Texas Internal Medicine 1

Question 1

Timing of EKG changes with MI ?

Answer 1

ST elevation (2mm+)  =  immediately
T-wave inversion  =  hrs to years
Q-waves  =  last forever

Question 2

ST elevation in V1-V4 ?

Answer 2

Anterior heart wall

- LAD

Question 3

ST elevation in II, III, aVF ?

Answer 3

2,3,floor = Inferior

- RCA

Question 4

ST elevation in V4 with right sided EKG?

Answer 4

R-ventricle = RCA

- 100% specific

Question 5

ST elevation in I, aVL, V4-V6

Answer 5

Lateral

- Circumflex

Question 6

Hypotension
Tachycardia
Clear lungs
JVD
NO pulsus paradoxus         Dx?

Answer 6

Right ventricle infarct

DON’T give nitro

Tx = aggressive fluid resuscitation

Question 7

New wide flat QRS

Answer 7

New LBBB

- stemi

Question 8

Patient comes in with chest pain. What are first 2 tests in order?

Answer 8

1. EKG

2. Cardiac enzymes

Question 9

When do the 3 cardiac enzymes peak?

Answer 9

Myoglobin = 2 hours
CKMB = 24 hours
Troponin I = 24-48 hours

Question 10

When are the 3 cardiac enzymes normal?

Answer 10

Myoglobin = 24 hours
CKMB = 72 hours
Troponin I = 7-10 days

Question 11

How treat NSTEMI?

Answer 11

MONA B
Morphine
Oxygen
Nitrates
Aspirin/clopidogrel
B-blocker

Question 12

When choose CABG over stenting?

Answer 12

If left main coronary disease
If 3 vessel disease
If 2 vessel + DM
. . . with > 70% occlusion, pain despite max medical therapy

Question 13

What are discharge meds for post MI or post stent?

Answer 13

Aspirin
\+ clopidogrel 9-12 mos if stent
B-blocker
ACEi
Statin
Short acting nitrates

Question 14

What is diagnosis if chest pain + no ST elevation + normal enzymes x3?

Answer 14

Unstable angina

Question 15

What are drugs for chemical stress test?

Answer 15

Dobutamine

Adenosine

Question 16

What is positive finding on exercise EKG for unstable angina?

Answer 16

Chest pain is reproduced
ST depression
Hypotension
. . . will need coronary angiography if +

Question 17

Main cause of death post MI ?

Answer 17

Arrhythmias especially V-fib

Question 18

New systolic murmur 5-7 days s/p MI?

Answer 18

Papillary muscle rupture

Question 19

Acute severe hypotension after MI?

Answer 19

Ventricular free wall rupture

Question 20

Step up in O2 concentration from RA to RV s/p MI?

Answer 20

Ventricular septal rupture

Question 21

Persistent ST elevation 1 mo s/p MI?

Answer 21

Ventricular wall aneurysm

Question 22

Cannon A-waves s/p MI?

Answer 22

AV-dissociation

• V-fib
• 3rd degree heart block

Question 23

5-10 weeks s/p MI get pleuritic chest pain + low grade temp?

Answer 23

Dressler Syndrome
- autoimmuni pericarditis

Tx: NSAIDs + aspirin

Question 24

Chest pain worse w/ inspiration
…better w/ leaning forward
What expect on ascultation?
What expect on EKG?

Answer 24

Friction rub
Diffuse ST elevation

PERICARDITIS

Question 25

Chest pain worse w/ palpation?

Answer 25

Constocondriasis

Question 26

Chest pain w/ hx viral infection + murmur?

Answer 26

Myocarditis

Question 27

Young patient w/ chest pain at rest, worse at night, few CAD risk factors + migraine HA

Answer 27

Prinzmetal’s angina

- see transient ST elevation during episodes only