Internal Medicine PAEA Questions with Complete Solutions Graded A+ 2024.

Internal Medicine PAEA Questions with Complete Solutions Graded A+ 2024. diagnose AAA: US what size AAA do you treat with surgery > 5 cm or growing >0.5 cm/year pain out of proportion to abdominal PE mesenteric ischemia-- triade- POP, afib, recently on digitalis pericardal knock constrictive pericarditis-> this is a loud s3 how do you diagnose constrictive pericarditis echo shows pericardial thickening and normal left ventricular function what murmur "widened pulse pressure" AR -> this is when systolic pulse- diastolic pulse is >40 how do you diagnose COA echo/doppler right sided heart failure blood backs up to the _______ periphery, will see JVD, hepatosplenomegaly, peripheral edema, ascities, left sided heart failure blood backs up to the ____ lungs, will see orthopnea, PND, dyspnea on exertion, s2 gallop, crackles what blood test will be elevated in CHF BNP MCC Right heart failure left heart failure Internal Medicine PAEA Questions with Complete Solutions Graded A+ 2024 McC Left heart failure CAD, hypertension, valvular disease endocarditis class I: no limitation class II CHF : slight limitations with exertion class III: marked limitation with exertion class IV: symptomatic at rest SE niacin: hyperglycemia treatment of choice hyperlipidemia: statins (HMG-CoA reductase inhibitors) treatment of htn for diabetic: ACE to protect the kidneys Duke criteria for infective endocarditis: 2 major, 1 major + 3 minor, or 5 minor: major: 1. 2 positive blood cultures taken at least 12 hours apart or 3 + positive cultures atleast 1 hour apart 2. echo vegetations are pathognomonic (TEE more sensitive 3. new regurgitate murmur minor: 1. predisposing lesion on valve or IVDA 2. fever >38 3. oslers nodes(painful), roth spots(retinal hemorrhage), janeway lesions(painless) 4. positive blood cultures 5. echo suspicious for endocarditis in IVDA what valve is typically affected in endocarditis tricuspid -> in a non IVDA the MC valve affected is mitral MCC infective endocarditis strep viridans --> MCC is staph aurues...i thought...strep virdians is for subacute when pt has a murmur or recent dental work... -Lexi loud holosystolic apical murmur radiating to the axilla MR a stress test is considered "positive" for coronary artery disease if which 3 things occur: 1. ECG changes--> 2mm ST depression 2. Hypotension 3. failure to exercise more than 2 minutes due to cardiac symptoms CPK is elevated within ________ in CAD and peaks at ______ elevated within 4-8 hours, peaks at 18-24 hours the extent of elevation of this cardiac serum marker correlates with the amount of cardiac damage CKMB -> so use CKMB to monitor a reinfarction. troponin is elevated within ____ hours but remains for __-__ days 3, 7-10 so this means you cant use it if suspecting a reinfarct bc it will still be high when a pt with suspected MI(STEMI & NSTEMI) comes to the ED we begin: Morphine Oxygen Nitrates ASA BB what are the five P's of occlusive arterial artherosclerosis 1. pain (b/c no blood flow) 2. *pulselessness* 3. *Poikilothermic (cold)* 4. Paresthesias (b/c vascular compromise) 5. pale how do you diagnose occlusive arterial artherosclerosis arteriogram pt presents with pleuritic chest pain on inspiration relieved with leaning forward. 1. what will you expect to hear on auscultation of this patient? 2. what will you see on EKG 3. how do you treat 1. pericardial friction rub 2. global ST elevations and **PR segment depressions*** 3. NSAIDs..colchine for recurrent in peripheral artery disease what color changes will you see in the legs? pale bluish arterial- pale, bluesh, shiny, loss of hair, bad nails what EKG is consistent with bradycardia then tachycardia then bradycardia? what is the definitive treatment? sick sinus syndrome PACEMAKER holosystolic blowing medium-pitched murmur left sternal border 5th ICS, what sign is associated with it? TR Carvallos sign - increased by inspiration post MI, coming in with symptoms of cardiac tamponade . On EKY there are ST elevation in v2- v4. ventricular aneurism,coronary angiography, treat with surgery accessory pathway that allows the electrical signal to travel from sinus node to ventricle bypassing the A-V node. what will you see on EKG? how do you treat?? WPW delta wave (slurring upstroke of QRS) tx:stable: procainamide, amiodarone unstable: synchronized cardioversion *chronic* episodic predicatable pain syndrome due to temporary myocardial ischemia, resolves with rest of medication. what is it and how do you treat? stable angina treat CHRONIC with *BB*..in acute attack give NTG.