INTERNAL MEDICINE EXAM STUDY GUIDE EOR
2026 FULL QUESTIONS AND ANSWERS
GRADED A+
◉ dx/tx of sick sinus syndrome aka brady-tachy syndrome? Answer:
-dx: combo of sinus arrest w/ alternating paroxysms of atrial
tacharrhythmias and bradyarrhythmias (commonly caused by
sinoatrial node dz and corrective cardiac surgery)
-tx: *permanent pacemaker* (+automatic implantable cardioverter-
defibrillator/AICD if runs of vtach)
◉ how do you diagnose 1st degree AV block? tx? Answer: -prolonged
PR interval (>0.2s/5 small boxes)
-tx: none, just observation
◉ what type of AV block causes a progressively longer PR interval
until a beat is dropped? tx? Answer: 2nd degree- Mobitz Type I
(Wenckebach)
-no tx, just monitor
◉ what type of AV block has a prolonged PR interval that causes
occasionally dropped beats? tx? Answer: 2nd degree- Mobitz Type II
,-tx w/ atropine or temporary pacing bc this one can go into 3rd
degree block!
◉ what type of AV block has complete dissociation of atrial and
ventricular contractions (P and QRS complexes)? tx? Answer: 3rd
degree AV block
-tx: temporary pacing acutely then *permanent pacemaker* for
definitive tx
◉ what is the characteristic appearance and rate of atrial flutter? tx?
Answer: -saw tooth pattern usually reg rhythm at 250-350 bpm
-tx: acutely: if hemodynamically stable w/ *vagal maneuvers, BB, or
CCB*; if unstable w/ *synchronized cardioversion*; definitive tx:
radiofrequency ablation
◉ what is the characteristic appearance and rate of atrial
fibrillation? Answer: -irregularly irregular rhythm w/ narrow QRS,
no P waves, and fibrillatory waves at 350-600 bpm
◉ management of hemodynamically stable atrial fibrillation focuses
on what 2 components of tx? Answer: 1. rate control- BB, CCB,
digoxin
2. rhythm control- synchronized cardioversion (only if Afib <48 hrs
or after 3-4 wks anticoag therapy + TEE to r/o atrial thrombus);
radiofrequency ablation or PPM
,◉ tx of hemodynamically unstable afib? Answer: synchronized
cardioversion
◉ how is a pt with afib or aflutter assessed for risk of embolization?
Answer: CHADS2-VASc
≥2 is mod-high risk and chronic oral anticoags are recommended
(non-vitK antagonist oral anticoagulants (dabigatran, rivaroxaban,
apixaban, edoxaban) > warfarin - bc less risk of ischemic stroke, less
drug interactions, and convenience of not having to check INR)
◉ when are NOACs (dabigatran/Pradaxa, rivaroxaban/Xarelto,
apixaban/Eliquis, edoxaban) preferred over warfarin therapy for
anticoagulation in tx of afib or aflutter? Answer: -CKD w/ GFR <30
-HIV pts on protease inhibitor therapy
-on CP450-inducing antiepileptic meds (carbemazepine, phenytoin)
-prosthetic heart valves
-when cost = dec compliance
◉ what is the INR goal of a pt on warfarin? Answer: 2-3
◉ what is the cause of long QT syndrome? sx's? tx? Answer: -cause:
congenital or acquired (macrolides, TCAs, electrolyte imbalances)
-sx's: syncope, ventricular arrhythmias, sudden cardiac death
, -tx: discontinue offending drugs, correct electrolyte imbalances;
definitive: *AICD*
◉ what are the causes of paroxysmal supraventricular tachycardia?
sx's? EKG appearance? tx? Answer: -causes: unknown but may be
alcohol, caffeine, dehydration, nicotine, psychological stress, WPW
-sx's: palps, lightheadedness, sweating, SOB, CP but often none at all
-EKG: rate b/t 150-240 and *narrow QRS* complexes
-tx: 1st *vagal* maneuvers; then if nml BP *adenosine*; next try BBs
or CCBs; if unstable synchronized cardioversion
◉ what irregular rhythm is associated with very ill pts w/ COPD?
Answer: multifocal atrial tachycardia
◉ how many P wave morphologies must be different to diagnose a
pt w/ wandering pacemaker or multifocal atrial tachycardia?
Answer: 3
◉ what is the difference between the 2 irregular rhythms
"wandering atrial pacemaker" and "multifocal atrial tachycardia"?
Answer: they both have atrial depolarization starting from locations
other than just the SA node (leading to different P wave
morphologies on EKG) but the only difference is WP has a HR <100
and MAT has a HR >100
2026 FULL QUESTIONS AND ANSWERS
GRADED A+
◉ dx/tx of sick sinus syndrome aka brady-tachy syndrome? Answer:
-dx: combo of sinus arrest w/ alternating paroxysms of atrial
tacharrhythmias and bradyarrhythmias (commonly caused by
sinoatrial node dz and corrective cardiac surgery)
-tx: *permanent pacemaker* (+automatic implantable cardioverter-
defibrillator/AICD if runs of vtach)
◉ how do you diagnose 1st degree AV block? tx? Answer: -prolonged
PR interval (>0.2s/5 small boxes)
-tx: none, just observation
◉ what type of AV block causes a progressively longer PR interval
until a beat is dropped? tx? Answer: 2nd degree- Mobitz Type I
(Wenckebach)
-no tx, just monitor
◉ what type of AV block has a prolonged PR interval that causes
occasionally dropped beats? tx? Answer: 2nd degree- Mobitz Type II
,-tx w/ atropine or temporary pacing bc this one can go into 3rd
degree block!
◉ what type of AV block has complete dissociation of atrial and
ventricular contractions (P and QRS complexes)? tx? Answer: 3rd
degree AV block
-tx: temporary pacing acutely then *permanent pacemaker* for
definitive tx
◉ what is the characteristic appearance and rate of atrial flutter? tx?
Answer: -saw tooth pattern usually reg rhythm at 250-350 bpm
-tx: acutely: if hemodynamically stable w/ *vagal maneuvers, BB, or
CCB*; if unstable w/ *synchronized cardioversion*; definitive tx:
radiofrequency ablation
◉ what is the characteristic appearance and rate of atrial
fibrillation? Answer: -irregularly irregular rhythm w/ narrow QRS,
no P waves, and fibrillatory waves at 350-600 bpm
◉ management of hemodynamically stable atrial fibrillation focuses
on what 2 components of tx? Answer: 1. rate control- BB, CCB,
digoxin
2. rhythm control- synchronized cardioversion (only if Afib <48 hrs
or after 3-4 wks anticoag therapy + TEE to r/o atrial thrombus);
radiofrequency ablation or PPM
,◉ tx of hemodynamically unstable afib? Answer: synchronized
cardioversion
◉ how is a pt with afib or aflutter assessed for risk of embolization?
Answer: CHADS2-VASc
≥2 is mod-high risk and chronic oral anticoags are recommended
(non-vitK antagonist oral anticoagulants (dabigatran, rivaroxaban,
apixaban, edoxaban) > warfarin - bc less risk of ischemic stroke, less
drug interactions, and convenience of not having to check INR)
◉ when are NOACs (dabigatran/Pradaxa, rivaroxaban/Xarelto,
apixaban/Eliquis, edoxaban) preferred over warfarin therapy for
anticoagulation in tx of afib or aflutter? Answer: -CKD w/ GFR <30
-HIV pts on protease inhibitor therapy
-on CP450-inducing antiepileptic meds (carbemazepine, phenytoin)
-prosthetic heart valves
-when cost = dec compliance
◉ what is the INR goal of a pt on warfarin? Answer: 2-3
◉ what is the cause of long QT syndrome? sx's? tx? Answer: -cause:
congenital or acquired (macrolides, TCAs, electrolyte imbalances)
-sx's: syncope, ventricular arrhythmias, sudden cardiac death
, -tx: discontinue offending drugs, correct electrolyte imbalances;
definitive: *AICD*
◉ what are the causes of paroxysmal supraventricular tachycardia?
sx's? EKG appearance? tx? Answer: -causes: unknown but may be
alcohol, caffeine, dehydration, nicotine, psychological stress, WPW
-sx's: palps, lightheadedness, sweating, SOB, CP but often none at all
-EKG: rate b/t 150-240 and *narrow QRS* complexes
-tx: 1st *vagal* maneuvers; then if nml BP *adenosine*; next try BBs
or CCBs; if unstable synchronized cardioversion
◉ what irregular rhythm is associated with very ill pts w/ COPD?
Answer: multifocal atrial tachycardia
◉ how many P wave morphologies must be different to diagnose a
pt w/ wandering pacemaker or multifocal atrial tachycardia?
Answer: 3
◉ what is the difference between the 2 irregular rhythms
"wandering atrial pacemaker" and "multifocal atrial tachycardia"?
Answer: they both have atrial depolarization starting from locations
other than just the SA node (leading to different P wave
morphologies on EKG) but the only difference is WP has a HR <100
and MAT has a HR >100
