INTERNAL MEDICINE EOR PRACTICE PAPER
2026 COMPLETE SOLUTIONS
◉ What is the definition of HFrEF [systolic heart failure]. Answer:
Heart failure with LVEF </= 40%
◉ What is the definition of HFpEF [diastolic heart failure]. Answer:
Heart failure with LVEF > 50%
◉ What are some pharmacologic therapy options for a patient with
Stage C HFrEF?. Answer: Routine use:
Diuretic (if has fluid retention)
ACE-I
ARB (if ACE-I intolerant)
Aldosterone receptor antagonists (NYHA class II-IV with LVEF </=
35% or following an acute MI with LVEF </= 40% w/sx of HF or DM)
Beta blocker
Selected patients:
Hydralazine and isosorbide dinitrate (For African Americans with
NYHA class III-IV HFrEF on GDMT)
Digoxin
,Anticoagulants
◉ What is the acute management of a patient with acute MI?.
Answer: Hospitalize
Possible cardioversion
Beta blocker (if no late stage heart failure)
Rate control
Morphine
ASA
Oxygen
Nitrates
◉ What do you *NOT* do with a patient with unstable angina?.
Answer: Send home to treat as outpatient
◉ Most common organism causing endocarditis in an IVDU?.
Answer: Staph aureus (or MRSA)
◉ Which heart valve is most commonly affected in IVDU with
endocarditis?. Answer: Tricuspid
,◉ How do you treat an IVDU with endocarditis?. Answer: IV
Vancomycin
◉ How do you treat diabetic neuropathy?. Answer:
Amitriptyline/Nortriptyline
Gabapentin/pregabalin
Duloxetine
Venlafaxine
◉ A patient presents with hemiparesis and conjugate gaze paresis.
What is the initial test you do?. Answer: CT of the head
◉ What are some signs/symptoms of a middle cerebral artery
stroke?. Answer: Contralateral hemiparesis (worse in the arm and
face than in the leg), dysarthria, hemianesthesia, contralateral
homonymous hemianopia, aphasia (if the dominant hemisphere is
affected) or apraxia and sensory neglect (if the nondominant
hemisphere is affected)
◉ What are some signs/symptoms of a posterior cerebral artery
stroke?. Answer: Contralateral homonymous hemianopia, unilateral
cortical blindness, memory loss, unilateral 3rd cranial nerve palsy,
hemiballismus (chorea - flailing, ballistic, undesired movements of
the limbs)
, ◉ What are some signs/symptoms of an anterior cerebral artery
stroke?. Answer: Contralateral hemiparesis (maximal in the leg),
urinary incontinence, apathy, confusion, poor judgment, mutism,
grasp reflex, gait apraxia
◉ What are some *absolute* contraindications to giving tPA?.
Answer: 1) Acute intracranial hemorrhage
2) History of ICH
3) Severe uncontrolled HTN (systolic >/= 185 mm Hg or diastolic
>/=110 mm Hg )
4) Serious head trauma or stroke in previous 3 months
5) Platelet count <100 000/mm
6) Pts on anticoagulation therapy
◉ Which diuretic causes *hyperkalemia*?. Answer: Spironolactone
◉ Which BP medication do you *NOT* give to a patient with heart
failure?. Answer: CCB (diltiazem or verapamil)
- negative inotropic effects can exacerbate CHF
◉ Which antihypertensive medications both slow heart rate and
lower blood pressure?. Answer: Calcium channel blockers
Beta blockers
2026 COMPLETE SOLUTIONS
◉ What is the definition of HFrEF [systolic heart failure]. Answer:
Heart failure with LVEF </= 40%
◉ What is the definition of HFpEF [diastolic heart failure]. Answer:
Heart failure with LVEF > 50%
◉ What are some pharmacologic therapy options for a patient with
Stage C HFrEF?. Answer: Routine use:
Diuretic (if has fluid retention)
ACE-I
ARB (if ACE-I intolerant)
Aldosterone receptor antagonists (NYHA class II-IV with LVEF </=
35% or following an acute MI with LVEF </= 40% w/sx of HF or DM)
Beta blocker
Selected patients:
Hydralazine and isosorbide dinitrate (For African Americans with
NYHA class III-IV HFrEF on GDMT)
Digoxin
,Anticoagulants
◉ What is the acute management of a patient with acute MI?.
Answer: Hospitalize
Possible cardioversion
Beta blocker (if no late stage heart failure)
Rate control
Morphine
ASA
Oxygen
Nitrates
◉ What do you *NOT* do with a patient with unstable angina?.
Answer: Send home to treat as outpatient
◉ Most common organism causing endocarditis in an IVDU?.
Answer: Staph aureus (or MRSA)
◉ Which heart valve is most commonly affected in IVDU with
endocarditis?. Answer: Tricuspid
,◉ How do you treat an IVDU with endocarditis?. Answer: IV
Vancomycin
◉ How do you treat diabetic neuropathy?. Answer:
Amitriptyline/Nortriptyline
Gabapentin/pregabalin
Duloxetine
Venlafaxine
◉ A patient presents with hemiparesis and conjugate gaze paresis.
What is the initial test you do?. Answer: CT of the head
◉ What are some signs/symptoms of a middle cerebral artery
stroke?. Answer: Contralateral hemiparesis (worse in the arm and
face than in the leg), dysarthria, hemianesthesia, contralateral
homonymous hemianopia, aphasia (if the dominant hemisphere is
affected) or apraxia and sensory neglect (if the nondominant
hemisphere is affected)
◉ What are some signs/symptoms of a posterior cerebral artery
stroke?. Answer: Contralateral homonymous hemianopia, unilateral
cortical blindness, memory loss, unilateral 3rd cranial nerve palsy,
hemiballismus (chorea - flailing, ballistic, undesired movements of
the limbs)
, ◉ What are some signs/symptoms of an anterior cerebral artery
stroke?. Answer: Contralateral hemiparesis (maximal in the leg),
urinary incontinence, apathy, confusion, poor judgment, mutism,
grasp reflex, gait apraxia
◉ What are some *absolute* contraindications to giving tPA?.
Answer: 1) Acute intracranial hemorrhage
2) History of ICH
3) Severe uncontrolled HTN (systolic >/= 185 mm Hg or diastolic
>/=110 mm Hg )
4) Serious head trauma or stroke in previous 3 months
5) Platelet count <100 000/mm
6) Pts on anticoagulation therapy
◉ Which diuretic causes *hyperkalemia*?. Answer: Spironolactone
◉ Which BP medication do you *NOT* give to a patient with heart
failure?. Answer: CCB (diltiazem or verapamil)
- negative inotropic effects can exacerbate CHF
◉ Which antihypertensive medications both slow heart rate and
lower blood pressure?. Answer: Calcium channel blockers
Beta blockers
