PAEA Internal Medicine EOR [2026/2027] |
UPDATED ACTUAL Exam Question and
Answer | 100% Verified Answers
• normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an
S4 gallop (atrial contraction into a stiff ventricle) is associated with systolic or
diastolic heart failure? -✓✓ diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
• what are the causes of systolic vs diastolic heart failure? -✓✓ -systolic: post
*MI*, *dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
• when the metabolic demands of the body exceed normal cardiac function (d/t
thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the
bone) this is termed ________ heart failure -✓✓ high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic
HTN
• what are some causes of acute vs chronic heart failure? -✓✓ -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
,• explain class I-IV New York Heart Association functional classes -✓✓ -class I:
*no sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary
activity
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even
with minimal exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry out
physical activity
• what compensations does the body make when heart failure (can be due to
something that causes either inc pre/afterload or dec contractility) begins? -✓✓ 1.
sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
• the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-
productive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or
S4, pale skin/cool extremities, sinus tachy, fatigue -✓✓ L-sided HF
• the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver
palpation) -✓✓ R-sided HF
• -CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural
effusion, pulmonary edema
-echo with dec EF
,-inc BNP on labs
are all signs of? -✓✓ heart failure
*BNP released from atrium with preload too high (volume overload)
• what drugs have shown to decrease mortality rates in pts with heart failure? -✓✓
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates,
spironolactone
• in pts who experience the following common side effects of an ACE inhibitor to
treat heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema -✓✓
ARBs (-sartans)
• what vasodilators are often used to treat heart failure? -✓✓ hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
• what is the most effective treatment for symptoms of heart failure? -✓✓ diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo
on these electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
, -HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia,
hyperuricemia, hyperglycemia
• what medications are used to treat acute severe heart failure? -✓✓
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
• giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart
failure? -✓✓ -dec RAAS activity
-inc Na+/H2O excretion
• why are beta-blockers started after ACE inhibitors/diuretics in heart failure? -✓✓
want to decrease afterload/preload before slowing down the heart rate
• at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator? -✓✓ EF <35% because they tolerate arrhythmias poorly and there is
inc mortality rate
• what medication used to treat *systolic* heart failure is a selective sinus node
inhibitor that slows the sinus rate? -✓✓ *ivabradine*: dec mortality rate in pts w/
EF ≤35%, in sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB
dose or unable to take BB
UPDATED ACTUAL Exam Question and
Answer | 100% Verified Answers
• normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an
S4 gallop (atrial contraction into a stiff ventricle) is associated with systolic or
diastolic heart failure? -✓✓ diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
• what are the causes of systolic vs diastolic heart failure? -✓✓ -systolic: post
*MI*, *dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
• when the metabolic demands of the body exceed normal cardiac function (d/t
thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the
bone) this is termed ________ heart failure -✓✓ high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic
HTN
• what are some causes of acute vs chronic heart failure? -✓✓ -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
,• explain class I-IV New York Heart Association functional classes -✓✓ -class I:
*no sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary
activity
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even
with minimal exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry out
physical activity
• what compensations does the body make when heart failure (can be due to
something that causes either inc pre/afterload or dec contractility) begins? -✓✓ 1.
sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
• the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-
productive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or
S4, pale skin/cool extremities, sinus tachy, fatigue -✓✓ L-sided HF
• the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver
palpation) -✓✓ R-sided HF
• -CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural
effusion, pulmonary edema
-echo with dec EF
,-inc BNP on labs
are all signs of? -✓✓ heart failure
*BNP released from atrium with preload too high (volume overload)
• what drugs have shown to decrease mortality rates in pts with heart failure? -✓✓
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates,
spironolactone
• in pts who experience the following common side effects of an ACE inhibitor to
treat heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema -✓✓
ARBs (-sartans)
• what vasodilators are often used to treat heart failure? -✓✓ hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
• what is the most effective treatment for symptoms of heart failure? -✓✓ diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo
on these electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
, -HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia,
hyperuricemia, hyperglycemia
• what medications are used to treat acute severe heart failure? -✓✓
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
• giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart
failure? -✓✓ -dec RAAS activity
-inc Na+/H2O excretion
• why are beta-blockers started after ACE inhibitors/diuretics in heart failure? -✓✓
want to decrease afterload/preload before slowing down the heart rate
• at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator? -✓✓ EF <35% because they tolerate arrhythmias poorly and there is
inc mortality rate
• what medication used to treat *systolic* heart failure is a selective sinus node
inhibitor that slows the sinus rate? -✓✓ *ivabradine*: dec mortality rate in pts w/
EF ≤35%, in sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB
dose or unable to take BB
