Aquifer IM Exam
In a patient presenting with possible ACS, what are the EKG, aspirin, troponins
next steps in management? (3)
Most likely diagnoses for chest pain? (5) GERD, muscular strain, NSTEMI, PE, unstable angina
What management for a patient with ongoing chest pain Angiography with PCI; aspirin; beta blocker; heparin; statin; sublingual
due to unstable angina? (6) nitroglycerin --> NO ACE
Appropriate admission orders for unstable angina? (4) Bed rest, PO metoprolol, telemetry monitoring, LMWH
What are the absolute contraindications for active internal bleeding, prior hemorrhagic stroke, recent head trauma
thrombolytics? (3)
Patient with STEMI should go home on what drugs? (6) ACE inhibitor, aspirin, beta blocker, clopidogrel, statin, sublingual nitro PRN
What are the top differential diagnoses for intermittent angina, GERD
exertional chest pain and SOB? (2)
What are risk factors for coronary artery disease? (8) age > 55 in females, DM, dyslipidemia, family history of sudden death or
premature CAD, HTN, male sex, obesity, smoking
How to evaluate suspected angina? (4) BMP, CBC, fasting lipid panel, TSH
What is first-line imaging for suspected angina? CXR
What is the next step after an abnormal treadmill stress coronary angiogram
test?
What are the drug classes for angina? (3) beta blockers, calcium channel blockers, nitrates
Most likely diagnoses for syncope? (4) Valvular cardiac disease; arrhythmia; neurocardiogenic syncope; ACS
Recommended evaluation of syncope? (4) EKG, CXR, cardiac enzymes, TSH
What meds control the ventricular rate in afib? (3) Beta blocker, calcium channel blocker, digoxin
What anticoagulation is most appropriate for afib? Warfarin po daily (or heparin)
, Aquifer IM Exam
What is on the differential of dyspnea with lower CHF, PE, angina, interstitial lung disease, pulmonary HTN, CKD
extremity edema? (6)
What are causes of 2/6 mid systolic murmur at aortic anemia, aortic sclerosis, aortic stenosis, fever
area? (4)
What are recommendations for HFrEF? (6) adhere to medicines, check weight daily, exercise training, immunizations, risk
factor control, salt and fluid restriction
What are meds for systolic heart failure shown to ACE inhibitors, aldosterone blockers, ARBs, beta blockers, hydralazine and
decrease mortality?(6) nitrates, sacubitril & valsartan
What are the two most likely causes of heart failure? CAD and HTN
What to look for on HTN PE? (6) displaced PMI, discrepant BP b/w arms & legs, pulsatile abdominal mass, renal
artery bruit, retinopathy, thyromegaly
What tests to get on initial evaluation of HTN? In addition diabetes screening, fasting lipid panel, hematocrit, TSH, urinalysis
to EKG, electrolytes (4)
When to follow up on BP that is 125/76? six months
What are potential side effects of lisinopril? (6) angioedema, cough, fatigue, hyperkalemia, hypotension, worsening renal
insufficiency
What is the goal BP for hypertensive urgency? 180/90
What is on the differential of hypotension, polyuria, acute hyperglycemia, adrenal insufficiency, gastroenteritis, pregnancy, urosepsis
nausea, vomiting, diarrhea? (5)
What is a classic sign of hyperglycemia in DKA? Kussumal breathing
What is the first step in management of HHS? normal saline
In a patient with DKA, when is it safe to start the insulin After the patient has had a dose of long-acting insulin; has had two successive
drip? panels showing an anion gap; when the patient can take food PO
What tests should be checked in a patient with newly fasting lipid panel, A1C, urine albumin/creatinine ratio
diagnosed T2DM?
T/F in critically ill medical patients, tight blood sugar False!
control is associated with lower mortality
In a patient presenting with possible ACS, what are the EKG, aspirin, troponins
next steps in management? (3)
Most likely diagnoses for chest pain? (5) GERD, muscular strain, NSTEMI, PE, unstable angina
What management for a patient with ongoing chest pain Angiography with PCI; aspirin; beta blocker; heparin; statin; sublingual
due to unstable angina? (6) nitroglycerin --> NO ACE
Appropriate admission orders for unstable angina? (4) Bed rest, PO metoprolol, telemetry monitoring, LMWH
What are the absolute contraindications for active internal bleeding, prior hemorrhagic stroke, recent head trauma
thrombolytics? (3)
Patient with STEMI should go home on what drugs? (6) ACE inhibitor, aspirin, beta blocker, clopidogrel, statin, sublingual nitro PRN
What are the top differential diagnoses for intermittent angina, GERD
exertional chest pain and SOB? (2)
What are risk factors for coronary artery disease? (8) age > 55 in females, DM, dyslipidemia, family history of sudden death or
premature CAD, HTN, male sex, obesity, smoking
How to evaluate suspected angina? (4) BMP, CBC, fasting lipid panel, TSH
What is first-line imaging for suspected angina? CXR
What is the next step after an abnormal treadmill stress coronary angiogram
test?
What are the drug classes for angina? (3) beta blockers, calcium channel blockers, nitrates
Most likely diagnoses for syncope? (4) Valvular cardiac disease; arrhythmia; neurocardiogenic syncope; ACS
Recommended evaluation of syncope? (4) EKG, CXR, cardiac enzymes, TSH
What meds control the ventricular rate in afib? (3) Beta blocker, calcium channel blocker, digoxin
What anticoagulation is most appropriate for afib? Warfarin po daily (or heparin)
, Aquifer IM Exam
What is on the differential of dyspnea with lower CHF, PE, angina, interstitial lung disease, pulmonary HTN, CKD
extremity edema? (6)
What are causes of 2/6 mid systolic murmur at aortic anemia, aortic sclerosis, aortic stenosis, fever
area? (4)
What are recommendations for HFrEF? (6) adhere to medicines, check weight daily, exercise training, immunizations, risk
factor control, salt and fluid restriction
What are meds for systolic heart failure shown to ACE inhibitors, aldosterone blockers, ARBs, beta blockers, hydralazine and
decrease mortality?(6) nitrates, sacubitril & valsartan
What are the two most likely causes of heart failure? CAD and HTN
What to look for on HTN PE? (6) displaced PMI, discrepant BP b/w arms & legs, pulsatile abdominal mass, renal
artery bruit, retinopathy, thyromegaly
What tests to get on initial evaluation of HTN? In addition diabetes screening, fasting lipid panel, hematocrit, TSH, urinalysis
to EKG, electrolytes (4)
When to follow up on BP that is 125/76? six months
What are potential side effects of lisinopril? (6) angioedema, cough, fatigue, hyperkalemia, hypotension, worsening renal
insufficiency
What is the goal BP for hypertensive urgency? 180/90
What is on the differential of hypotension, polyuria, acute hyperglycemia, adrenal insufficiency, gastroenteritis, pregnancy, urosepsis
nausea, vomiting, diarrhea? (5)
What is a classic sign of hyperglycemia in DKA? Kussumal breathing
What is the first step in management of HHS? normal saline
In a patient with DKA, when is it safe to start the insulin After the patient has had a dose of long-acting insulin; has had two successive
drip? panels showing an anion gap; when the patient can take food PO
What tests should be checked in a patient with newly fasting lipid panel, A1C, urine albumin/creatinine ratio
diagnosed T2DM?
T/F in critically ill medical patients, tight blood sugar False!
control is associated with lower mortality
