INTERNAL MEDICINE REVIEW ABIM PART 1 TEST
BANK 2026: 500+ MOST-TESTED QUESTIONS AND
100% VERIFIED ANSWERS | GRADED A+ |
GUARANTEED PASS!!
What is a positive stress test
- answer-Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
What causes a physiologic split S2
- answer-Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2
- answer-Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2
- answer-LBBB,
RV pacing,
HOCM
What causes an S3?
- answer-Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
What are the parts of the venous waveform?
- answer-A wave - atrial contraction
,X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens,
passive emptying into ventricle
What gives elevated a and v waves
- answer-Pulmonary HTN,
RV infarction
Large r side v waves
- answer-Septal rupture
Large v waves
- answer-TR (right),
MR (left)
Rapid x and y descent
- answer-Constrictive pericarditis,
restrictive cardiomyopathy,
tamponade
(x descent only, loss of y descent)
Large a waves
- answer-TS,
severe RVH (on right),
MS
Cannon a waves
- answer-AV disassociation -
complete heart block,
ventricular pacing
When to stop a stress test
- answer-St segment depression > 2 mm,
ventricular tachycardia,
,drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing?
- answer-Myocardial perfusion imaging with adenosine,
NOT exercising!
When to not use doutamine for stress
- answer-History of VT,
severe HTN,
Low BP,
poor echo images
When to not use adenosine for stress
- answer-Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures
- answer-RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP
- answer-tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension
- answer-RV MI
, Elevated PCWP, RA pressure
decreased SBP/cardiac output
- answer-cardiogenic shock
high RA,
PA very elevated
high PCWP
nl SBP
- answer-mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP
- answer-pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats
- answer-pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle)
- answer-Aortic regurgitation,
HOCM
What causes pulsus alternans
- answer-Severe LV dysfunction
What causes pulsus tardus
- answer-Aortic stenosis
How do positional maneuvers affect blood flow and murmurs
- answer--standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
BANK 2026: 500+ MOST-TESTED QUESTIONS AND
100% VERIFIED ANSWERS | GRADED A+ |
GUARANTEED PASS!!
What is a positive stress test
- answer-Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
What causes a physiologic split S2
- answer-Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2
- answer-Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2
- answer-LBBB,
RV pacing,
HOCM
What causes an S3?
- answer-Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
What are the parts of the venous waveform?
- answer-A wave - atrial contraction
,X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens,
passive emptying into ventricle
What gives elevated a and v waves
- answer-Pulmonary HTN,
RV infarction
Large r side v waves
- answer-Septal rupture
Large v waves
- answer-TR (right),
MR (left)
Rapid x and y descent
- answer-Constrictive pericarditis,
restrictive cardiomyopathy,
tamponade
(x descent only, loss of y descent)
Large a waves
- answer-TS,
severe RVH (on right),
MS
Cannon a waves
- answer-AV disassociation -
complete heart block,
ventricular pacing
When to stop a stress test
- answer-St segment depression > 2 mm,
ventricular tachycardia,
,drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing?
- answer-Myocardial perfusion imaging with adenosine,
NOT exercising!
When to not use doutamine for stress
- answer-History of VT,
severe HTN,
Low BP,
poor echo images
When to not use adenosine for stress
- answer-Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures
- answer-RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP
- answer-tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension
- answer-RV MI
, Elevated PCWP, RA pressure
decreased SBP/cardiac output
- answer-cardiogenic shock
high RA,
PA very elevated
high PCWP
nl SBP
- answer-mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP
- answer-pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats
- answer-pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle)
- answer-Aortic regurgitation,
HOCM
What causes pulsus alternans
- answer-Severe LV dysfunction
What causes pulsus tardus
- answer-Aortic stenosis
How do positional maneuvers affect blood flow and murmurs
- answer--standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
