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Internal Medicine

Hypertension levels: 1. prehypertension 2. stage 1 3. stage 2 1. 120/80 to 139/89 2. 14090 to 159/99 3. >160 systolic or >100 diastolic
Treatment for stage 2 hypertension. diuretic with an ACE/ARB/CCB or beta blocker
Which populations should have a blood pressure below 130/80? 1. diabetics 2. renal disease 3. end organ damage: CHF, retinopathy, stroke, PAD
1. Drug to manage hypertension in pregnancy 2. Hypertensive drug contraindicated in pregnancy 1. alpha-methyldopa, hydralazine 2. ACE inhibitors
Patient with chest pain and a difference in blood pressure (>20 mmHg) in both arms aortic dissection
Chest pain with: 1. S4 heart sound 2. acute swelling of legs 3. wide splitting of S2 1. myocardial infarction 2. pulmonary embolism 3. RBBB
1. Pleuritic chest pain, reproduced with chest wall palpitation. 2. Chest pain that is relieved by sitting up 3. Pleuritic chest pain, dyspnea and hemoptysis. 1. costochondritis 2. pericarditis 3. pulmonary embolism
Single most important subgroup that carries risk for ischemic heart disease? LDL cholesterol
EKG changes that are typically seen in: 1. angina 2. Prinzemetal's (variant) angina 1. ST depression 2. ST elevation
What indicates a positive stress test? 1. large (> 2mm) ST-segment depression 2. hypotension (>10 mmHg drop)
Which drugs are used in a chemical stress test? 1. dipyridamole 2. dobutamine 3. adenosine
What are the lipid goals for an individual with ischemic heart disease: 1. LDL 2. HDL 3. triglycerides 1. < 100 2. > 40 3. < 150
What is the pathophysiology of an acute coronary syndrome that differentiates it from stable angina? acute coronary syndromes have atherosclerosis with superimposed thrombotic occlusion
Chest pain with ST elevation and negative cardiac injury panel. unstable angina
Chest pain without ST elevation but with positive cardiac injury panel NSTEMI
Treatment of unstable angina/NSTEMI 1. aspirin 2. nitroglycerin 3. beta-blocker 4. heparin
How long after presentation to hospital should a STEMI undergo PCI? 90 minutes
Recommended discharge medications after acute coronary syndrome: 1. aspirin 2. β-blocker 3. ACE inhibitor 4. Statin 6. Nitrate 7. Warfarin - only if a-fib or CHF
1. Most common risk factor for CAD 2. Worst factor for CAD 1. hypertension 2. diabetes
What are the following from 1. S3 heart sound 2. S4 heart sound 1. fluid overload 2. stiffened left ventricle
Biomarker for reinfarction soon after a previous MI CK-MB
What are the 3 presentations of aortic stenosis? 1. syncope 2. CHF 3. angina
Most specific EKG finding for pericardtiits? PR segment depression
Treatment of pericarditis NSAIDs
Lifestyle changes has the greatest effect on which part of the lipid profile? HDL
Which leads indicate inferior wall MI? 1. II 2. III 3. aVF
Which thrombolytic should not be given repeatedly? streptokinase because antibodies develop
How do you treat symptomatic bradycardia? atropine
1. Friction rub after an MI? 2. What is the treatment? 1. Dressler syndrome 2. aspirin, NSAIDs
Common cause of death following MI? ventricular fibrillation
Treatment for STEMI in II, III, aVF? inferior wall MI treat with fluids
Prinzemental's angina 1. diagnosis 2. Treatment 1. normal stress test and angio 2. nitrates and calcium channel blockers
Management for malignant hypertension. nitroprusside and labetalol to reduce the BP by no more than 25% within 1-2 hours
What is malignant hypertension? acute onset of severe hypertension associated with end-organ damage
1. Hypertension with hypokalemia (2 adrenal causes) 2. Treatment (2) 1. adenoma - surgical resection 2. bilateral hyperplasia - spironolactone
Most common cause of mitral stenosis. rheumatic fever
What is the management for mitral stenosis leading to atrial enlargement? diuretics and salt-restricted diet are helpfull because they decrease volume of preload
Medical management of atrial fibrillation digitalis to control ventricular rate and anticoagulants
Medical management of mitral regurgitation. 1. arteriole vasodilators (ACE inhibitors) 2. diuretics 3. digitalis
Indication for mitral valve replacement from regurgitation 1. increased end systolic diameter (>40 mm) 2. decreased ejection fraction (< 60%)
Patient with mitral valve prolapse complaining of chest pain. What is the medical management? beta blocker
Treatment for aortic stenosis surgical therapy is indicated for symptomatic patients
Indication for aortic valve replacement from regurgitation 1. increased end systolic diameter (>55 mm) 2. decreased ejection fraction (< 55%
How do the following effect blood flow to the heart? 1. squatting 2. valsalva 3. standing 1. more blood to heart 2. less blood to heart 3. less blood to heart
How are the following murmurs effected affected by squatting: 1. regurgitant murmurs 2. stenotic murmurs 3. HOCM 4. MVP more blood to heart 1. increases 2. increases 3. decreases 4. decreases
How are the following murmurs effected affected by valsalva: 1. regurgitant murmurs 2. stenotic murmurs 3. HOCM 4. MVP less blood to heart 1. decreases 2. decreases 3. increases 4. increases
Treatment for dyspnea from HOCM. slow heart to allow longer filling time 1. β-blocker 2. Ca2+ channel blocker
1. What is Kussmaul sign? 2. What disorders is this seen in? 1. JVD upon inhalation 2. Cardiac tamponade, restrictive cardiomyopathy, constrictive pericardtitis
What the sudden loss of consciousness from hypotension due to a 3rd degree AV block? Adam-Stoke attack
1. Definitive treatment for Wolff-Parkinson-White 2. Hemodynamically unstable patient with WPW 3. Medical treatment of WPW in stable patients until definitive therapy can be used 1. radioablation 2. electrical cardioversion 3. procainamide
Why should β-blocker, Ca2+ channel blocker and digoxin be avoided in Wolf-Parkinson-White? they inhibit conduction in the normal conduction pathway
Treatment for: 1. Stable ventricular tachycard 2. Unstable ventricular tachycardia 1. loading dose of amiodarone followed by lidocaine until VT resolves 2. electrical cardioversion
Treatment of third degree heart block. pacemaker



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