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Internal Medicine COMAT Review
Questions and Answers
ECG leads representing anterior wall
Ans: V1-4 (LAD)
ECG leads representing the inferior portion of the heart
Ans: II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall
Ans: I, AVL, V5, & V6
When should you consider immediate diagnostic coronary
angiography?
Ans: order immediate diagnostic coronary angiography for a STEMI or
new-onset Left BBB
Another name for angioplasty...
Ans: Primary
In an acute inferior wall myocardial infarction, occlusion of which
coronary artery is usually implicated?
Ans: Right coronary artery
Difference in sounds between COPD and pulmonary
edema/interstitial lung disease.
Ans: Wheezing or rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung
disease.
Most common cause of an S3 heart sound
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, 2 | Page
Ans: CHF
What are S3 heart sounds
Ans: S3 results from increased atrial pressure leading to increased flow
rates, as seen in congestive heart failure, which is the most common
cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur
Ans: High output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated?
Ans: It's an early DIASTOLIC murmur heard in the 2nd LEFT-upper
sternal border.
Indications for ordering an echocardiogram
Ans: 1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE
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Ans: Hampton hump (shallow wedge-shaped opacity in the periphery of
the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to
collapse of vessel) seen distal to a PE. It's due to a combo of dilation of
the pulmonary arteries proximal to the embolus & collapse of the distal
vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure
Ans: Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in
systolic heart failure
Ans: -ACE inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency
Ans: BP reduction of 25% in the first few hours to day in order to avoid
reducing the BP too quickly.
Roth spots
Ans: Retinal hemorrhages w/pale centers...usually seen in bacterial
endocarditis
Definition of metabolic syndrome
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Ans: Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for
hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for
hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50
mg/dL for women (or on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for
women)
4 groups of ppl most likely to benefit from statin therapy
Ans: 1. current ASCVD (atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria
Ans: Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema,
and (3) asymmetric calf swelling
*Virchow's Triad
Ans: Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient
© 2025 All rights reserved
Internal Medicine COMAT Review
Questions and Answers
ECG leads representing anterior wall
Ans: V1-4 (LAD)
ECG leads representing the inferior portion of the heart
Ans: II, III, and aVF (right coronary artery)
ECG leads representing the lateral myocardial wall
Ans: I, AVL, V5, & V6
When should you consider immediate diagnostic coronary
angiography?
Ans: order immediate diagnostic coronary angiography for a STEMI or
new-onset Left BBB
Another name for angioplasty...
Ans: Primary
In an acute inferior wall myocardial infarction, occlusion of which
coronary artery is usually implicated?
Ans: Right coronary artery
Difference in sounds between COPD and pulmonary
edema/interstitial lung disease.
Ans: Wheezing or rhonchi= more suggestive of COPD
Crackles= more suggestive of pulmonary edema or interstitial lung
disease.
Most common cause of an S3 heart sound
© 2025 All rights reserved
, 2 | Page
Ans: CHF
What are S3 heart sounds
Ans: S3 results from increased atrial pressure leading to increased flow
rates, as seen in congestive heart failure, which is the most common
cause of an S3 heart sound.
causes of a mid-systolic non-radiating murmur
Ans: High output states (anemia, fever, thyrotoxicosis, pregnancy).
Aortic stenosis (ejecting systolic murmur that radiates to carotids).
Aortic sclerosis (valve thickening w/o outflow obstruction).
Pulmonic stenosis
Hypertrophic cardiomyopathy (consider in younger patients).
Where is aortic regurgitation auscultated?
Ans: It's an early DIASTOLIC murmur heard in the 2nd LEFT-upper
sternal border.
Indications for ordering an echocardiogram
Ans: 1. Patient is symptomatic w/murmur.
2. Pt has continuous murmur.
3. Pt has diastolic murmur
4. Pt has murmur w/intensity >3/6.
Radiographic signs seen occasionally in PE
© 2025 All rights reserved
, 3 | Page
Ans: Hampton hump (shallow wedge-shaped opacity in the periphery of
the lung w/its base against the pleural surface).
Westermark sign=sign that represents a focus of oligemia (leading to
collapse of vessel) seen distal to a PE. It's due to a combo of dilation of
the pulmonary arteries proximal to the embolus & collapse of the distal
vasculature creating the appearance of a sharp cut off on CXR.
Why can TSH be helpful in diagnosing heart failure
Ans: Severe hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
Medications that have been shown to decrease mortality in
systolic heart failure
Ans: -ACE inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
Goal of treating hypertensive urgency
Ans: BP reduction of 25% in the first few hours to day in order to avoid
reducing the BP too quickly.
Roth spots
Ans: Retinal hemorrhages w/pale centers...usually seen in bacterial
endocarditis
Definition of metabolic syndrome
© 2025 All rights reserved
, 4 | Page
Ans: Any three of the following five:
1. Fasting plasma glucose > 100 mg/dL (or on medical therapy for
hyperglycemia)
2. BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
3. Triglycerides ≥ 150 mg/dL (or on medical therapy for
hypertriglyceridemia)
4. High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50
mg/dL for women (or on medical therapy for low HDL cholesterol)
5. Abdominal obesity (waist circumference > 40" for men, > 35" for
women)
4 groups of ppl most likely to benefit from statin therapy
Ans: 1. current ASCVD (atherosclerotic vascular dz)
2. LDL cholesterol > 190
3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
Well's Criteria
Ans: Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema,
and (3) asymmetric calf swelling
*Virchow's Triad
Ans: Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
Arterial Blood Gas (ABG) in a PE patient
© 2025 All rights reserved
