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Internal Medicine Review ABIM part 1
Exam Questions With 100% Verified
Answers.
What is a positive stress test - answer✔Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - answer✔St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - answer✔Myocardial perfusion
imaging with adenosine,
NOT exercising!
When to not use doutamine for stress - answer✔History of VT,
severe HTN,
Low BP,
poor echo images
When to not use adenosine for stress - answer✔Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
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heophylline dependent
Normals for PA catheter pressures - answer✔RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - answer✔tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - answer✔RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - answer✔cardiogenic shock
high RA,
PA very elevated
high PCWP
nl SBP - answer✔mitral stenosis with RV failure
Elevated PAP, RAP
nl PCWP, SBP - answer✔pulmonary HTN
decr in SBP>10mmHg with nl inspiration;
palpated as weakened pulse with inspiration &
more heart contractions to pulse beats - answer✔pulsus paradoxus:
Constrictive or restrictive pericarditis,
asthma,
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tension pneumothorax
What gives you pulsus bisferiens
(two systolic peaks per cycle) - answer✔Aortic regurgitation,
HOCM
What causes pulsus alternans - answer✔Severe LV dysfunction
What causes pulsus tardus - answer✔Aortic stenosis
How do positional maneuvers affect blood flow and murmurs - answer✔-standing/valsalva:
decreased cardiac filling,
decreases most murmurs
except MVP and HOCM
-squatting/ lying down:
increase cardiac volume,
increased murmurs
except MVP, HOCM
-sustained handgrip:
increases systemic resistance
decreases murmur in HOCM, AS
What causes a physiologic split S2 - answer✔Increased blood volume in the RV
prolongs systole and
delays pulmonary valve closure
What causes a fixed split S2 - answer✔Pulmonary stenosis,
PE,
LV pacer,
RBBB,
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MR (early AV closure),
ASD,
RV failue
What causes a paradoxic split S2 - answer✔LBBB,
RV pacing,
HOCM
What causes an S3? - answer✔Rapid LV filling:
acute ventricular decompensation,
severe AR or MR
What are the parts of the venous waveform? - answer✔A wave - atrial contraction
X descent - atria relax, RV fills rapidly
Bottom of x descent is TC valve closure
V wave - ventricle contacting against closed TC valve
Y descent - TC valve opens,
passive emptying into ventricle
What gives elevated a and v waves - answer✔Pulmonary HTN,
RV infarction
Large r side v waves - answer✔Septal rupture
Large v waves - answer✔TR (right),
MR (left)
Rapid x and y descent - answer✔Constrictive pericarditis,
restrictive cardiomyopathy,
tamponade
