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Internal Medicine COMAT Review Exam-293 Questions with Updated Solutions
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Internal Medicine COMAT Review Exam-293 Questions with Updated Solutions
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Internal Medicine COMAT Review Exam-293 Questions with Updated Solutions
ECG leads representing anterior wall - -V1-4 (LAD)
-ECG leads representing the inferior portion of the heart - -II, III, and aVF
(right coronary artery)
-ECG leads representing the lateral myocardial wall - -I, AVL, V5, & V6
-When should you consider immediate diagnostic coronary angiography? - -
order immediate diagnostic coronary angiography for a STEMI or new-onset
Left BBB
-Another name for angioplasty... - -Primary
-In an acute inferior wall myocardial infarction, occlusion of which coronary
artery is usually implicated? - -Right coronary artery
-Difference in sounds between COPD and pulmonary edema/interstitial lung
disease. - -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 - -CHF
-What are S3 heart sounds - -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 - -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? - -It's an early DIASTOLIC
murmur heard in the 2nd LEFT-upper sternal border.
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-Indications for ordering an echocardiogram - -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 - -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 - -Severe
hypothyroidism can cause CHF.
Hyperthyroidism can cause high output HF.
-Medications that have been shown to decrease mortality in systolic heart
failure - --ACE inhibitors
-ARBs (angiotensin receptor blockers)
-Beta blockers
-Aldosterone blockers
-Hydralazine & nitrates
-Goal of treating hypertensive urgency - -BP reduction of 25% in the first
few hours to day in order to avoid reducing the BP too quickly.
-Roth spots - -Retinal hemorrhages w/pale centers...usually seen in bacterial
endocarditis
-Definition of metabolic syndrome - -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 - -1. current
ASCVD (atherosclerotic vascular dz)
2. LDL cholesterol > 190
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3. Diabetes (type 1 or 2) ages 40-75
4. Estimated 10-year ASCVD risk by pooled cohort equations >7.5%
-Well's Criteria - -Criteria for diagnosing a DVT:
A point each for (1) localized tenderness, (2) asymmetric pitting edema, and
(3) asymmetric calf swelling
-*Virchow's Triad - -Risk for DVT
Triad=
1. Stasis
2. Vascular Injury
3. Hypercoagulability
-Arterial Blood Gas (ABG) in a PE patient - -Arterial blood gases (ABGs) in
pulmonary thromboembolism usually reveal an acute respiratory alkalosis
secondary to hyperventilation.
-Timeframe for acute vs chronic arthritis - -Acute <6 weeks
Chronic >6 weeks
-Rhonchi - -Low-pitched, continuous sounds often described as similar to a
snoring sound. Generated by narrowing of larger airways due to mucus from
bronchitis or narrowing from asthma or COPD
-Wheezes - -High-pitched whistling sound during breathing when air flows
through a narrowed airway, most commonly heard in asthmatics.
-Crackles - -Synonymous with rales. A discontinuous sound heard more
often during inhalation caused by airway opening. The sounds are often
divided into dry or moist, with the dryness being caused by disease
processes such as fibrosis and the moistness or wetness being secondary to
heart failure or pneumonia.
-Antibiotic of choice for uncomplicated pneumonia - -Azithromycin
-What is neutropenic fever - -Neutropenic fever= temperature greater than
38.3 C (101 F) & an absolute neutrophil count less than 500.
-What antibiotics are appropriate for patients with neutropenic fever? - -
Antibiotics used in neutropenic fever need to treat for pseudomonas (since it
can be lethal in septic patients if left untreated)--> ceftazadime, cefepime,
piperacillin-tazobactam, meropenem, imipenem.
-For persistent neutropenic fevers, after giving broad spectrum antibiotics
that cover for pseudomonas, what should be added? - -For persistenet Powered by TCPDF (www.tcpdf.org)
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