Texas Internal Medicine 2

Question 1

How dx and tx Prinzmetal’s angina?

Answer 1

Ergonovine stimulation test

CCB or nitrates

Question 2

Systolic ejection murmur
Crescendo/decrescendo
Louder with?
+ ?

Answer 2

Aortic Stenosis:

• louder w/ squatting
• softer w/ valsalva

+ parvus et tardus

Question 3

Systolic ejection murmur

- softer with squatting or handgrip

Answer 3

HOCM

- louder w/ valsalva

Question 4

Late systolic murmur w/ click

- louder w/ valsalva and handgrip

Answer 4

Mitral valve prolapse

Question 5

Holosystolic murmur radiating to axilla

w/ LAE

Answer 5

Mitral Regurgitation

Question 6

Holosystolic murmur w/ late diastolic rumble in kids?

Answer 6

VSD

Question 7

Wide fixed and split S2

Answer 7

ASD

Question 8

Rumbling diastolic murmur w/ opening snap

Answer 8

Mitral stenosis

Question 9

Blowing diastolic murmur w/ widened pulse pressure and eponym parade?

Answer 9

Aortic regurgitation

Question 10

SOB + history of cancer?

Answer 10

Suspect PE
- or lots of butt sitting!

Tx = heparin

Question 11

SOB + O2 sats < 90%

Next best step?

Answer 11

Tx = give O2

Question 12

SOB + s/s of pneumonia

Next best step?

Answer 12

CXR

Question 13

SOB + murmur or hx CHF

Next best step?

Answer 13

ECHO

Question 14

How treat acute pulmonary edema?

Answer 14

Nitrates
Furosemide
Morphine

Question 15

SOB in young pt + s/s CHF
- with prior hx viral infection
Dx?

Answer 15

Myocarditis

- coxsackie B

Question 16

SOB + young pt + no cardiomegaly on CXR?

Answer 16

Primary pulmonary HTN

Question 17

CHF

• systolic problem
• diastolic problem

Answer 17

Systolic - decreased EF (<55%)
- ischemia or dilated

Diastolic - normal EF, heart can’t fill

Question 18

Reasons for Systolic CHF dysfunction?

Answer 18

Ischemia / Dilated

• Viral
• ETOH
• Cocaine
• Chagas

Question 19

Reasons for Diastolic CHF dysfunction?

Answer 19

HTN
Amyloidosis
Hemachromatosis = restrictive CM

Question 20

How reverse:

• ETOH dilated CM?
• Hemachromatosis restrictive CM?

Answer 20

Stop the booze

Phlebotomy

Question 21

5 Drugs to Treat CHF?

Answer 21

ACEi = improve survival (prevent remodeling)
b-blocker (meto/carv) = improve survival (prevent remodeling
Spironolactone = improve survival in NYHA II / IV
Furosemide = only improve sxs
Digoxin = only improve sxs and decrease hospitalizations

Question 22

What symptoms will furosemide improve in CHF?

Answer 22

SOB
Crackles
Edema