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PLE 2022 > INTERNAL MEDICINE BOARD CORRELATES > Flashcards

INTERNAL MEDICINE BOARD CORRELATES Flashcards

1
Q

Most efficient extractor of oxygen from the blood

A

heart

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2
Q

Intracellular junctions responsible for the cardiac syncytium

A

Gap Junctions

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3
Q

Most potent vasoconstrictor

A

ADH

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4
Q

Triad of Ruptured Aneurysm

A

Left flank pain
hypotension
pulsatile mass

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5
Q

Diagnostic triad of Wolff-Parkinson-White (WPH) ecg pattern

A

Wide QRA Complex
Relatively SHORT PR interval
Slurring of the initial part of the QRS (Delta wave)

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6
Q

3 principal features of Becks triad

A

hypotension
soft/absent heart sounds
Jugular venous distention with a prominent x descent but an absent y-descent

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7
Q

major determinants of myocardial 0xygen demand (MVO2)

A

HR
Myocardial contractility
Myocardial wall tension (stress)

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8
Q

triad of buergers diseases

A

claudication of affected extremity
raynauds phenomenon
migratory superficial vein thromnphlebitis

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9
Q

triad of buergers diseases

A

claudication of affected extremity
raynauds phenomenon
migratory superficial vein thromnphlebitis

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10
Q

virchows triad

A

stasis
vascular/endothelial damage
hypercoagulability

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11
Q

Dressler Triad (Post MI pericarditis)

A

Fever
Pleuritic pain
Pericardial effusion

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12
Q

drugs increases contractility

A

digoxin
dobutamine
milrinone

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13
Q

drugs reduces preload

A

Diuretics
vasodilators
ace inhibitors

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14
Q

Drugs reduces afterload

A

diuretics
vasodilators
ACE inhibitors
Beta blockers

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15
Q

Drugs causes Causes Na excretion and reduction in blood volume

A

Diuretics

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16
Q

Drugs Calcium Channel Blocker that exerts more effect in the vessels than the heart

A

Dihydropyridines

Nifedipine, Felodipine, Amlodipine

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17
Q

Calcium Channel blocker that exerts more effect on the heart than the vessels

A

Nondihydropyridines

Verapamil, Diltiazem

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18
Q

Decreases the work load of the heart

A

Beta-blockers

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19
Q

Blocks the AT1 receptor of angiotensin II

A

ARBs

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20
Q

Notorious for drug-induced cough by increasing bradykinin

A

ACE inhibitors

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21
Q

Blocks aldosterone action in the collecting tubules

A

Spironolactone, Eplerenone

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22
Q

Hypertension with Benign Prostatic Hyperplasia (BPH)

A

Alpha-1 antagonists (Prazosin)

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23
Q

Maintenance medication for pre-eclampsia

A

Methyldopa

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24
Q

Physiologic basis for normal ECG tracing

A

P-wave: atrial depolarization
QRS complex: ventricular depolarization
T wave: ventricular repolarization

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25
Q

Master pacemaker of the heart

A

Sinoatrial (SA) Node

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26
Q

Causes depolarization of the SA node

A

Calcium influx (Sodium influx will merely
bring potential closer to threshold;
however, sodium is still the determinant
of heart rate)

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27
Q

The only electrical connection between the atria and ventricles

A

AV node

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28
Q

Only reliable therapy for symptomatic bradycardia in the absence of extrinsic
and reversible etiologies

A

Permanent pacemaking

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29
Q

Most rapid conduction in the heart

A

His bundle and bundle branches

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30
Q

Most expeditious technique in the management of AV conduction block

A

Transcutaneous pacing

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31
Q

Most common arrhythmia identified during extended ECG monitoring

A

Atrial Premature Complexes

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32
Q

Most common sustained arrhythmia

A

Atrial Fibrillation

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33
Q

Most common arrhythmia post-MI

A

Premature Ventricular Contraction

PVC

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34
Q

Most common lethal arrhythmia post-MI

A

Ventricular Fibrillation

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35
Q

Most common cause of systolic dysfunction that leads to L-sided HF

A

Coronary Artery Disease (CAD)

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36
Q

Most common cause of diastolic dysfunction that leads to L-sided HF

A

Concentric LVH due to HPN

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37
Q

Most common cause of R-sided HF

A

L-sided HF

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38
Q

Earliest cardinal symptom of L-sided HF

A

Dyspnea

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39
Q

Earliest cardinal sign of L-sided HF

A

L-sided S3

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40
Q

Presentation of L-sided HF

A 
Dyspnea, left-sided S3, PND,
orthopnea, Mitral regurgitation,
increased Brain Natriuretic Peptide
(BNP), Siderophages (hemosiderinladen
macrophages or HF cells),
pulmonary edema (septal edema,
peribronchiolar edema)
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41
Q

Presentation of R-sided HF

A

Peripheral ankle edema (hallmark of Rsided
HF), NVE, tricuspid regurgitation,
ascites, chronic passive congestion of
the liver (nutmeg liver), cardiac cirrhosis

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42
Q

Most sensitive index of cardiac function

A

Ejection fraction

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43
Q

Single most important bedside measurement to estimate volume status

A

JVP (internal jugular vein is preferred)

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44
Q

Cardinal symptoms of HF

A

Fatigue and shortness of breath

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45
Q

Only pharmacologic agents that can adequately control fluid retention in
advanced HF

A

Diuretics

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46
Q

Major problem of Aldosterone Antagonists

A

Development of life-threatening

hyperkalemia

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47
Q

Cornerstones of modern therapy for HF with a depressed EF

A

ACE-I/ARBs and Beta Blockers

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48
Q

Most common side effect of all vasodilating agents

A

Hypotension

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49
Q

Most commonly used inotropic agent for acute HF

A

Dobutamine

50
Q

First choice for therapy in which modest inotropy & pressor support are
required

A

Dopamine

51
Q

Most common reason for rehospitalization in HF

A

Failure to meet criteria for discharge

52
Q

Most common symptom of cor pulmonale

A

Dyspnea

53
Q

Murmurs that always signify structural heart disease

A 
Diastolic murmurs (Grade I-II systolic
murmurs are usually benign
54
Q

Leading cause of MS

A

Rheumatic Heart Disease

55
Q

Pansystolic Murmur; may be due to Mitral Valve Prolapse (MVP)

A

Mitral Regurgitation (MR)

56
Q

Most common cause of midsystolic murmur in an adult

A

Aortic Stenosis (AS)

57
Q

Most common congenital heart valve defect

A

Bicuspid Aortic Valve Disease

58
Q

Three cardinal symptoms of AS

A

Exertional Dyspnea
Angina Pectoris
Syncope

59
Q

Most common pathologic process involving the pericardium

A

Acute Pericarditis

60
Q

Typical pain in pericarditis

A

Worse when supine and relieved by

sitting upright and leaning forward

61
Q

Pericardial friction rub in acute pericarditis is heard not frequently at

A

End-expiration with patient upright and

leaning forward

62
Q

Three most causes of tamponade

A

Neoplastic disease
Idiopathic pericarditis
Renal failure

63
Q

Most common primary malignant pericardial tumor

A

Mesothelioma (e.g., from asbestosis)

64
Q

Most common primary malignant pericardial tumor

A

Mesothelioma (e.g., from asbestosis)

65
Q

Most common type of primary cardiac tumor in all age groups and occurring at
all ages

A

Myxomas (90% are sporadic)

66
Q

Most common tumors of the cardiac valves

A

Papillary Fibroelastomas

67
Q

Most common cardiac tumors in infants and children

A

Rhabdomyomas

68
Q

Almost all primary cardiac malignancies are

A

Sarcomas (commonly involve the right

side of the heart)

69
Q

Most common primary originating sites of cardiac metastases

A

Cancer of the breast and lung

70
Q

Most often involved in metastasis to the heart

A

Pericardium > Myocardium >

Endocardium or Cardiac Valves

71
Q

Central role in the diagnostic evaluation of cardiac metastases and cardiac
tumors

A

Cardiac MRI

72
Q

Most common form of non-penetrating cardiac injury

A

Myocardial contusions

73
Q

Most common valves that rupture in non-penetrating cardiac injury

A

TV or MV (heralded by the development

of a loud murmur)

74
Q

Most serious consequence of non-penetrating injury

A

Myocardial rupture

75
Q

Most serious consequence of non-penetrating injury

A

Myocardial rupture

76
Q

Most common vascular deceleration injury

A

Rupture of the aorta

77
Q

Most common cause of sudden death in contact sports (e.g., American
football)

A

Commotion Cordis

78
Q

Most common congenital heart disease; CXR shows biventricular enlargement
& dilated left atrium; most common type is membranous

A

Ventricular Septal Defect (VSD)

79
Q

Most common congenital heart disease diagnosed in adults; CXR shows
dilated right atrium and right ventricle

A

Atrial Septal Defect (ASD)

80
Q

CHD with Early Cyanosis (R to L shunt)

A 
Mnemonic: All CHDs that start with “T”:
􀁸 Tetralogy of Fallot (TOF)
􀁸 Tricuspid Atresia
􀁸 Truncus Arteriosus
􀁸 Total Anomalous Pulmonary
Venous Connection (TAPVC)
􀁸 Transposition of the Great
Arteries (TGA)
81
Q

CHD with Late Cyanosis (L to R shunt)

A

ASD, VSD, PDA, AVSD

82
Q

CHD associated with Congenital Rubella Syndrome; “continuous machinery
like murmur”; needs indomethacin to close and PGE1 to remain open

A

Patent Ductus Arteriosus (PDA)

83
Q

CHD associated with Turner’s Syndrome

A

Preductal Coarctation of the Aorta

CoA

84
Q

CHD associated with Down Syndrome

A

ASD, Endocardial Cushion Defect

85
Q

CHD associated with Marfan Syndrome

A

MVP, Aortic Dissection

86
Q

CHD associated with offspring of diabetic moms

A

TGA

87
Q

CXR shows boot-shaped heart (Coeur en Sabot); Components: subpulmonic
stenosis (main determinant of severity), RVH, VSD, overriding of the aorta

A

TOF

88
Q

CXR shows egg-shaped silhouette or egg-on-its-side appearance

A

TGA

89
Q

CXR shows snowman sign/cottage-loaf heart

A

TAPVC

90
Q

CXR shows figure of 3 sign

A

CoA (rib-notching is seen in the adult or

post-ductal form)

91
Q

Most common underlying cause of myocardial ischemia and injury

A

Obstruction of coronary arteries by

atherosclerosis

92
Q

Most common cause of anterior chest musculoskeletal pain

A

Costochondral and chondrosternal

syndromes

93
Q

Major cause of death and premature disability in developed societies

A

Atherosclerosis

94
Q

Represents the initial lesion of atherosclerosis

A

Fatty Streak

95
Q

Major features of metabolic syndrome

A 
Central obesity
Hyperglycemia
Hypertriglyceridemia
Hypertension
Low HDL cholesterol
96
Q

Age when lipid screening should start (based on current ATP III guidelines)

A

All adults > 20 years (fasting lipid
profile: total cholesterol, triglycerides,
LDL and HDL) repeated every 5 years

97
Q

First maneuver to achieve LDL goal

A

Therapeutic lifestyle changes (TLC)

98
Q

Ultimately causes the gravest complications of atherosclerosis

A

Thrombosis

99
Q

Key feature of the metabolic syndrome

A

Central adiposity

100
Q

Most accepted & unifying hypothesis to describe pathophysiology of metabolic
syndrome

A

Insulin resistance

101
Q

Driving force behind the metabolic syndrome

A

Obesity

102
Q

Primary approach to metabolic syndrome

A 
Weight reduction (caloric restriction:
most important component)
103
Q

Drug of choice to lower LDL

A

HMG-CoA reductase inhibitors (Statins)

104
Q

Drug of choice to lower fasting TG

A

Fibrates

105
Q

Only currently available drug with predictable HDL-raising properties

A

Nicotinic acid

106
Q

Most common cause of myocardial ischemia

A

Atherosclerotic disease of epicardial

coronary artery

107
Q

Major site of atherosclerotic disease

A 
Epicardial arteries (most common: Left
Anterior Descending Artery)
108
Q

Sites of predilection for atherosclerotic plaques to develop due to increased
turbulence

A

Branch points in the epicardial arteries

109
Q

Time frame for reversible damage in myocardium

A

<20 minutes for total occlusion in the

absence of collaterals

110
Q

Route of administration where absorption of nitrates is most rapid and
complete

A

Sublingual/through mucus membranes

111
Q

Most common pathophysiologic cause of unstable angina

A

Plaque rupture or erosion with

superimposed non occlusive thrombus

112
Q

Only absolute contraindications to nitrate use

A

Hypotension
Sildenafil or other drugs in that class in
previous 24-48 hours

113
Q

Most common artery involved in focal spasms of Prinzmetal angina

A

Right Coronary Artery

114
Q

Type of necrosis seen in MI

A 
Coagulation Necrosis (preserved
architecture, faded details)
115
Q

Time frame where gross changes in MI occur

A

12 hours after the onset of symptoms

116
Q

Color changes in MI

A 
Mottling: 4 hours
Bright yellow: 1 wk
Surrounding red granulation tissue: 2
weeks
Gray-white scar: 2 months
117
Q

Fibrinous Pericarditis (bread & butter pericarditis) post-MI

A

Dressler’s Syndrome

118
Q

Myocardial rupture post-MI occurs in patients who are

A

1st time MI patients (cardiac scar in

those with previous MI prevents rupture)

119
Q

Pivotal diagnostic and triage tool because it is at the center of the decision
pathway for management in STEMI

A

12-Lead ECG

120
Q

Most common presenting complaint in STEMI

A

Chest pain

121
Q

Preferred biochemical markers for MI

A

Cardiac-Specific Troponin T & Cardiac-

Specific Troponin I

PLE 2022 (1 decks)

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