ABIM core scripts Study Set | Questions with 100%
Correct Answers
Healthy patient with acute onset of:
Generalized hives
Dyspnea, wheezing after using latex gloves for the first time
Tachycardia
hypoxia
Decreased air movement in lungs with audible wheezing - ✔✔Anaphylaxis
Do NOT require HoTN
Common triggers: drugs (B-lactams), insect stings, foods (shellfish, peanuts), food
additives
Healthy pt with:
Itchy hives on thighs, chest after exercise and hot showers
No wheezing, dyspnea - ✔✔Cholinergic urticaria
Healthy pt with:
Chronic rhinorrhea and nasal congestion in the spring and fall
Bilateral conjunctival injection, dark circles around the eyes, Dennie-Morgan lines
(accentuated lines under the eyes)
Pale blue nasal mucose with edema of the turbinates - ✔✔Allergic rhinitis
Pt presents with:
Chronic nasal congestion, worse in spring and fall
,Swollen and "beefy red" or "boggy, erythematous" nasal mucosa - ✔✔Rhinitis
medicamentosa
Note nasal exam is different from AR
Young patient with:
Diarrhea
Foul smelling stools
PMH: frequent ear, sinus infections as a child, allergies to several foods
+ Giardia stool antigen - ✔✔Selective IgA deficiency
85% have no symptoms
Can see false positive pregnancy test, anaphylaxis with blood transfusion
Previously healthy person presents with 1 week of:
Exertional dyspnea and fatigue
Chest discomfort and fullness
Leg edema with clear lungs
Low BP, SBP drops >10 with ispiration
JVD with rapid x descent (nl/ absent y descent)
EKG: sinus tach, low voltage, diffuse ST elevation with some T wave inversions
CXR- enlarged cardiac silhouette - ✔✔Acute pericarditis with tamponade
Subacute onset, usually idiopathic
Pulsus paradoxus (also in asthma, COPD, PE)
Could see PA cath with equalization of diastolic pressures
DDx - constrictive pericarditis (both x+y descent), MI (different EKG), Ao dissection (no
JVD, edema)
,Pt with HO HTN, presents with acute CP and:
HoTN
JVD, increased a+v waves
EKG: sinus brady, ST elevation in II, III, aVF, and V4R-V6R
PA cath: low CO, PCWP, increased RAP - ✔✔IWMI with RV infarct
Pt with confusion and hypotension:
low CO
High PCWP
High RAP - ✔✔Cardiogenic shock
Pt with history of exertional syncope presents with:
Nl PCWP
high RAP - ✔✔Pulmonary HTN
Pt admitted to the CCU for MI, has CV cath placed in R IJ position, develops:
Recurrent CP
Dyspnea and confusion
Tachypnea, hypotension with decrease in SBP>10 with inspiration
Distended neck veins
Diminished breath sounds on the right - ✔✔Tension penumothorax
In DDX of post MI decompensation (papillary muscle rupture, free wall rupture, septal
rupture), none have pulsus paradoxus, distended neck veins, reduced breath sounds
Can also see in pt on vent with high levels of PEEP
, Young patient with long history of fatigue, exercise intolerance, episodic palps presents
with acute onset of:
R had weakness and dysarthria
Nl JVP but irregular pulse
No edema
Wide, fixed split S2 when standing
Midsystolic ejection murmur at 2nd ICS on L
EKG- tachycardic, sawtootth morphology
CXR- RA enlargement - ✔✔Atrial septal defect, now with atrial flutter and embolic
CVA
ASD->RAE->A. flutt-> CVA
Can also see 1st degr AV block, R axis deviation, incomplete RBBB
If severe RV overload, development of pulm HTN, can see fixed split S2. S2 gets louder
with pulm HTN
Pt with ischemic HD presents with:
Recent onset of lightheadedness and feeling like going to pass out
Decreased exercise capacity
Increased SL NTG use
HR<40
No JVD
Cannon a waves
EKG: wide QRS escape rhythm - ✔✔Complete HB
Slow HR with wide QRS makes it an escape rhythm, unlike wide complex tachycardia
Female patient, smoker, on OCPs, presents with acute onset of:
Correct Answers
Healthy patient with acute onset of:
Generalized hives
Dyspnea, wheezing after using latex gloves for the first time
Tachycardia
hypoxia
Decreased air movement in lungs with audible wheezing - ✔✔Anaphylaxis
Do NOT require HoTN
Common triggers: drugs (B-lactams), insect stings, foods (shellfish, peanuts), food
additives
Healthy pt with:
Itchy hives on thighs, chest after exercise and hot showers
No wheezing, dyspnea - ✔✔Cholinergic urticaria
Healthy pt with:
Chronic rhinorrhea and nasal congestion in the spring and fall
Bilateral conjunctival injection, dark circles around the eyes, Dennie-Morgan lines
(accentuated lines under the eyes)
Pale blue nasal mucose with edema of the turbinates - ✔✔Allergic rhinitis
Pt presents with:
Chronic nasal congestion, worse in spring and fall
,Swollen and "beefy red" or "boggy, erythematous" nasal mucosa - ✔✔Rhinitis
medicamentosa
Note nasal exam is different from AR
Young patient with:
Diarrhea
Foul smelling stools
PMH: frequent ear, sinus infections as a child, allergies to several foods
+ Giardia stool antigen - ✔✔Selective IgA deficiency
85% have no symptoms
Can see false positive pregnancy test, anaphylaxis with blood transfusion
Previously healthy person presents with 1 week of:
Exertional dyspnea and fatigue
Chest discomfort and fullness
Leg edema with clear lungs
Low BP, SBP drops >10 with ispiration
JVD with rapid x descent (nl/ absent y descent)
EKG: sinus tach, low voltage, diffuse ST elevation with some T wave inversions
CXR- enlarged cardiac silhouette - ✔✔Acute pericarditis with tamponade
Subacute onset, usually idiopathic
Pulsus paradoxus (also in asthma, COPD, PE)
Could see PA cath with equalization of diastolic pressures
DDx - constrictive pericarditis (both x+y descent), MI (different EKG), Ao dissection (no
JVD, edema)
,Pt with HO HTN, presents with acute CP and:
HoTN
JVD, increased a+v waves
EKG: sinus brady, ST elevation in II, III, aVF, and V4R-V6R
PA cath: low CO, PCWP, increased RAP - ✔✔IWMI with RV infarct
Pt with confusion and hypotension:
low CO
High PCWP
High RAP - ✔✔Cardiogenic shock
Pt with history of exertional syncope presents with:
Nl PCWP
high RAP - ✔✔Pulmonary HTN
Pt admitted to the CCU for MI, has CV cath placed in R IJ position, develops:
Recurrent CP
Dyspnea and confusion
Tachypnea, hypotension with decrease in SBP>10 with inspiration
Distended neck veins
Diminished breath sounds on the right - ✔✔Tension penumothorax
In DDX of post MI decompensation (papillary muscle rupture, free wall rupture, septal
rupture), none have pulsus paradoxus, distended neck veins, reduced breath sounds
Can also see in pt on vent with high levels of PEEP
, Young patient with long history of fatigue, exercise intolerance, episodic palps presents
with acute onset of:
R had weakness and dysarthria
Nl JVP but irregular pulse
No edema
Wide, fixed split S2 when standing
Midsystolic ejection murmur at 2nd ICS on L
EKG- tachycardic, sawtootth morphology
CXR- RA enlargement - ✔✔Atrial septal defect, now with atrial flutter and embolic
CVA
ASD->RAE->A. flutt-> CVA
Can also see 1st degr AV block, R axis deviation, incomplete RBBB
If severe RV overload, development of pulm HTN, can see fixed split S2. S2 gets louder
with pulm HTN
Pt with ischemic HD presents with:
Recent onset of lightheadedness and feeling like going to pass out
Decreased exercise capacity
Increased SL NTG use
HR<40
No JVD
Cannon a waves
EKG: wide QRS escape rhythm - ✔✔Complete HB
Slow HR with wide QRS makes it an escape rhythm, unlike wide complex tachycardia
Female patient, smoker, on OCPs, presents with acute onset of:
