PAEA Internal Medicine EOR Questions with Complete Solutions
2024, PAEA Emergency Medicine EOR Exam Study Guide, Internal
Medicine PAEA Questions with Complete Solutions Graded A+ 2024,
Emergency Medicine PAEA Questions With Complete Solutions
Rated A+ 20
what is the most common cause of heart failure? specifically left sided? right sided?
-MC is CAD (coronary artery disease)
-L sided: CAD & HTN
-R sided: L sided HF & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling of
dilated ventricle) is associated with systolic or diastolic heart failure?
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial
contraction into a stiff ventricle) is associated with systolic or diastolic heart failure?
diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure?
-systolic: post MI, dilated cardiomyopathy, myocarditis
-diastolic: HTN, LVH, elderly, valvular heart dz, hypertrophic or restrictive cardiomyopathy,
constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis, wet
beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________ heart
failure
high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what will the FEV1 and FEV1/FVC ratio of pts w/ intermittent, mild, moderate, vs severe asthma
be?
-intermittent: FEV1 > 80% predicted, FEV1/FVC nml
-mild: FEV1 ≥ 80% predicted, FEV1/FVC nml
-moderate: FEV1 60-80% predicted, FEV1/FVC reduced by 5%
-severe: FEV1 <60% predicted, FEV1/FVC reduced >5%
,what are the daily treatment recommendations for intermittent, mild, moderate, and severe
asthma control?
-intermittent: SABA prn
-mild: SABA prn + low dose ICS daily
-mod: low dose ICS + LABA OR med dose ICS +/- LTRA
-severe: high dose ICS + LABA +/- Omalizumab
remember all forms of asthma need a rescue inhaler/SABA to use prn
what is the only genetic disease linked with COPD?
alpha-1 antitrypsin deficiency (it normally protects elastin in lungs from damage by WBCs)- seen in
younger pts <40y
abnormal, permanent enlargement of the terminal airspaces, loss of elastic recoil, increased
compliance, and increased air trapping d/t obstruction
COPD- emphysema
chronic bronchitis COPD is diagnosed after ____ months total of productive cough in ___
consecutive years
≥3 mos total x 2 consecutive years
which type of COPD has severe V/Q mismatch, severe hypoxemia, and hypercapnia that can cause
respiratory acidosis? this is also strongly associated with multifocal atrial tachycardia (MAT), cor
pulmonale and eventual R HF
chronic bronchitis
PFTs (gold std) for diagnosing COPD will show a FEV1/FVC ratio of <____% and increased _______
FEV1/FVC of <70%
inc TLC, RV (inc lung volumes from hyperinflation)
what can be seen on CXR/CT of a pt w/ emphysema COPD?
hyperinflation (flattened diaphragm, inc AP diameter, dec vascular markings, +/- bullae)
how is COPD tx'd long term?
-smoking cessation!
bronchodilators:
-anticholinergics 1st line (tiotropium, ipratropium) CI: BPH, glaucoma
-B2 agonists (albuterol, terbutaline, salmeterol)
-theophylline- only for refractory cases bc narrow TI
corticosteroids- added to a LABA
oxygen- only therapy shown to dec mortality BUT only prescribe if 1. cor pulmonale 2. O2 sat <88%
3. PaO2 <55mmHg
when are antibiotics indicated for COPD chronic bronchitis exacerbations?
,1. inc sputum
2. change in sputum quality
3. CXR evidence of infxn
in tx of acute exacerbation of chronic bronchitis COPD, at what FEV1 levels should
1. only a short acting bronchodilator (SABA- albuterol, terbutaline) be used?
2. + a long acting bronchodilator (anticholinergics like tio/ipratropium or LABAs like salmeterol)?
3. + pulmonary rehab or steroids if inc exacerbations?
4. + O2 therapy?
FEV1 of:
1. SABA @ ≥80%
2. SABA + anticholinergics/LABA @ 50-79%
3. SABA + anticholinergics/LABA + pulmonary rehab and/or steroids @ 30-50%
4. SABA + anticholinergics/LABA + pulmonary rehab and/or steroids + oxygen @ <30% -OR- cor
pulmonale, respiratory failure, or HF
dx/tx? a (+/- productive) cough lasting 1-3 weeks after a recent URI with a nml CXR?
-dx: acute bronchitis
-tx: supportive (fluids, rest, +/- bronchodilators, +/- antitussives in adults)
*abx not helpful bc usually caused by adenovirus!
community acquired pneumonia is most commonly caused by? if admitted to hospital, PNA occurs
<___ hrs from admission; how does sputum appear? tx?
-strep. pneumoniae (2nd MC is h. influenzae)
-develops within 48 hrs of admission
-sputum: rusty (blood-tinged)
-tx: macrolide, doxycycline, B lactam, or broad spectrum FQ if severe or admitted
hospital acquired pneumonia is most commonly caused by? if admitted to hospital, PNA occurs
>___ hrs from admission; tx?
-pseudomonas and MRSA
-develops >48 hrs from admission
-tx: anti-pseudomonal B lactam (piperacillin/tazobactam aka Zosyn or cefepime), anti-pseudomonal
aminoglycoside or FQ; + vanc or linezolid if MRSA suspected, + levofloxacin or azithromycin if
legionella suspected
aspiration pneumonia tx?
-need anaerobe coverage:
-clindamycin, metronidazole or amoxicillin/clavulanic acid (augmentin)
"walking pneumonia" is most commonly caused by? what else is seen on PE? workup? tx?
-mycoplasma pneumoniae- seen in school-aged children, college students, and military recruits
-ear pain, bullous myringitis, persisitent non-productive cough
-w/u: PCR, serum cold agglutinin test & serology/enzyme immunoassays (serum or sputum Ab
detection)
-tx: macrolide or tetracycline
, pts ages 2-64 should receive what pneumococcal vaccine? age 65? what do children receive?
-Pneumovax (23) once
-once at age 65 and then not indicated after that
-children receive Prevnar 13 at 2, 4, 6, and 12-15 mos of age
what is the MC viral cause of pneumonia in infants/small children vs adults?
-infants/children: RSV & parainfluenza
-adults: influenza
what cause of pneumonia is associated with the mississippi and ohio river valleys and soil
contaminated with bird/bat droppings?
histoplasma capsulatum (fungal PNA)
what causes of pneumonia are seen in patients with HIV?
-pseudomonas aeruginosa
(piperacillin/tazobactam, meropenem, doripenem, cefepime, ceftazidime, levo/ciprofloxacin, amin
oglycosides)
-CMV
-pneumocystis jirovecii (PCP) (fungal) (bactrim, dapsone, atovaquone, pentamidine)
-histoplasma capsulatum (fungal) (itraconazole, amphotericin B)
-cryptococcus neoformans (fungal) (fluconazole, amphotericin B)
-atypical mycobacterium like MAC (macrolide, rifabutin)
1st line in bold
a pulmonary nodule is defined as <___cm and a pulmonary mass is defined as >___cm
nodule: <3cm
mass: >3cm
what are the MC causes of benign pulmonary nodules?
-infectious: tuberculosis MC, histoplasmosis, coccidiodomycosis
-tumors: hamartomas (benign fatty malformation of lung tissue)
-inflammation: RA, sarcoidosis, wedener's granulomatosis
-mediastinal tumors (thymoma)
what size pulmonary nodule should be serially reassessed for growth by imaging?
6-8mm
if >8mm solid pulmonary nodule what is the mgmt for low, intermediate and high risk?
-low: CT surveillance at 3 mos
-intermediate: PET/CT and biopsy (bronchoscopy for central lesions, needle aspiration for peripheral
lesions)
-high: biopsy or excision
what are factors that increase likelihood that a pulmonary nodule is malignant?
2024, PAEA Emergency Medicine EOR Exam Study Guide, Internal
Medicine PAEA Questions with Complete Solutions Graded A+ 2024,
Emergency Medicine PAEA Questions With Complete Solutions
Rated A+ 20
what is the most common cause of heart failure? specifically left sided? right sided?
-MC is CAD (coronary artery disease)
-L sided: CAD & HTN
-R sided: L sided HF & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling of
dilated ventricle) is associated with systolic or diastolic heart failure?
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial
contraction into a stiff ventricle) is associated with systolic or diastolic heart failure?
diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure?
-systolic: post MI, dilated cardiomyopathy, myocarditis
-diastolic: HTN, LVH, elderly, valvular heart dz, hypertrophic or restrictive cardiomyopathy,
constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis, wet
beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________ heart
failure
high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what will the FEV1 and FEV1/FVC ratio of pts w/ intermittent, mild, moderate, vs severe asthma
be?
-intermittent: FEV1 > 80% predicted, FEV1/FVC nml
-mild: FEV1 ≥ 80% predicted, FEV1/FVC nml
-moderate: FEV1 60-80% predicted, FEV1/FVC reduced by 5%
-severe: FEV1 <60% predicted, FEV1/FVC reduced >5%
,what are the daily treatment recommendations for intermittent, mild, moderate, and severe
asthma control?
-intermittent: SABA prn
-mild: SABA prn + low dose ICS daily
-mod: low dose ICS + LABA OR med dose ICS +/- LTRA
-severe: high dose ICS + LABA +/- Omalizumab
remember all forms of asthma need a rescue inhaler/SABA to use prn
what is the only genetic disease linked with COPD?
alpha-1 antitrypsin deficiency (it normally protects elastin in lungs from damage by WBCs)- seen in
younger pts <40y
abnormal, permanent enlargement of the terminal airspaces, loss of elastic recoil, increased
compliance, and increased air trapping d/t obstruction
COPD- emphysema
chronic bronchitis COPD is diagnosed after ____ months total of productive cough in ___
consecutive years
≥3 mos total x 2 consecutive years
which type of COPD has severe V/Q mismatch, severe hypoxemia, and hypercapnia that can cause
respiratory acidosis? this is also strongly associated with multifocal atrial tachycardia (MAT), cor
pulmonale and eventual R HF
chronic bronchitis
PFTs (gold std) for diagnosing COPD will show a FEV1/FVC ratio of <____% and increased _______
FEV1/FVC of <70%
inc TLC, RV (inc lung volumes from hyperinflation)
what can be seen on CXR/CT of a pt w/ emphysema COPD?
hyperinflation (flattened diaphragm, inc AP diameter, dec vascular markings, +/- bullae)
how is COPD tx'd long term?
-smoking cessation!
bronchodilators:
-anticholinergics 1st line (tiotropium, ipratropium) CI: BPH, glaucoma
-B2 agonists (albuterol, terbutaline, salmeterol)
-theophylline- only for refractory cases bc narrow TI
corticosteroids- added to a LABA
oxygen- only therapy shown to dec mortality BUT only prescribe if 1. cor pulmonale 2. O2 sat <88%
3. PaO2 <55mmHg
when are antibiotics indicated for COPD chronic bronchitis exacerbations?
,1. inc sputum
2. change in sputum quality
3. CXR evidence of infxn
in tx of acute exacerbation of chronic bronchitis COPD, at what FEV1 levels should
1. only a short acting bronchodilator (SABA- albuterol, terbutaline) be used?
2. + a long acting bronchodilator (anticholinergics like tio/ipratropium or LABAs like salmeterol)?
3. + pulmonary rehab or steroids if inc exacerbations?
4. + O2 therapy?
FEV1 of:
1. SABA @ ≥80%
2. SABA + anticholinergics/LABA @ 50-79%
3. SABA + anticholinergics/LABA + pulmonary rehab and/or steroids @ 30-50%
4. SABA + anticholinergics/LABA + pulmonary rehab and/or steroids + oxygen @ <30% -OR- cor
pulmonale, respiratory failure, or HF
dx/tx? a (+/- productive) cough lasting 1-3 weeks after a recent URI with a nml CXR?
-dx: acute bronchitis
-tx: supportive (fluids, rest, +/- bronchodilators, +/- antitussives in adults)
*abx not helpful bc usually caused by adenovirus!
community acquired pneumonia is most commonly caused by? if admitted to hospital, PNA occurs
<___ hrs from admission; how does sputum appear? tx?
-strep. pneumoniae (2nd MC is h. influenzae)
-develops within 48 hrs of admission
-sputum: rusty (blood-tinged)
-tx: macrolide, doxycycline, B lactam, or broad spectrum FQ if severe or admitted
hospital acquired pneumonia is most commonly caused by? if admitted to hospital, PNA occurs
>___ hrs from admission; tx?
-pseudomonas and MRSA
-develops >48 hrs from admission
-tx: anti-pseudomonal B lactam (piperacillin/tazobactam aka Zosyn or cefepime), anti-pseudomonal
aminoglycoside or FQ; + vanc or linezolid if MRSA suspected, + levofloxacin or azithromycin if
legionella suspected
aspiration pneumonia tx?
-need anaerobe coverage:
-clindamycin, metronidazole or amoxicillin/clavulanic acid (augmentin)
"walking pneumonia" is most commonly caused by? what else is seen on PE? workup? tx?
-mycoplasma pneumoniae- seen in school-aged children, college students, and military recruits
-ear pain, bullous myringitis, persisitent non-productive cough
-w/u: PCR, serum cold agglutinin test & serology/enzyme immunoassays (serum or sputum Ab
detection)
-tx: macrolide or tetracycline
, pts ages 2-64 should receive what pneumococcal vaccine? age 65? what do children receive?
-Pneumovax (23) once
-once at age 65 and then not indicated after that
-children receive Prevnar 13 at 2, 4, 6, and 12-15 mos of age
what is the MC viral cause of pneumonia in infants/small children vs adults?
-infants/children: RSV & parainfluenza
-adults: influenza
what cause of pneumonia is associated with the mississippi and ohio river valleys and soil
contaminated with bird/bat droppings?
histoplasma capsulatum (fungal PNA)
what causes of pneumonia are seen in patients with HIV?
-pseudomonas aeruginosa
(piperacillin/tazobactam, meropenem, doripenem, cefepime, ceftazidime, levo/ciprofloxacin, amin
oglycosides)
-CMV
-pneumocystis jirovecii (PCP) (fungal) (bactrim, dapsone, atovaquone, pentamidine)
-histoplasma capsulatum (fungal) (itraconazole, amphotericin B)
-cryptococcus neoformans (fungal) (fluconazole, amphotericin B)
-atypical mycobacterium like MAC (macrolide, rifabutin)
1st line in bold
a pulmonary nodule is defined as <___cm and a pulmonary mass is defined as >___cm
nodule: <3cm
mass: >3cm
what are the MC causes of benign pulmonary nodules?
-infectious: tuberculosis MC, histoplasmosis, coccidiodomycosis
-tumors: hamartomas (benign fatty malformation of lung tissue)
-inflammation: RA, sarcoidosis, wedener's granulomatosis
-mediastinal tumors (thymoma)
what size pulmonary nodule should be serially reassessed for growth by imaging?
6-8mm
if >8mm solid pulmonary nodule what is the mgmt for low, intermediate and high risk?
-low: CT surveillance at 3 mos
-intermediate: PET/CT and biopsy (bronchoscopy for central lesions, needle aspiration for peripheral
lesions)
-high: biopsy or excision
what are factors that increase likelihood that a pulmonary nodule is malignant?
