Internal Medicine EOR Exam
From the hospital: What is a single antibiotic that can be zosyn ie. piperacillin/tazobactam
used for colitis that covers all bacteria? It is NOT QT prolongation
levofloxacin and metronidazole. What is a bad side effect
of levo?
CARDIOLOGY: EKG should be obtained if CP appears CT
cardiac in nature. CXR is initial step to rule out
pneumothorax, pulmonary infiltrates, and rib fractures.
____should be done for patients w worrisome histories
for aortic dissection regardless of CXR or EKG results.
_____is minimally invasive and rapid for detecting aortic TEE - transesophageal echocardiogram
dissection at the bedside.
A ____ is used for pleuritic pain w normal CXR when a V/Q scan - but not good for a small PE
PE is suspected.
A _____is sensitive for small PE and may detect other helical chest CT
chest abnormalities leading to pain.
____is used when CP is esophageal in origin. Esophageal pH monitoring
EKG: A ______suggests underlying heart disease left bundle branch block
(ischemic, hypertensive).
A _____may be indicative of right heart strain (as in right bundle branch block
pulmonary embolus).
____is a term used to describe decreased perfusion and Shock; hypovolemic, cardiogenic, distributive
oxygen delivery to the body. This is best defined by BP =
CO x SVR. What are the three main types?
______shock can be from pump failure from infarction, Cardiogenic
cardiomyopathy, or tamponade, arrhythmia, valve failure,
obstructed outflow from tension pneumothorax or
massive PE.
______shock can be from hemorrhage, diarrhea, heat Hypovolemic
stroke, or third spacing.
______shock can be from sepsis, anaphylaxis, adrenal Distributive
crisis, or myxedema coma.
The formation of _______occurs via: atherosclerotic plaque
a. endothelial dysfunction & formation of fatty streak
b. LDL enters fatty streak and attracts macrophages
c. proliferating smooth muscle cells, connective tissue, &
lipids become incorporated into plaque
d. "fibrous cap" forms
Name some risk factors for CHD. Diabetes Mellitus
Patient Age
Peripheral Vascular disease
Chronic Renal Failure
Elevated homocysteine level
elevated inflammatory markers like CRP
Low Activity Level
Low intake of fruits and vegetables
lack of moderate alcohol intake
, Internal Medicine EOR Exam
_____is insufficiently specific for assessment of patients Exercise stress testing; coronary angiography
with low (<10%) pretest probability of CHD. It is best
reserved for patients with intermediate pretest
probability. Sensitivity and specificity can be increased
with imaging studies such as radionuclide imaging or
echocardiography. What is the gold standard to diagnose
coronary artery disease?
The AHA suggests the following mnemonic for the A: aspirin, ACEi, antianginals - nitrates/CCB
important elements in treatment of stable angina: B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
CCB: Short acting dihydropyridine CCBs ie ____ have Nifedipine
been shown to increase cardiac risk therefore verapamil or diltiazem
nondihydropyridines are recommended. They are amlodipine or nicardipine
___or___. Second generation dihydropyridines have
fewer negative inotropic effects and can be used in
settings of reduced ejection fraction. (ie. ___or___)
Patients with stenosis of left anterior descending, left coronary artery bypass grafting (CABG)
main coronary disease, three vessel disease, or
survivors of sudden cardiac death or sustained VF/VT
would benefit from _________.
_______can be used to relieve symptoms in patients PCI - percutaneous coronary intervention
who fail medical therapy but who do not have significant
enough disease to require CABG.
What are some physical exam findings in an acute MI? entirely normal, fourth heart sound, third heart sound, systolic murmur of acute
mitral regurgitation -- physical exam should focus on signs of PVD which may
increase the suspicion for coronary disease
What is the typical evolution of the EKG in the setting of 1. increase in amplitude of the T wave
a STEMI? 2. ST segment elevation
3. development of Q waves (hours to days)
4. resolution of ST-segment elevation
Cardiac-specific ____is drawn to detect damaged troponin
myocardium. It begins to rise is 6-9 hours, peaks at
approximately 20 hours, and remains in the circulation
for 7-10 days.
For patients with UA or NSTEMI to assess risk. Age >65
TIMI SCORE - 7 point system, more points, higher risk at least 3 risk factors
known coronary artery disease w at least 50% stenosis
ST segment changes
2 episodes of angina in past 24 hours
aspirin use in past week
elevated CK-MB or troponin
What are the absolute contraindications to thrombolytic BHTASC
therapy? BHTASC 1. active Bleeding
2. previous intracranial Hemorrhage
3. intracranial tumor
4. aortic dissection
5. stroke within 1 year
6. closed head injury within past 3 months
Thrombolytics should be given within ______of pain 12 hours; 90 minutes
onset. PCI needs to be performed within _____ of
presentation to medical provider.
CHF: Systolic dysfunction is from decreased ____. contractility (the pump); compliance (the fill)
Diastolic dysfunction is from a decrease in _____.
, Internal Medicine EOR Exam
Most symptoms of heart failure are pulmonary in nature because of increased LV end diastolic pressure that results in pulmonary venous
ie. dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and capillary congestion
cough, & wheezing. Why?
What heart sound is indication of systolic dysfunction? systolic - S3
diastolic dysfunction? diastolic - S4
What are the principal diagnostic testing for CHF? chest radiograph, electrocardiogram, BNP, and echocardiogram
What is the acute treatment for pulmonary edema in L = Lasix
heart failure? LMNOP M = morphine
N = nitroglycerine
O = oxygen
P = positive pressure ventilation
inotropic agents like dobutamine
In chronic CHF with systolic dysfunction, what three ACE inhibitors, cardioselective beta blockers (carvedalol, metaprolol, bisoprolol),
treatments are shown to decrease mortality? Digoxin, and aldosterone antagonists(aldactone)
other inotropic agents, and loop or thiaxide diuretics are
used as required for symptoms - benefit in fewer
hospitalizations.
Hydralazine and nitrates in combination when combined African Americans
with standard therapy is shown to reduce mortality for
what race with class III or IV CHF?
What treatment is used in diastolic dysfunction to control of BP and HR; cardioversion and antiarrythmic medication
improve filling? A fib often worsens with diastolic
dysfunction because of elevated HR and loss of atrial
kick. What two treatments are sometimes necessary?
What treatments improve survival when EF <35% in Automatic cardiac defibrillators, cardiac resynchronization through biventricular
class II/III CFH and sustained VT. pacing
The following are systemic causes for what? brandyarrhythmias
hypoxia
increased intracranial pressure
hypothermia
hypothyroidism
hyperkalemia
What medications may result in bradyarrhythmias? BB, CCB, digoxin
Emergent treatment of bradyarrythmias is with _____for atropine 0.5mg
a patient with bradycardia causing hypotension, CHF,
and syncope.
With sick sinus syndrome or complete heart block, when for symptomatic patients
is a permanent pacemaker indicated?
What type of block are pacemakers indicated even when type II second degree AV block (Mobitz) or bifascicular block with intermittent
the patient is asymptomatic? type II second degree AV block
When accessing for a tachyarrhythmia, what electrolyte disturbances (hypokalemia or hypomagnesemia), digoxin level, TSH,
exacerbating conditions should be evaluated? ethanol, cocaine
From the hospital: What is a single antibiotic that can be zosyn ie. piperacillin/tazobactam
used for colitis that covers all bacteria? It is NOT QT prolongation
levofloxacin and metronidazole. What is a bad side effect
of levo?
CARDIOLOGY: EKG should be obtained if CP appears CT
cardiac in nature. CXR is initial step to rule out
pneumothorax, pulmonary infiltrates, and rib fractures.
____should be done for patients w worrisome histories
for aortic dissection regardless of CXR or EKG results.
_____is minimally invasive and rapid for detecting aortic TEE - transesophageal echocardiogram
dissection at the bedside.
A ____ is used for pleuritic pain w normal CXR when a V/Q scan - but not good for a small PE
PE is suspected.
A _____is sensitive for small PE and may detect other helical chest CT
chest abnormalities leading to pain.
____is used when CP is esophageal in origin. Esophageal pH monitoring
EKG: A ______suggests underlying heart disease left bundle branch block
(ischemic, hypertensive).
A _____may be indicative of right heart strain (as in right bundle branch block
pulmonary embolus).
____is a term used to describe decreased perfusion and Shock; hypovolemic, cardiogenic, distributive
oxygen delivery to the body. This is best defined by BP =
CO x SVR. What are the three main types?
______shock can be from pump failure from infarction, Cardiogenic
cardiomyopathy, or tamponade, arrhythmia, valve failure,
obstructed outflow from tension pneumothorax or
massive PE.
______shock can be from hemorrhage, diarrhea, heat Hypovolemic
stroke, or third spacing.
______shock can be from sepsis, anaphylaxis, adrenal Distributive
crisis, or myxedema coma.
The formation of _______occurs via: atherosclerotic plaque
a. endothelial dysfunction & formation of fatty streak
b. LDL enters fatty streak and attracts macrophages
c. proliferating smooth muscle cells, connective tissue, &
lipids become incorporated into plaque
d. "fibrous cap" forms
Name some risk factors for CHD. Diabetes Mellitus
Patient Age
Peripheral Vascular disease
Chronic Renal Failure
Elevated homocysteine level
elevated inflammatory markers like CRP
Low Activity Level
Low intake of fruits and vegetables
lack of moderate alcohol intake
, Internal Medicine EOR Exam
_____is insufficiently specific for assessment of patients Exercise stress testing; coronary angiography
with low (<10%) pretest probability of CHD. It is best
reserved for patients with intermediate pretest
probability. Sensitivity and specificity can be increased
with imaging studies such as radionuclide imaging or
echocardiography. What is the gold standard to diagnose
coronary artery disease?
The AHA suggests the following mnemonic for the A: aspirin, ACEi, antianginals - nitrates/CCB
important elements in treatment of stable angina: B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
CCB: Short acting dihydropyridine CCBs ie ____ have Nifedipine
been shown to increase cardiac risk therefore verapamil or diltiazem
nondihydropyridines are recommended. They are amlodipine or nicardipine
___or___. Second generation dihydropyridines have
fewer negative inotropic effects and can be used in
settings of reduced ejection fraction. (ie. ___or___)
Patients with stenosis of left anterior descending, left coronary artery bypass grafting (CABG)
main coronary disease, three vessel disease, or
survivors of sudden cardiac death or sustained VF/VT
would benefit from _________.
_______can be used to relieve symptoms in patients PCI - percutaneous coronary intervention
who fail medical therapy but who do not have significant
enough disease to require CABG.
What are some physical exam findings in an acute MI? entirely normal, fourth heart sound, third heart sound, systolic murmur of acute
mitral regurgitation -- physical exam should focus on signs of PVD which may
increase the suspicion for coronary disease
What is the typical evolution of the EKG in the setting of 1. increase in amplitude of the T wave
a STEMI? 2. ST segment elevation
3. development of Q waves (hours to days)
4. resolution of ST-segment elevation
Cardiac-specific ____is drawn to detect damaged troponin
myocardium. It begins to rise is 6-9 hours, peaks at
approximately 20 hours, and remains in the circulation
for 7-10 days.
For patients with UA or NSTEMI to assess risk. Age >65
TIMI SCORE - 7 point system, more points, higher risk at least 3 risk factors
known coronary artery disease w at least 50% stenosis
ST segment changes
2 episodes of angina in past 24 hours
aspirin use in past week
elevated CK-MB or troponin
What are the absolute contraindications to thrombolytic BHTASC
therapy? BHTASC 1. active Bleeding
2. previous intracranial Hemorrhage
3. intracranial tumor
4. aortic dissection
5. stroke within 1 year
6. closed head injury within past 3 months
Thrombolytics should be given within ______of pain 12 hours; 90 minutes
onset. PCI needs to be performed within _____ of
presentation to medical provider.
CHF: Systolic dysfunction is from decreased ____. contractility (the pump); compliance (the fill)
Diastolic dysfunction is from a decrease in _____.
, Internal Medicine EOR Exam
Most symptoms of heart failure are pulmonary in nature because of increased LV end diastolic pressure that results in pulmonary venous
ie. dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and capillary congestion
cough, & wheezing. Why?
What heart sound is indication of systolic dysfunction? systolic - S3
diastolic dysfunction? diastolic - S4
What are the principal diagnostic testing for CHF? chest radiograph, electrocardiogram, BNP, and echocardiogram
What is the acute treatment for pulmonary edema in L = Lasix
heart failure? LMNOP M = morphine
N = nitroglycerine
O = oxygen
P = positive pressure ventilation
inotropic agents like dobutamine
In chronic CHF with systolic dysfunction, what three ACE inhibitors, cardioselective beta blockers (carvedalol, metaprolol, bisoprolol),
treatments are shown to decrease mortality? Digoxin, and aldosterone antagonists(aldactone)
other inotropic agents, and loop or thiaxide diuretics are
used as required for symptoms - benefit in fewer
hospitalizations.
Hydralazine and nitrates in combination when combined African Americans
with standard therapy is shown to reduce mortality for
what race with class III or IV CHF?
What treatment is used in diastolic dysfunction to control of BP and HR; cardioversion and antiarrythmic medication
improve filling? A fib often worsens with diastolic
dysfunction because of elevated HR and loss of atrial
kick. What two treatments are sometimes necessary?
What treatments improve survival when EF <35% in Automatic cardiac defibrillators, cardiac resynchronization through biventricular
class II/III CFH and sustained VT. pacing
The following are systemic causes for what? brandyarrhythmias
hypoxia
increased intracranial pressure
hypothermia
hypothyroidism
hyperkalemia
What medications may result in bradyarrhythmias? BB, CCB, digoxin
Emergent treatment of bradyarrythmias is with _____for atropine 0.5mg
a patient with bradycardia causing hypotension, CHF,
and syncope.
With sick sinus syndrome or complete heart block, when for symptomatic patients
is a permanent pacemaker indicated?
What type of block are pacemakers indicated even when type II second degree AV block (Mobitz) or bifascicular block with intermittent
the patient is asymptomatic? type II second degree AV block
When accessing for a tachyarrhythmia, what electrolyte disturbances (hypokalemia or hypomagnesemia), digoxin level, TSH,
exacerbating conditions should be evaluated? ethanol, cocaine
