INTERNAL MEDICINE EOR COMPREHENSIVE EXAMS SET
QUESTIONS AND ANSWERS 2025/2026 ALL RATED A+
✔✔_____is insufficiently specific for assessment of patients 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? - ✔✔Exercise stress testing; coronary angiography
✔✔The AHA suggests the following mnemonic for the important elements in treatment
of stable angina: - ✔✔A: aspirin, ACEi, antianginals - nitrates/CCB
B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
✔✔CCB: Short acting dihydropyridine CCBs ie ____ have been shown to increase
cardiac risk therefore nondihydropyridines are recommended. They are ___or___.
Second generation dihydropyridines have fewer negative inotropic effects and can be
used in settings of reduced ejection fraction. (ie. ___or___) - ✔✔Nifedipine
verapamil or diltiazem
amlodipine or nicardipine
✔✔Patients with stenosis of left anterior descending, left main coronary disease, three
vessel disease, or survivors of sudden cardiac death or sustained VF/VT would benefit
from _________. - ✔✔coronary artery bypass grafting (CABG)
✔✔_______can be used to relieve symptoms in patients who fail medical therapy but
who do not have significant enough disease to require CABG. - ✔✔PCI - percutaneous
coronary intervention
✔✔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 a STEMI? - ✔✔1. increase
in amplitude of the T wave
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 myocardium. It begins to rise is 6-
9 hours, peaks at approximately 20 hours, and remains in the circulation for 7-10 days. -
✔✔troponin
✔✔For patients with UA or NSTEMI to assess risk.
TIMI SCORE - 7 point system, more points, higher risk - ✔✔Age >65
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 therapy? BHTASC -
✔✔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 onset. PCI needs to be
performed within _____ of presentation to medical provider. - ✔✔12 hours; 90 minutes
✔✔CHF: Systolic dysfunction is from decreased ____. Diastolic dysfunction is from a
decrease in _____. - ✔✔contractility (the pump); compliance (the fill)
✔✔Most symptoms of heart failure are pulmonary in nature ie. dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, cough, & wheezing. Why? - ✔✔because of increased
LV end diastolic pressure that results in pulmonary venous and capillary congestion
✔✔What heart sound is indication of systolic dysfunction? diastolic dysfunction? -
✔✔systolic - S3
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 heart failure? LMNOP - ✔✔L =
Lasix
M = morphine
N = nitroglycerine
O = oxygen
,P = positive pressure ventilation
inotropic agents like dobutamine
✔✔In chronic CHF with systolic dysfunction, what three treatments are shown to
decrease mortality? Digoxin, other inotropic agents, and loop or thiaxide diuretics are
used as required for symptoms - benefit in fewer hospitalizations. - ✔✔ACE inhibitors,
cardioselective beta blockers (carvedalol, metaprolol, bisoprolol), and aldosterone
antagonists(aldactone)
✔✔Hydralazine and nitrates in combination when combined with standard therapy is
shown to reduce mortality for what race with class III or IV CHF? - ✔✔African
Americans
✔✔What treatment is used in diastolic dysfunction to improve filling? A fib often
worsens with diastolic dysfunction because of elevated HR and loss of atrial kick. What
two treatments are sometimes necessary? - ✔✔control of BP and HR; cardioversion
and antiarrythmic medication
✔✔What treatments improve survival when EF <35% in class II/III CFH and sustained
VT. - ✔✔Automatic cardiac defibrillators, cardiac resynchronization through biventricular
pacing
✔✔The following are systemic causes for what?
hypoxia
increased intracranial pressure
hypothermia
hypothyroidism
hyperkalemia - ✔✔brandyarrhythmias
✔✔What medications may result in bradyarrhythmias? - ✔✔BB, CCB, digoxin
✔✔Emergent treatment of bradyarrythmias is with _____for a patient with bradycardia
causing hypotension, CHF, and syncope. - ✔✔atropine 0.5mg
✔✔With sick sinus syndrome or complete heart block, when is a permanent pacemaker
indicated? - ✔✔for symptomatic patients
✔✔What type of block are pacemakers indicated even when the patient is
asymptomatic? - ✔✔type II second degree AV block (Mobitz) or bifascicular block with
intermittent type II second degree AV block
, ✔✔When accessing for a tachyarrhythmia, what exacerbating conditions should be
evaluated? - ✔✔electrolyte disturbances (hypokalemia or hypomagnesemia), digoxin
level, TSH, ethanol, cocaine
✔✔In patients with a hemodynamically _______wide QRS tachyarrhythmia/SVT,
blocking the AV node with vagal maneuvers, adenosine, BB, CCB, or digoxin is done. -
✔✔stable; unstable means synchronized cardioversion
✔✔_____toxicity can lead to paroxysmal atrial tachycardia with 2:1 block or
nonparoxysmal junctional tachycardia. - ✔✔Digitalis
✔✔The ____syndrome is characterized by a short PR interval, delta wave, and AVRT.
AV nodal blocking agents (BB, CCB, dig, adenosine) should be avoided when AF is
present with WPW. - ✔✔WPW - wolfe Parkinson white
✔✔AVNRT and AVRT should be treated initially with _____. Radiofrequency
____should be considered for long-term management. - ✔✔AV nodal blocking agents;
ablation
✔✔Torsades de pointes is a multifocal VT, associated with a long QT interval.
Treatment is _______&_______. - ✔✔overdrive pacing and magnesium.
✔✔_____is the drug of choice to treat regular narrow complex tachycardias after vagal
maneuvers have been unsuccessful. - ✔✔Adenosine, BB or CCB
✔✔Treatment of ___&___involves rate control, rhythm control, and prevention of
thromboembolism. - ✔✔a fib and a flutter
✔✔Hypertension is defined as a blood pressure over ___. Over 95% of patients have
HTN due to what cause? - ✔✔140/90; essential hypertension with a UNKNOWN cause
✔✔The initial treatment of HTN is with what medication? What is the first line agent for
patients with diabetes, heart disease, or proteinuria? - ✔✔thiazide diuretic; ACE
inhibitor
✔✔GO OVER MRTAPS - ✔✔GO OVER MRTAPS
✔✔Mitral Stenosis impairs diastolic LV filling. Medical therapy involves heart rate control
with what meds? - ✔✔BB or CCB
✔✔Mitral Regurgitation results in left atrial enlargement and a dilated left ventricle. What
meds are used for afterload reduction? - ✔✔ACE inhibitors, ARBs, or a combination of
hydralazine/nitrates
QUESTIONS AND ANSWERS 2025/2026 ALL RATED A+
✔✔_____is insufficiently specific for assessment of patients 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? - ✔✔Exercise stress testing; coronary angiography
✔✔The AHA suggests the following mnemonic for the important elements in treatment
of stable angina: - ✔✔A: aspirin, ACEi, antianginals - nitrates/CCB
B: B-blocker, bp
C: cholesterol & cigarettes
D: diet and diabetes
E: education and exercise
✔✔CCB: Short acting dihydropyridine CCBs ie ____ have been shown to increase
cardiac risk therefore nondihydropyridines are recommended. They are ___or___.
Second generation dihydropyridines have fewer negative inotropic effects and can be
used in settings of reduced ejection fraction. (ie. ___or___) - ✔✔Nifedipine
verapamil or diltiazem
amlodipine or nicardipine
✔✔Patients with stenosis of left anterior descending, left main coronary disease, three
vessel disease, or survivors of sudden cardiac death or sustained VF/VT would benefit
from _________. - ✔✔coronary artery bypass grafting (CABG)
✔✔_______can be used to relieve symptoms in patients who fail medical therapy but
who do not have significant enough disease to require CABG. - ✔✔PCI - percutaneous
coronary intervention
✔✔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 a STEMI? - ✔✔1. increase
in amplitude of the T wave
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 myocardium. It begins to rise is 6-
9 hours, peaks at approximately 20 hours, and remains in the circulation for 7-10 days. -
✔✔troponin
✔✔For patients with UA or NSTEMI to assess risk.
TIMI SCORE - 7 point system, more points, higher risk - ✔✔Age >65
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 therapy? BHTASC -
✔✔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 onset. PCI needs to be
performed within _____ of presentation to medical provider. - ✔✔12 hours; 90 minutes
✔✔CHF: Systolic dysfunction is from decreased ____. Diastolic dysfunction is from a
decrease in _____. - ✔✔contractility (the pump); compliance (the fill)
✔✔Most symptoms of heart failure are pulmonary in nature ie. dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, cough, & wheezing. Why? - ✔✔because of increased
LV end diastolic pressure that results in pulmonary venous and capillary congestion
✔✔What heart sound is indication of systolic dysfunction? diastolic dysfunction? -
✔✔systolic - S3
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 heart failure? LMNOP - ✔✔L =
Lasix
M = morphine
N = nitroglycerine
O = oxygen
,P = positive pressure ventilation
inotropic agents like dobutamine
✔✔In chronic CHF with systolic dysfunction, what three treatments are shown to
decrease mortality? Digoxin, other inotropic agents, and loop or thiaxide diuretics are
used as required for symptoms - benefit in fewer hospitalizations. - ✔✔ACE inhibitors,
cardioselective beta blockers (carvedalol, metaprolol, bisoprolol), and aldosterone
antagonists(aldactone)
✔✔Hydralazine and nitrates in combination when combined with standard therapy is
shown to reduce mortality for what race with class III or IV CHF? - ✔✔African
Americans
✔✔What treatment is used in diastolic dysfunction to improve filling? A fib often
worsens with diastolic dysfunction because of elevated HR and loss of atrial kick. What
two treatments are sometimes necessary? - ✔✔control of BP and HR; cardioversion
and antiarrythmic medication
✔✔What treatments improve survival when EF <35% in class II/III CFH and sustained
VT. - ✔✔Automatic cardiac defibrillators, cardiac resynchronization through biventricular
pacing
✔✔The following are systemic causes for what?
hypoxia
increased intracranial pressure
hypothermia
hypothyroidism
hyperkalemia - ✔✔brandyarrhythmias
✔✔What medications may result in bradyarrhythmias? - ✔✔BB, CCB, digoxin
✔✔Emergent treatment of bradyarrythmias is with _____for a patient with bradycardia
causing hypotension, CHF, and syncope. - ✔✔atropine 0.5mg
✔✔With sick sinus syndrome or complete heart block, when is a permanent pacemaker
indicated? - ✔✔for symptomatic patients
✔✔What type of block are pacemakers indicated even when the patient is
asymptomatic? - ✔✔type II second degree AV block (Mobitz) or bifascicular block with
intermittent type II second degree AV block
, ✔✔When accessing for a tachyarrhythmia, what exacerbating conditions should be
evaluated? - ✔✔electrolyte disturbances (hypokalemia or hypomagnesemia), digoxin
level, TSH, ethanol, cocaine
✔✔In patients with a hemodynamically _______wide QRS tachyarrhythmia/SVT,
blocking the AV node with vagal maneuvers, adenosine, BB, CCB, or digoxin is done. -
✔✔stable; unstable means synchronized cardioversion
✔✔_____toxicity can lead to paroxysmal atrial tachycardia with 2:1 block or
nonparoxysmal junctional tachycardia. - ✔✔Digitalis
✔✔The ____syndrome is characterized by a short PR interval, delta wave, and AVRT.
AV nodal blocking agents (BB, CCB, dig, adenosine) should be avoided when AF is
present with WPW. - ✔✔WPW - wolfe Parkinson white
✔✔AVNRT and AVRT should be treated initially with _____. Radiofrequency
____should be considered for long-term management. - ✔✔AV nodal blocking agents;
ablation
✔✔Torsades de pointes is a multifocal VT, associated with a long QT interval.
Treatment is _______&_______. - ✔✔overdrive pacing and magnesium.
✔✔_____is the drug of choice to treat regular narrow complex tachycardias after vagal
maneuvers have been unsuccessful. - ✔✔Adenosine, BB or CCB
✔✔Treatment of ___&___involves rate control, rhythm control, and prevention of
thromboembolism. - ✔✔a fib and a flutter
✔✔Hypertension is defined as a blood pressure over ___. Over 95% of patients have
HTN due to what cause? - ✔✔140/90; essential hypertension with a UNKNOWN cause
✔✔The initial treatment of HTN is with what medication? What is the first line agent for
patients with diabetes, heart disease, or proteinuria? - ✔✔thiazide diuretic; ACE
inhibitor
✔✔GO OVER MRTAPS - ✔✔GO OVER MRTAPS
✔✔Mitral Stenosis impairs diastolic LV filling. Medical therapy involves heart rate control
with what meds? - ✔✔BB or CCB
✔✔Mitral Regurgitation results in left atrial enlargement and a dilated left ventricle. What
meds are used for afterload reduction? - ✔✔ACE inhibitors, ARBs, or a combination of
hydralazine/nitrates
