Internal Medicine Review-1928 Questions with Complete Solutions
Internal Medicine Review-1928 Questions with Complete Solutions EKG diagnosis of an MI? - CORRECT ANSWER ST elevation - immediately T wave inversion - 6 hrs - 1 day Q wave - lasts forever ECG leads corresponding to areas of MI? - CORRECT ANSWER Anterior wall - LAD artery - V1-V4 Lateral wall - circumflex artery - Lead I, aVL Inferior wall - RCA - Lead II, III, aVF Best first and second test for chest pain? - CORRECT ANSWER 1. EKG 2. Cardiac enzymes Cardiac enzymes? - CORRECT ANSWER 1. Myoglobin - rises 1st, peaks in 2 hrs, normal by 24 hrs 2. CKMB - rises in 3-5 hrs, peaks 24 hrs, normal by 72 hrs. 3. Troponin I - rises in 3-5 hrs, peaks 24 hrs, normal by 7-10 days CKMB best for diagnosis of reinfarction How often to draw cardiac enzymes? - CORRECT ANSWER Draw cardiac enzymes once on admission and every 8 hours until 3 samples are obtained Post MI complications? (3) MCC of death? New systolic murmur? Acute severe hypotension? VSD? Persistent ST elevation? 1-2 months later - friction rub? - CORRECT ANSWER Most common complications: 1. Arrhythmia 2. LV failure 3. Cardiogenic shock MCC death - V fib Papillary muscle rupture Free wall Cardiac tamponade Interventricular wall rupture Ventricular wall aneurysm Dressler's syndrome (autoimmune pericarditis) Cardiac Tamponade signs/symptoms? - CORRECT ANSWER Beck's triad: Hypotension JVD Muffled heart sounds Pulsus paradoxus (decrease in systolic BP 10 mmHg during inspiration) ECG shows low voltage QRS and electrical alterans due to "swinging" movement of heart in large effusion Acute pericarditis pain - CORRECT ANSWER Worse with inspiration Better w/ leaning forward Friction rub Diffuse ST elevation
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