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.PAEA Internal Medicine Inpatient EOR
Topics 2023 Questions and Answers
Complete;(everything on topic list
except hematology (5%) and infectious
disease (5%))
what is the most common cause of heart failure? specifically left sided? right sided? - -
MC is CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop
(filling of dilated ventricle) is associated with systolic or diastolic heart failure? - systolic
(MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop
(atrial contraction into a stiff ventricle) is associated with systolic or diastolic heart
failure? - diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure? - -systolic: post *MI*, *dilated
cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t
thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the bone)
this is termed ________ heart failure - high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what are some causes of acute vs chronic heart failure? - -acute: *largely systolic*;
hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)

explain class I-IV New York Heart Association functional classes - -class I: *no sx's*, *no
limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary activity
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even with
minimal exertion
-class IV: *sx's even while at rest*, severe limitations, inability to carry out physical
activity
what compensations does the body make when heart failure (can be due to something
that causes either inc pre/afterload or dec contractility) begins? - 1. sympathetic nervous
system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic nonproductive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4,
pale skin/cool extremities, sinus tachy, fatigue - L-sided HF
the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver
palpation) - R-sided HF
-CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion,
pulmonary edema
-echo with dec EF
-inc BNP on labs
are all signs of? - heart failure
*BNP released from atrium with preload too high (volume overload)
what drugs have shown to decrease mortality rates in pts with heart failure? - *ACE
inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates, spironolactone
in pts who experience the following common side effects of an ACE inhibitor to treat
heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema - ARBs (-
sartans)
what vasodilators are often used to treat heart failure? - hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
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