖💖✔<<<<<Dec by 5 mm Hg per modication:
weight loss
dash diet
exercise
limit alcohol
First line HTN meds in non-aftrican - correct answer.💖💖💖💖✔<<<<<ACE/ARB
CCB
Thiazide
Management of HTN with comorbidities:
AFib
Angina
Post MI
Sys Heart failure
DM/CKD
BPH
africans
young, caucasion males
Gout - correct answer.💖💖💖💖✔<<<<<AFib - BB or CCB
Angina - BB or CCB
Post MI - BB or ACE
, Sys Heart failure - ACE/ARB , BB, diuretic
DM/CKD - ACE
BPH - alpha blocker
africans - thiazide/CCB
young, caucasion males - thiazide
Gout - Losartan(only ARB that doesnt cause hyperuricemia, CCB
systolic ejctection crescendo descrescendo murmer heard best at RUSB - correct
answer.💖💖💖💖✔<<<<<aortic stenosis
Diastolic rumble murmer heard best at the apex in left lateral decubitus position that may be preceded
by opening snap - correct answer.💖💖💖💖✔<<<<<Mitral Stenosis
Disastolic blowing decrescendo murmer herad best at left upper sternal border
increases with handgrip
descreases with nitrate - correct answer.💖💖💖💖✔<<<<<Aortic Regurgitation
Blowing holosytolic murmer heard best at the apex - correct answer.💖💖💖💖✔<<<<<Mitral
Regurgitation
Mid - Late systolic ejection click heard best at the apex that is accentuated by valsalve maneuver -
correct answer.💖💖💖💖✔<<<<<Mitral Valve prolapse
Harsh midsystolic ejection crescendo decrescendo murmuer heard best at LUSB that radiates to the
neck - correct answer.💖💖💖💖✔<<<<<Pulmonic Stenosis
Graham Steell Murmer - brief decrescendo early diastolic murmuer heard best at LUSB if with full
inspiration - correct answer.💖💖💖💖✔<<<<<Pulmonic Regurgitation
Mid diastolic murmur heard best at left lower sternal border - correct
answer.💖💖💖💖✔<<<<<Tricuspid stenosis
