PAEA Internal Medicine EOR [2026/2027] | UPDATED
ACTUAL Exam Question and Answer | Exam Script &
Answers
• What is the 1st cardiac enzyme to rise? -✓✓ Troponin, elevated 3 hrs post MI and stay
elevated up to 10-14 days post MI
-Negative Troponin between 6-72 hrs post CP onset indicates strong evidence against
MI
• CK-MB -✓✓ The MB type is specific to myocardial cells. The CK level will increase
approximately 3-4 hours after an MI, peaks at 24 hrs, and stays elevated for 3-4 days.
• MI treatment -✓✓ MONA (morphine, O2, nitrates, ASA), BB, ACEI, thrombolytics
• Beck's triad -✓✓ JVD, hypotension, muffled heart tones
(tamponade)
• S/S of systolic HF -✓✓ orthopnea, nocturnal dyspnea, JVD, edema
• What is diastolic heart failure and what are signs and symptoms of it? -✓✓ ventricle
can't relax which leads to higher filling pressure, pulmonary congestion and decreased
cardiac return
• Treatment for heart failure -✓✓ diuretics (1st line for systolic)
ACEI (slows dz progression)
BB (helpful if HF secondary to ischemia)
Spironolactone
Digoxin (with systolic HF if uncontrolled on ACEI & diuretics)
• Dilated Cardiomyopathy -✓✓ most common type of cardiomyopathy; reduced
ventricular contraction results in dilation of LV
• Diagnosis of dilated cardiomyopathy -✓✓ ECHO: LV dilation
EKG: nonspecific ST and T wave changes
CXR: cardiomegaly, pulmonary congestion
• Hypertrophic Cardiomyopathy -✓✓ small LV, massive hypertrophy especially the
septum, diastolic dysfunction
-transmitted genetically
, • Tx for hypertrophic cardiomyopathy -✓✓ BB/CCB, surgical ablation, dual chamber
pacing
• Restrictive Cardiomyopathy -✓✓ LV small/normal with reduced EF; results from
fibrosis or infiltration of ventricular wall due to many diff causes like DM, radiation,
amyloidosis, etc.
• S/S of Restrictive Cardiomyopathy -✓✓ decreased exercise tolerance, advanced dz
pts have Rt sided congestive failure, pulmonary HTN
• NSTEMI -✓✓ results from incomplete coronary artery occlusion causing ischemia of
only the innermost layers of myocardium
• STEMI -✓✓ results from full thickness necrosis caused by total prolonged occlusion of
coronary artery
• Stable angina lasts how long? -✓✓ subsides at rest, >15 seconds to <15 minutes
• Signs of myocardial ischemia -✓✓ ST depression
inverted T waves
• Acute myocardial infarct -✓✓ ST elevation of 1mm in 2 continuous lead
• Why do IV drug users get infective endocarditis? -✓✓ prone to development of right
side infective endocarditis (pulmonary/tricuspid valves) secondary to injection of
nonsterile material into venous circulation
• S/S of endocarditis -✓✓ fever, AMS, sepsis, dyspnea, stroke due to embolic
phenomena
• Endocarditis physical exam -✓✓ roth spots in eyes (sm white spots on retina
surrounded by hemorrhage), new mitral regurg. or aortic insufficiency murmurs, splinter
hemorrhages, Osler nodes, janeway lesions.
• Splinter hemorrhages -✓✓ linear hemorrhages under nails that represent microemboli
• Osler nodes -✓✓ small tender lesions on fat pads of fingers/toes and represents
immune complex deposition
• Janeway lesions -✓✓ painless, red, macular lesions on hands/feet
• How do you diagnose Endocarditis? -✓✓ modified Duke criteria plus blood cultures
(get cx before giving abx). TEE is 1st test for pt with suspected infective endocarditis
(detection of vegetation is + test)
ACTUAL Exam Question and Answer | Exam Script &
Answers
• What is the 1st cardiac enzyme to rise? -✓✓ Troponin, elevated 3 hrs post MI and stay
elevated up to 10-14 days post MI
-Negative Troponin between 6-72 hrs post CP onset indicates strong evidence against
MI
• CK-MB -✓✓ The MB type is specific to myocardial cells. The CK level will increase
approximately 3-4 hours after an MI, peaks at 24 hrs, and stays elevated for 3-4 days.
• MI treatment -✓✓ MONA (morphine, O2, nitrates, ASA), BB, ACEI, thrombolytics
• Beck's triad -✓✓ JVD, hypotension, muffled heart tones
(tamponade)
• S/S of systolic HF -✓✓ orthopnea, nocturnal dyspnea, JVD, edema
• What is diastolic heart failure and what are signs and symptoms of it? -✓✓ ventricle
can't relax which leads to higher filling pressure, pulmonary congestion and decreased
cardiac return
• Treatment for heart failure -✓✓ diuretics (1st line for systolic)
ACEI (slows dz progression)
BB (helpful if HF secondary to ischemia)
Spironolactone
Digoxin (with systolic HF if uncontrolled on ACEI & diuretics)
• Dilated Cardiomyopathy -✓✓ most common type of cardiomyopathy; reduced
ventricular contraction results in dilation of LV
• Diagnosis of dilated cardiomyopathy -✓✓ ECHO: LV dilation
EKG: nonspecific ST and T wave changes
CXR: cardiomegaly, pulmonary congestion
• Hypertrophic Cardiomyopathy -✓✓ small LV, massive hypertrophy especially the
septum, diastolic dysfunction
-transmitted genetically
, • Tx for hypertrophic cardiomyopathy -✓✓ BB/CCB, surgical ablation, dual chamber
pacing
• Restrictive Cardiomyopathy -✓✓ LV small/normal with reduced EF; results from
fibrosis or infiltration of ventricular wall due to many diff causes like DM, radiation,
amyloidosis, etc.
• S/S of Restrictive Cardiomyopathy -✓✓ decreased exercise tolerance, advanced dz
pts have Rt sided congestive failure, pulmonary HTN
• NSTEMI -✓✓ results from incomplete coronary artery occlusion causing ischemia of
only the innermost layers of myocardium
• STEMI -✓✓ results from full thickness necrosis caused by total prolonged occlusion of
coronary artery
• Stable angina lasts how long? -✓✓ subsides at rest, >15 seconds to <15 minutes
• Signs of myocardial ischemia -✓✓ ST depression
inverted T waves
• Acute myocardial infarct -✓✓ ST elevation of 1mm in 2 continuous lead
• Why do IV drug users get infective endocarditis? -✓✓ prone to development of right
side infective endocarditis (pulmonary/tricuspid valves) secondary to injection of
nonsterile material into venous circulation
• S/S of endocarditis -✓✓ fever, AMS, sepsis, dyspnea, stroke due to embolic
phenomena
• Endocarditis physical exam -✓✓ roth spots in eyes (sm white spots on retina
surrounded by hemorrhage), new mitral regurg. or aortic insufficiency murmurs, splinter
hemorrhages, Osler nodes, janeway lesions.
• Splinter hemorrhages -✓✓ linear hemorrhages under nails that represent microemboli
• Osler nodes -✓✓ small tender lesions on fat pads of fingers/toes and represents
immune complex deposition
• Janeway lesions -✓✓ painless, red, macular lesions on hands/feet
• How do you diagnose Endocarditis? -✓✓ modified Duke criteria plus blood cultures
(get cx before giving abx). TEE is 1st test for pt with suspected infective endocarditis
(detection of vegetation is + test)
