Internal Medicine COMAT Review | Complete Practice Questions & Verified Answers
ECG leads representing anterior wall V1-4 (LAD)
ECG leads representing the inferior portion of the heart II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall I, AVL, V5, & V6
When should you consider immediate diagnostic order immediate diagnostic coronary angiography for a STEMI or new-onset Left
coronary angiography? BBB
Another name for angioplasty... Primary
In an acute inferior wall myocardial infarction, occlusion Right coronary artery
of which coronary artery is usually implicated?
Difference in sounds between COPD and pulmonary Wheezing or rhonchi= more suggestive of COPD
edema/interstitial lung disease. Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound CHF
What are S3 heart sounds S3 results from increased atrial pressure leading to increased flow rates, as seen
in congestive heart failure, which is the most common cause of an S3 heart
sound.
causes of a mid-systolic non-radiating murmur High output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? It's an early DIASTOLIC murmur heard in the 2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram 1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE Hampton hump (shallow wedge-shaped opacity in the periphery of the lung w/its
base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of
vessel) seen distal to a PE. It's due to a combo of dilation of the pulmonary
arteries proximal to the embolus & collapse of the distal vasculature creating the
appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
, Internal Medicine COMAT Review | Complete Practice Questions & Verified Answers
Medications that have been shown to decrease mortality -ACE inhibitors
in systolic heart failure -ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency BP reduction of 25% in the first few hours to day in order to avoid reducing the
BP too quickly.
Roth spots Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for
hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for
women (or on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy 1. current ASCVD (atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3)
asymmetric calf swelling
*Virchow's Triad Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient Arterial blood gases (ABGs) in pulmonary thromboembolism usually reveal an
acute respiratory alkalosis secondary to hyperventilation.
Timeframe for acute vs chronic arthritis Acute <6 weeks
Chronic >6 weeks
Rhonchi Low-pitched, continuous sounds often described as similar to a snoring sound.
Generated by narrowing of larger airways due to mucus from bronchitis or
narrowing from asthma or COPD
Wheezes High-pitched whistling sound during breathing when air flows through a narrowed
airway, most commonly heard in asthmatics.
Crackles Synonymous with rales. A discontinuous sound heard more often during
inhalation caused by airway opening. The sounds are often divided into dry or
moist, with the dryness being caused by disease processes such as fibrosis and
the moistness or wetness being secondary to heart failure or pneumonia.
Antibiotic of choice for uncomplicated pneumonia Azithromycin
What is neutropenic fever Neutropenic fever= temperature greater than 38.3 C (101 F) & an absolute
neutrophil count less than 500.
, Internal Medicine COMAT Review | Complete Practice Questions & Verified Answers
What antibiotics are appropriate for patients with Antibiotics used in neutropenic fever need to treat for pseudomonas (since it can
neutropenic fever? be lethal in septic patients if left untreated)--> ceftazadime, cefepime, piperacillin-
tazobactam, meropenem, imipenem.
For persistent neutropenic fevers, after giving broad For persistenet neutropenic fevers, add a broad spectrum anti-fungal agent (like
spectrum antibiotics that cover for pseudomonas, what amphotericin B).
should be added?
Centor Criteria for Strep Throat 4 criteria= fever, tonsillar exudates, tender anterior cervical lymphadenopathy,
absence of cough.
Score of 0/1= no test.
Score of 2= RADT (rapid antigen detection test)
Score of 3/4= not test.
Score of 0/1= no treatment
Score of 2= Penicillin V if positive RADT
Score of 3/4= Emperic Penicillin V
Causes of orthostatic hypotension Causes of orthostatic hypotension can include medications, hypovolemia,
cardiac insufficiency, and diabetic neuropathy.
vesicular breath sounds Normal breath sounds in the lung, characterized by a long inspiratory phase
followed by a short expiratory phase
Bronchial breath sounds Compared to vesicular breath sounds, bronchial breath sounds have a louder,
shorter inspiratory phase and louder, prolonged expiratory phase. This is a
normal finding when heard over the trachea. However, when bronchial breath
sounds are heard in a location other than the trachea, it is suggestive of
pulmonary consolidation (meaning the alveoli are full of something other than air
such as pus, water, or blood).
What do you do if you hear decreased breath sounds When you hear decreased breath sounds, percuss out the lungs.
upon auscultation? Dullness to percussion in an area of decreased breath sounds suggests pleural
effusion, whereas hyperresonance suggests pneumothorax.
Criteria used to decide whether to admit patients with PORT (pneumonia severity index score) & CURB-65:
community-acquired pneumonia C=confusion
U=blood Urea nitrogen >19
R=Respiratory rate (>30 breaths/minute)
B=Blood Pressure (systolic <90 or diastolic <60)
age>65
w/CURB-65, consider hospitalization w/score of 1/2; urgent hospitalization if
score score 3-4
Bloody lumbar puncture is associated with... Subarachnoid hemorrhage & herpes encephalopathy.
Common associations w/Waterhouse-Friderichsen DIC & petechial rash.
syndrome (hemorrhage of adrenal glands & septic shock
from N meningitidis)
Common presentation of acute lymphoblastic leukemia Presents in a younger child (2-5 years old) with fever (due to neutropenia), pallor
(ALL) & fatigue due to anemia, & petechiae (due to thrombocytopenia).
What's a major differentiating factor between TTP/HUS DIC is associated with an increase in both PT and PTT (not TTP/HUS), and
and DIC? bleeding usually occurs at venipuncture sites.
What are some differentiating factors btwn TTP and HUS HUS is often associated with a prodromal bloody diarrhea
TTP often is associated with neurological deficits
ECG leads representing anterior wall V1-4 (LAD)
ECG leads representing the inferior portion of the heart II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall I, AVL, V5, & V6
When should you consider immediate diagnostic order immediate diagnostic coronary angiography for a STEMI or new-onset Left
coronary angiography? BBB
Another name for angioplasty... Primary
In an acute inferior wall myocardial infarction, occlusion Right coronary artery
of which coronary artery is usually implicated?
Difference in sounds between COPD and pulmonary Wheezing or rhonchi= more suggestive of COPD
edema/interstitial lung disease. Crackles= more suggestive of pulmonary edema or interstitial lung disease.
Most common cause of an S3 heart sound CHF
What are S3 heart sounds S3 results from increased atrial pressure leading to increased flow rates, as seen
in congestive heart failure, which is the most common cause of an S3 heart
sound.
causes of a mid-systolic non-radiating murmur High output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated? It's an early DIASTOLIC murmur heard in the 2nd LEFT-upper sternal border.
Indications for ordering an echocardiogram 1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE Hampton hump (shallow wedge-shaped opacity in the periphery of the lung w/its
base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to collapse of
vessel) seen distal to a PE. It's due to a combo of dilation of the pulmonary
arteries proximal to the embolus & collapse of the distal vasculature creating the
appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
, Internal Medicine COMAT Review | Complete Practice Questions & Verified Answers
Medications that have been shown to decrease mortality -ACE inhibitors
in systolic heart failure -ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency BP reduction of 25% in the first few hours to day in order to avoid reducing the
BP too quickly.
Roth spots Retinal hemorrhages w/pale centers...usually seen in bacterial endocarditis
Definition of metabolic syndrome Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for
hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for
women (or on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for women)
4 groups of ppl most likely to benefit from statin therapy 1. current ASCVD (atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3)
asymmetric calf swelling
*Virchow's Triad Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient Arterial blood gases (ABGs) in pulmonary thromboembolism usually reveal an
acute respiratory alkalosis secondary to hyperventilation.
Timeframe for acute vs chronic arthritis Acute <6 weeks
Chronic >6 weeks
Rhonchi Low-pitched, continuous sounds often described as similar to a snoring sound.
Generated by narrowing of larger airways due to mucus from bronchitis or
narrowing from asthma or COPD
Wheezes High-pitched whistling sound during breathing when air flows through a narrowed
airway, most commonly heard in asthmatics.
Crackles Synonymous with rales. A discontinuous sound heard more often during
inhalation caused by airway opening. The sounds are often divided into dry or
moist, with the dryness being caused by disease processes such as fibrosis and
the moistness or wetness being secondary to heart failure or pneumonia.
Antibiotic of choice for uncomplicated pneumonia Azithromycin
What is neutropenic fever Neutropenic fever= temperature greater than 38.3 C (101 F) & an absolute
neutrophil count less than 500.
, Internal Medicine COMAT Review | Complete Practice Questions & Verified Answers
What antibiotics are appropriate for patients with Antibiotics used in neutropenic fever need to treat for pseudomonas (since it can
neutropenic fever? be lethal in septic patients if left untreated)--> ceftazadime, cefepime, piperacillin-
tazobactam, meropenem, imipenem.
For persistent neutropenic fevers, after giving broad For persistenet neutropenic fevers, add a broad spectrum anti-fungal agent (like
spectrum antibiotics that cover for pseudomonas, what amphotericin B).
should be added?
Centor Criteria for Strep Throat 4 criteria= fever, tonsillar exudates, tender anterior cervical lymphadenopathy,
absence of cough.
Score of 0/1= no test.
Score of 2= RADT (rapid antigen detection test)
Score of 3/4= not test.
Score of 0/1= no treatment
Score of 2= Penicillin V if positive RADT
Score of 3/4= Emperic Penicillin V
Causes of orthostatic hypotension Causes of orthostatic hypotension can include medications, hypovolemia,
cardiac insufficiency, and diabetic neuropathy.
vesicular breath sounds Normal breath sounds in the lung, characterized by a long inspiratory phase
followed by a short expiratory phase
Bronchial breath sounds Compared to vesicular breath sounds, bronchial breath sounds have a louder,
shorter inspiratory phase and louder, prolonged expiratory phase. This is a
normal finding when heard over the trachea. However, when bronchial breath
sounds are heard in a location other than the trachea, it is suggestive of
pulmonary consolidation (meaning the alveoli are full of something other than air
such as pus, water, or blood).
What do you do if you hear decreased breath sounds When you hear decreased breath sounds, percuss out the lungs.
upon auscultation? Dullness to percussion in an area of decreased breath sounds suggests pleural
effusion, whereas hyperresonance suggests pneumothorax.
Criteria used to decide whether to admit patients with PORT (pneumonia severity index score) & CURB-65:
community-acquired pneumonia C=confusion
U=blood Urea nitrogen >19
R=Respiratory rate (>30 breaths/minute)
B=Blood Pressure (systolic <90 or diastolic <60)
age>65
w/CURB-65, consider hospitalization w/score of 1/2; urgent hospitalization if
score score 3-4
Bloody lumbar puncture is associated with... Subarachnoid hemorrhage & herpes encephalopathy.
Common associations w/Waterhouse-Friderichsen DIC & petechial rash.
syndrome (hemorrhage of adrenal glands & septic shock
from N meningitidis)
Common presentation of acute lymphoblastic leukemia Presents in a younger child (2-5 years old) with fever (due to neutropenia), pallor
(ALL) & fatigue due to anemia, & petechiae (due to thrombocytopenia).
What's a major differentiating factor between TTP/HUS DIC is associated with an increase in both PT and PTT (not TTP/HUS), and
and DIC? bleeding usually occurs at venipuncture sites.
What are some differentiating factors btwn TTP and HUS HUS is often associated with a prodromal bloody diarrhea
TTP often is associated with neurological deficits
