Internal Medicine Review ABIM part 1
exam questions with correct answers
What is a positive stress test - CORRECT ANSWER-✔✔✅Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - CORRECT ANSWER-✔✔✅St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - CORRECT ANSWER-✔✔✅Myocardial perfusion
imaging with adenosine,
NOT exercising!
When to not use doutamine for stress - CORRECT ANSWER-✔✔✅History of VT,
severe HTN,
Low BP,
poor echo images
When to not use adenosine for stress - CORRECT ANSWER-✔✔✅Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
,Normals for PA catheter pressures - CORRECT ANSWER-✔✔✅RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - CORRECT ANSWER-✔✔✅tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - CORRECT ANSWER-✔✔✅RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - CORRECT ANSWER-✔✔✅cardiogenic shock
high RA,
PA very elevated
high PCWP
nl SBP - CORRECT ANSWER-✔✔✅mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP - CORRECT ANSWER-✔✔✅pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
,palpated as weakened pulse with inspiration &
more heart contractions to pulse beats - CORRECT ANSWER-✔✔✅pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle) - CORRECT ANSWER-✔✔✅Aortic regurgitation,
HOCM
What causes pulsus alternans - CORRECT ANSWER-✔✔✅Severe LV dysfunction
What causes pulsus tardus - CORRECT ANSWER-✔✔✅Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - CORRECT ANSWER-✔✔✅-
standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
increase cardiac volume,
increased murmurs
except MVP, HOCM
-sustained handgrip:
increases systemic resistance
decreases murmur in HOCM, AS
, What causes a physiologic split S2 - CORRECT ANSWER-✔✔✅Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2 - CORRECT ANSWER-✔✔✅Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2 - CORRECT ANSWER-✔✔✅LBBB,
RV pacing,
HOCM
What causes an S3? - CORRECT ANSWER-✔✔✅Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
What are the parts of the venous waveform? - CORRECT ANSWER-✔✔✅A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens,
exam questions with correct answers
What is a positive stress test - CORRECT ANSWER-✔✔✅Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - CORRECT ANSWER-✔✔✅St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - CORRECT ANSWER-✔✔✅Myocardial perfusion
imaging with adenosine,
NOT exercising!
When to not use doutamine for stress - CORRECT ANSWER-✔✔✅History of VT,
severe HTN,
Low BP,
poor echo images
When to not use adenosine for stress - CORRECT ANSWER-✔✔✅Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
,Normals for PA catheter pressures - CORRECT ANSWER-✔✔✅RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - CORRECT ANSWER-✔✔✅tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - CORRECT ANSWER-✔✔✅RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - CORRECT ANSWER-✔✔✅cardiogenic shock
high RA,
PA very elevated
high PCWP
nl SBP - CORRECT ANSWER-✔✔✅mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP - CORRECT ANSWER-✔✔✅pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
,palpated as weakened pulse with inspiration &
more heart contractions to pulse beats - CORRECT ANSWER-✔✔✅pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle) - CORRECT ANSWER-✔✔✅Aortic regurgitation,
HOCM
What causes pulsus alternans - CORRECT ANSWER-✔✔✅Severe LV dysfunction
What causes pulsus tardus - CORRECT ANSWER-✔✔✅Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - CORRECT ANSWER-✔✔✅-
standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
increase cardiac volume,
increased murmurs
except MVP, HOCM
-sustained handgrip:
increases systemic resistance
decreases murmur in HOCM, AS
, What causes a physiologic split S2 - CORRECT ANSWER-✔✔✅Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2 - CORRECT ANSWER-✔✔✅Pulmonary stenosis,
PE,
LV pacer,
RBBB,
MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2 - CORRECT ANSWER-✔✔✅LBBB,
RV pacing,
HOCM
What causes an S3? - CORRECT ANSWER-✔✔✅Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
What are the parts of the venous waveform? - CORRECT ANSWER-✔✔✅A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens,
