48 Questions
Which of the following cases should a cardiac stress test be obtained for Angina Pectoris?
A 60-year-old female hypertensive and smoker with retrosternal chest pain precipitated by exertion and relieved by rest
What is the most likely diagnosis for the second case mentioned (60-year-old female with retrosternal chest pain precipitated by exertion and relieved by rest)?
Angina Pectoris
What should be considered when determining the next best step in patient management?
Diagnostic information, staging, or therapy
What is the recommended dose of Aspirin for event prevention?
81-162mg/day
What is the mechanism of action of Clopidogrel? Clopidogrel is a P2Y12 inhibitor that decreases ______ aggregation.
platelet
Which class of drugs reduces heart rate, contractility, atrioventricular conduction, and ectopic activity?
Beta blockers
What is one of the anginal equivalents commonly seen in women and older adults?
Dyspnea
To increase the sensitivity of detection of CAD beyond ECG, the choice is a ______________ test.
Stress
What is an indicator of severe coronary artery disease (CAD) based on the redistribution of coronary blood flow?
Postprandial angina
Exercise as a form of stress test can provide physiologic data such as exercise time and workload.
True
What is the next best step for a patient with traumatic tension pneumothorax?
Immediate decompression by doing needling thoracentesis
For a patient considered to have an acute coronary syndrome, what is the next best step?
How to distinguish anginal chest pain from other causes: _ chest pain vs. _ chest pain
Which of the following chest pain descriptions would MOST likely point to a possible acute coronary syndrome?
Pain lasting more than 10 minutes
Which among the following laboratory parameters/procedures will dictate the management for ACS?
Trop I
Given the clinical picture of anginal chest pain, which of the following features will lead you to proceed with urgent coronary angiogram possible angioplasty?
New abnormal wall motion and contractility on 2D Echo
A 68-year-old male came in for sudden onset substernal chest pain. ECG revealed inferior wall STEMI, without Right Ventricle involvement. What is the next step in management?
Immediate PCI
Which of the following medications is CONTRAINDICATED in this case?
Aspirin
What is the most common cause of in-hospital death among patients suffering from ACS?
Ventricular Fibrillation
Which of the following will you NOT CONSIDER first in the case mentioned? (Patient brought to the emergency room for chest heaviness)
Acute coronary syndrome
For patients with STE-ACS (Infarct), what is the diagnostic procedure of choice to determine the direction of management?
2D echocardiogram
Which of the following medications is contraindicated for a 68-year-old male with inferior wall STEMI without Right Ventricle involvement?
Metoprolol
What is the most common cause of in-hospital death among patients suffering from ACS?
Pump Failure
In which phase of the cardiac cycle is the Left Ventricle emptied?
Systole
The most common cause of out-of-hospital death from STEMI is Ventricular Fibrillation, while the most common cause of in-hospital death is ___________.
Pump Failure
What makes up the second heart sound (S2)?
Aortic (A2) and pulmonic (P2) valve closure
Where are the individual components of the second heart sound BEST heard?
Second left interspace
The A2-P2 interval narrows with expiration. True or False?
True
A widened A2-P2 interval is associated with severe _?
MR
Match the following diastolic sounds with their associated conditions:
Opening Snap = Mitral StenosisTumor Plop = Atrial MyxomaPericardial Knock = Constrictive Pericarditis
What is the next best step for a patient with traumatic tension pneumothorax?
Immediate decompression by doing needling thoracentesis
For a patient being considered for acute coronary syndrome, what is the next best step?
Treat with Aspirin to save myocardium
What is the best initial test for a male patient presenting with sudden severe headache and focal neurologic deficit?
Non-contrast head CT scan
What type of murmurs generally INCREASE with inspiration?
Right-sided murmurs (TS, TR, PS, PR)
What is the most likely diagnosis for the 69-year-old man with severe chest pain, bibasal crackles, and ST elevation in V3 and V4 leads?
Acute ST-elevation MI, anterior wall, Killip II
Which type of murmurs are usually LOUDER during expiration?
Left-sided murmurs (AS, AR, MS, MR)
What happens to most murmurs in terms of length and intensity?
MOST murmurs DECREASE in length and intensity
What is the underlying pathophysiology in the case of the 69-year-old man?
Acute plaque rupture
What is considered a pivotal diagnostic test for management of ST-elevation MI?
ECG
Give two exceptions to the general trend of murmurs decreasing in intensity.
- HOCM: becomes much louder
- MVP: becomes longer and often louder
What happens to right-sided murmurs after the release of the Valsalva maneuver?
Return to baseline intensity earlier than left-sided murmurs
What is the primary goal in the management of ST-elevation MI?
Reperfusion therapy
Which of the following chest pain descriptions would MOST likely point to a possible acute coronary syndrome?
Pain lasting more than 10 minutes
What typically happens to most murmurs with standing?
DIMINISH
What is the average rate of hemodynamic progression involving aortic valve area?
Decrease in aortic valve area of 0.12 cm2/year
Which laboratory parameter/procedure will dictate the management for Acute Coronary Syndrome?
Troponin I
In the context of anginal chest pain, what feature would lead to the decision to proceed with urgent coronary angiogram or possible angioplasty?
Elevated Troponin
Which two factors are associated with more rapid hemodynamic progression?
- Older age
- Other factors not specified
Topnotch Medical Board Prep's handout for Internal Medicine review, specifically designed for the October 2023 PLE batch. This handout is only valid for this batch and will be updated regularly.
