PAEA Internal Medicine EOR Practice Exam Questions with Complete Solutions
What is the classic description of stable angina pectoris? Substernal chest pressure/squeezing (Levine sign), lasting <30 min, precipitated
by exertion, relieved by rest/nitroglycerin
What is the gold standard for diagnosing coronary artery Coronary Angiography
disease (angina)?
What is the first-line pharmacologic treatment for chronic Beta-blockers (e.g., Metoprolol, Atenolol)
stable angina?
What is Prinzmetal (variant) angina? Coronary artery vasospasm causing transient ST elevations, usually at rest/early
morning; treat with Calcium Channel Blockers
What is the most common cause of sudden cardiac Hypertrophic Cardiomyopathy (HOCM)
death in young athletes?
What is the classic murmur of Hypertrophic Harsh crescendo-decrescendo systolic murmur at LLSB that INCREASES with
Cardiomyopathy (HOCM)? Valsalva/standing and DECREASES with squatting/handgrip
What is the mainstay of treatment for HOCM? Beta-blockers (avoid diuretics/nitrates which decrease preload)
What is the most common cause of restrictive Amyloidosis
cardiomyopathy?
What are the classic signs of Left-Sided Heart Failure? Dyspnea, Orthopnea, Paroxysmal Nocturnal Dyspnea (PND), Rales/Crackles, S3
gallop
What are the classic signs of Right-Sided Heart Failure? JVD, Peripheral edema, Hepatomegaly, Ascites (often caused by Left Heart
Failure)
What is the most useful diagnostic test for diagnosing Echocardiogram (to determine Ejection Fraction)
Heart Failure?
What BNP level supports a diagnosis of Congestive BNP > 100 pg/mL (often >400 in acute failure)
Heart Failure?
What medications provide a mortality benefit in systolic ACE Inhibitors/ARBs, Beta-blockers (Carvedilol, Metoprolol succinate,
Heart Failure? Bisoprolol), Spironolactone, Hydralazine+Nitrates (in African Americans)
What is the most common arrhythmia associated with Multifocal Atrial Tachycardia (MAT) - 3 different P wave morphologies
COPD/Lung disease?
What is the treatment for unstable Atrial Fibrillation? Synchronized Cardioversion
What is the CHADS2-VASc score used for? To determine the need for anticoagulation in Atrial Fibrillation (Score ≥2 requires
anticoagulation)
,PAEA Internal Medicine EOR Practice Exam Questions with Complete Solutions
What is the hallmark ECG finding in Atrial Flutter? "Sawtooth" P waves (F waves) at 250-350 bpm
What is the definitive treatment for Supraventricular Adenosine (6mg IV push, followed by 12mg if no conversion)
Tachycardia (SVT) after vagal maneuvers fail?
What is the specific treatment for Torsades de Pointes? IV Magnesium Sulfate
What defines First Degree AV Block? Fixed PR interval > 0.20 seconds (one large box) without dropped beats
What is the difference between Mobitz I (Wenckebach) Mobitz I: Progressive PR lengthening until a drop (benign); Mobitz II: Fixed PR
and Mobitz II? interval with random dropped beats (requires pacemaker)
What is the Duke Criteria used for? Diagnosing Infective Endocarditis (requires 2 Major, or 1 Major + 3 Minor, or 5
Minor)
What are the two Major Duke Criteria? Positive blood cultures (typical organism) and Evidence of endocardial
involvement (Vegetation on Echo or new murmur)
What is the most common organism in native valve Staphylococcus aureus (acute), Viridans streptococci (subacute/dental
endocarditis? procedures)
What is the most common organism in IV drug user Staphylococcus aureus; Tricuspid valve
endocarditis and which valve is affected?
What are the classic physical signs of Infective FROM JANE: Fever, Roth spots, Osler nodes (painful), Murmur, Janeway lesions
Endocarditis? (painless), Anemia, Nailbed hemorrhages, Emboli
What is the antibiotic prophylaxis for endocarditis before Amoxicillin 2g PO 30-60 min prior to procedure (Clindamycin if PCN allergic)
dental procedures?
What is the characteristic murmur of Aortic Stenosis? Systolic crescendo-decrescendo murmur at RUSB, radiates to carotids
What are the classic symptoms of Aortic Stenosis? Use Syncope, Angina, Dyspnea (indicates valve replacement needed)
mnemonic SAD
What is the characteristic murmur of Mitral Blowing holosystolic murmur at the Apex, radiates to Axilla
Regurgitation?
What is the characteristic murmur of Mitral Stenosis? Diastolic low-pitched rumbling murmur with an Opening Snap at the Apex
(associated with Rheumatic Fever)
What is the characteristic murmur of Mitral Valve Mid-systolic click followed by a late systolic murmur
Prolapse?
, PAEA Internal Medicine EOR Practice Exam Questions with Complete Solutions
What is the gold standard for diagnosing Valvular Heart Echocardiogram
Disease?
What defines Hypertensive Urgency vs. Emergency? Urgency: BP >180/120 without end-organ damage; Emergency: BP >180/120
WITH end-organ damage (stroke, MI, AKI, papilledema)
What is the first-line hypertension treatment for non- Thiazide, ACEI/ARB, or CCB
African Americans?
What is the first-line hypertension treatment for African Thiazide diuretics or Calcium Channel Blockers (ACEI less effective unless CKD
Americans? present)
What is the blood pressure goal for most patients < 130/80 mmHg
according to ACC/AHA?
What is the lipid guideline for starting statin therapy in Moderate-to-high intensity statin regardless of ASCVD score
diabetics (age 40-75)?
What are the classic signs of Xanthomas? Lipid deposits in skin/tendons suggestive of familial hypercholesterolemia
What is the gold standard for diagnosing Myocardial Cardiac Troponin (I or T) - rises in 3-4 hours, peaks 12-24 hours
Infarction?
What ECG leads indicate an Inferior Wall MI? II, III, aVF (supplied by Right Coronary Artery)
What medication is contraindicated in Inferior Wall MI Nitroglycerin and Morphine (preload dependent - can cause severe hypotension)
(Right Ventricular Infarct)?
What is the classic ECG finding for STEMI? ST elevation >1mm in 2 contiguous leads + reciprocal changes (ST depression)
What is the immediate treatment for STEMI? Use Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker + PCI (within 90 min) or
mnemonic MONA-B + Reperfusion Thrombolytics (within 30 min)
What is Dressler Syndrome? Post-MI pericarditis occurring 2-10 weeks after MI (fever, pericarditis,
leukocytosis)
What is the classic presentation of Acute Pericarditis? Pleuritic chest pain (worse with inspiration), worse supine, relieved by sitting
forward
What is the pathognomonic ECG finding in Acute Diffuse ST elevation (concave up) and PR depression
Pericarditis?
What is the first-line treatment for Acute Pericarditis? NSAIDs (Ibuprofen/Indomethacin) + Colchicine
What is the classic description of stable angina pectoris? Substernal chest pressure/squeezing (Levine sign), lasting <30 min, precipitated
by exertion, relieved by rest/nitroglycerin
What is the gold standard for diagnosing coronary artery Coronary Angiography
disease (angina)?
What is the first-line pharmacologic treatment for chronic Beta-blockers (e.g., Metoprolol, Atenolol)
stable angina?
What is Prinzmetal (variant) angina? Coronary artery vasospasm causing transient ST elevations, usually at rest/early
morning; treat with Calcium Channel Blockers
What is the most common cause of sudden cardiac Hypertrophic Cardiomyopathy (HOCM)
death in young athletes?
What is the classic murmur of Hypertrophic Harsh crescendo-decrescendo systolic murmur at LLSB that INCREASES with
Cardiomyopathy (HOCM)? Valsalva/standing and DECREASES with squatting/handgrip
What is the mainstay of treatment for HOCM? Beta-blockers (avoid diuretics/nitrates which decrease preload)
What is the most common cause of restrictive Amyloidosis
cardiomyopathy?
What are the classic signs of Left-Sided Heart Failure? Dyspnea, Orthopnea, Paroxysmal Nocturnal Dyspnea (PND), Rales/Crackles, S3
gallop
What are the classic signs of Right-Sided Heart Failure? JVD, Peripheral edema, Hepatomegaly, Ascites (often caused by Left Heart
Failure)
What is the most useful diagnostic test for diagnosing Echocardiogram (to determine Ejection Fraction)
Heart Failure?
What BNP level supports a diagnosis of Congestive BNP > 100 pg/mL (often >400 in acute failure)
Heart Failure?
What medications provide a mortality benefit in systolic ACE Inhibitors/ARBs, Beta-blockers (Carvedilol, Metoprolol succinate,
Heart Failure? Bisoprolol), Spironolactone, Hydralazine+Nitrates (in African Americans)
What is the most common arrhythmia associated with Multifocal Atrial Tachycardia (MAT) - 3 different P wave morphologies
COPD/Lung disease?
What is the treatment for unstable Atrial Fibrillation? Synchronized Cardioversion
What is the CHADS2-VASc score used for? To determine the need for anticoagulation in Atrial Fibrillation (Score ≥2 requires
anticoagulation)
,PAEA Internal Medicine EOR Practice Exam Questions with Complete Solutions
What is the hallmark ECG finding in Atrial Flutter? "Sawtooth" P waves (F waves) at 250-350 bpm
What is the definitive treatment for Supraventricular Adenosine (6mg IV push, followed by 12mg if no conversion)
Tachycardia (SVT) after vagal maneuvers fail?
What is the specific treatment for Torsades de Pointes? IV Magnesium Sulfate
What defines First Degree AV Block? Fixed PR interval > 0.20 seconds (one large box) without dropped beats
What is the difference between Mobitz I (Wenckebach) Mobitz I: Progressive PR lengthening until a drop (benign); Mobitz II: Fixed PR
and Mobitz II? interval with random dropped beats (requires pacemaker)
What is the Duke Criteria used for? Diagnosing Infective Endocarditis (requires 2 Major, or 1 Major + 3 Minor, or 5
Minor)
What are the two Major Duke Criteria? Positive blood cultures (typical organism) and Evidence of endocardial
involvement (Vegetation on Echo or new murmur)
What is the most common organism in native valve Staphylococcus aureus (acute), Viridans streptococci (subacute/dental
endocarditis? procedures)
What is the most common organism in IV drug user Staphylococcus aureus; Tricuspid valve
endocarditis and which valve is affected?
What are the classic physical signs of Infective FROM JANE: Fever, Roth spots, Osler nodes (painful), Murmur, Janeway lesions
Endocarditis? (painless), Anemia, Nailbed hemorrhages, Emboli
What is the antibiotic prophylaxis for endocarditis before Amoxicillin 2g PO 30-60 min prior to procedure (Clindamycin if PCN allergic)
dental procedures?
What is the characteristic murmur of Aortic Stenosis? Systolic crescendo-decrescendo murmur at RUSB, radiates to carotids
What are the classic symptoms of Aortic Stenosis? Use Syncope, Angina, Dyspnea (indicates valve replacement needed)
mnemonic SAD
What is the characteristic murmur of Mitral Blowing holosystolic murmur at the Apex, radiates to Axilla
Regurgitation?
What is the characteristic murmur of Mitral Stenosis? Diastolic low-pitched rumbling murmur with an Opening Snap at the Apex
(associated with Rheumatic Fever)
What is the characteristic murmur of Mitral Valve Mid-systolic click followed by a late systolic murmur
Prolapse?
, PAEA Internal Medicine EOR Practice Exam Questions with Complete Solutions
What is the gold standard for diagnosing Valvular Heart Echocardiogram
Disease?
What defines Hypertensive Urgency vs. Emergency? Urgency: BP >180/120 without end-organ damage; Emergency: BP >180/120
WITH end-organ damage (stroke, MI, AKI, papilledema)
What is the first-line hypertension treatment for non- Thiazide, ACEI/ARB, or CCB
African Americans?
What is the first-line hypertension treatment for African Thiazide diuretics or Calcium Channel Blockers (ACEI less effective unless CKD
Americans? present)
What is the blood pressure goal for most patients < 130/80 mmHg
according to ACC/AHA?
What is the lipid guideline for starting statin therapy in Moderate-to-high intensity statin regardless of ASCVD score
diabetics (age 40-75)?
What are the classic signs of Xanthomas? Lipid deposits in skin/tendons suggestive of familial hypercholesterolemia
What is the gold standard for diagnosing Myocardial Cardiac Troponin (I or T) - rises in 3-4 hours, peaks 12-24 hours
Infarction?
What ECG leads indicate an Inferior Wall MI? II, III, aVF (supplied by Right Coronary Artery)
What medication is contraindicated in Inferior Wall MI Nitroglycerin and Morphine (preload dependent - can cause severe hypotension)
(Right Ventricular Infarct)?
What is the classic ECG finding for STEMI? ST elevation >1mm in 2 contiguous leads + reciprocal changes (ST depression)
What is the immediate treatment for STEMI? Use Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker + PCI (within 90 min) or
mnemonic MONA-B + Reperfusion Thrombolytics (within 30 min)
What is Dressler Syndrome? Post-MI pericarditis occurring 2-10 weeks after MI (fever, pericarditis,
leukocytosis)
What is the classic presentation of Acute Pericarditis? Pleuritic chest pain (worse with inspiration), worse supine, relieved by sitting
forward
What is the pathognomonic ECG finding in Acute Diffuse ST elevation (concave up) and PR depression
Pericarditis?
What is the first-line treatment for Acute Pericarditis? NSAIDs (Ibuprofen/Indomethacin) + Colchicine
