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TABLE OF CONTENTS
INTRODUCTION .................................................................................... 1
CHAPTER 1: CARDIOLOGY ................................................................. 2
-REVIEW QUESTIONS ................................................................................................. 34
-REVIEW ANSWERS .................................................................................................... 37
-QUICK FACTS/ASSOCIATIONS ................................................................................. 43
CHAPTER 2: PULMONOLOGY ............................................................. 46
-REVIEW QUESTIONS ................................................................................................. 71
-REVIEW ANSWERS .................................................................................................... 74
-QUICK FACTS/ASSOCIATIONS ................................................................................. 79
CHAPTER 3: MUSKULOSKELETAL/RHEUMATOLOGY .................... 81
-REVIEW QUESTIONS ................................................................................................. 120
-REVIEW ANSWERS .................................................................................................... 124
-QUICK FACTS/ASSOCIATIONS ................................................................................. 131
CHAPTER 4: GASTROENTEROLOGY ................................................. 135
-REVIEW QUESTIONS .................................................................................................. 166
-REVIEW ANSWERS .................................................................................................... 169
-QUICK FACTS/ASSOCIATIONS ................................................................................. 174
CHAPTER 5: REPRODUCTION ............................................................. 176
-REVIEW QUESTIONS .................................................................................................. 210
-REVIEW ANSWERS ..................................................................................................... 213
-QUICK FACTS/ASSOCIATIONS ................................................................................. 218
CHAPTER 6: GENITOURINARY ............................................................ 220
-REVIEW QUESTIONS .................................................................................................. 252
-REVIEW ANSWERS ..................................................................................................... 255
-QUICK FACTS/ASSOCIATIONS ................................................................................. 260
CHAPTER 7: EENT ................................................................................ 262
-REVIEW QUESTIONS .................................................................................................. 293
-REVIEW ANSWERS .................................................................................................... 295
-QUICK FACTS/ASSOCIATIONS ................................................................................. 299
CHAPTER 8: ENDOCRINOLOGY .......................................................... 301
-REVIEW QUESTIONS .................................................................................................. 319
-REVIEW ANSWERS ..................................................................................................... 322
-QUICK FACTS/ASSOCIATIONS .................................................................................. 327
CHAPTER 9: NEUROLOGY ................................................................... 329
-REVIEW QUESTIONS .................................................................................................. 350
-REVIEW ANSWERS ..................................................................................................... 353
-QUICK FACTS/ASSOCIATIONS .................................................................................. 358
CHAPTER 10: HEMATOLOGY .............................................................. 360
-REVIEW QUESTIONS .................................................................................................. 378
-REVIEW ANSWERS ..................................................................................................... 381
-QUICK FACTS/ASSOCIATIONS ................................................................................. 385
TABLE OF CONTENTS
This book will give you a straight forward way to learn the many disease processes
out there. I didnt write a lot of bullet points with a lot of random facts. Instead, I
wrote down what is done first, and what will be done next. The boards want to
make sure that you know the order in which to do things, even though everything
is usually done simultaneously in clinical practice.
This book contains everything you need to know to pass your boards. The first
section of each chapter is filled with all the diseases required by the NCCPA
blueprint. The second section is a set of review questions that goes over the entire
chapter. The third section is a set of tables that detail important facts and
associations. This third section is a nice way to rapidly review everything the night
or morning before an exam.
Purchasing this book is much more than just a book purchase. You will also have
access to me should any questions arise. If there are ever any questions or
clarification that is needed, please dont hesitate to email me:
AndrewReid@PhysicianAssistantBoards.com
Before you know it, you will be out in clinical practice helping others. Always
believe in your abilities, and remember:
Diastolic dysfunction: Decreased filling due to poor relaxation of the ventricle. Because
the problem here is filling, and not pumping blood out, the ejection fraction will remain
normal.
Systolic dysfunction: Decreased ejection fraction usually less than 50%. This percentage
correlates to the amount of blood that leaves the left ventricle (50% of the blood is
pumped out of the ventricle).
Diagnostic Testing
The first and most useful test that should be performed is an echocardiogram. An ECG
should be done to screen for arrhythmias and to look for Q waves (old in-farct). ECG
might also show signs of ischemia and/or left ventricular hypertrophy. Stress testing is
used to asses exercise tolerance and risk stratification. Chest X-ray is used in the
evaluation of dyspnea (not to diagnose CHF).
Diuretics are given to reduce symptoms: fluid overload. Digoxin is also used for symptom
control such as SOB. Digoxin decreases the time spent hospitalized, but does not reduce
mortality in patients. Spironolactone or eplerenone (less endocrine side eects than spiro-
nolactone) are only beneficial to those who are classified as having class 3 or class 4 CHF.
Be careful with the use of calcium channel blockers, as they may increase mortality in CHF
patients. For those patients who continue to be symptomatic, the addition of nitrates and
hydralazine has proven benefit (more so with African Americans). An ICD (implantable car-
diac defibrillator) is used when the ejection fraction is below 35%, those with sutained VT,
and/or those with unexplained syncope to prevent a fatal arrhythmia.
Caveat: An ICD should only be used if the patient is expected to survive for at least one
year. If everything up to this point has failed, the final option includes transplantation.
ACUTE EXACERBATION
An ECG is done to look for arrhythmias and myocardial infarction. What about BNP?
Well, this is used as an attempt to distinguish between CHF exacerbation and COPD exac-
erbation as the cause of dyspnea. This is a sensitive, but nonspecific test. Meaning, a
normal BNP will exclude CHF, but an elevated BNP can be caused by a variety of
reasons. A severely elevated BNP (>400) increases the likelihood of CHF exacerbation;
<100 virtually excludes the diagnosis. Cardiac enzymes should be drawn, to look for an MI
as the cause of exacerbation.
Next, begin treatment with the acronym LMNOP:
Loop diuretics
Morphine
Nitrates
CARDIOMYOPATHY
Introduction
This is a disease of the heart muscle associated with cardiac dysfunction. The strict defini-
tion requires that no etiology is found (but most will usually have a genetic component).
Because there usually is no etiology, cardiomyopathies can be present during any decade
of life, including childhood. There are three main types: Dilated cardiomyopathy, hypertro-
phic cardiomyopathy, and restrictive cardiomyopathy. All of these can lead to heart
failure.
Diagnostic Testing
The echocardiogram is the test of choice to distinguish between the three.
Ventricle is dilated,
leading to decreased
Dilated Systolic Same as CHF
contraction of the
ventricle
Normal or impaired
ventricular filling with Beta Blockers, followed
Hypertrophic ventricular hypertrophy Diastolic by Calcium Channel
and preserved systolic Blockers.
function.
Impaired ventricular
filling without
hypertrophy of the
ventricle. Also has Diastolic dysfunction,
No specific Treatment
Restrictive impaired contractility. which can lead to
available
This is the least systolic dysfunction
common cause of
cardiomyopathy in the
states.
Harsh systolic ejection murmur heard best at the left sternal border.
Tet spells: hyper cyanotic episodes that develop during crying or feeding. Bringing the
childs knees to the chest will decrease venous return and increase vascular resistance,
which will in turn make the child more comfortable.
VSD
A direct connection between both ventricles through a defect in the septum.
Eisenmenger syndrome: First, there will be a left to right shunting of blood, which will
eventually lead to pulmonary hypertension. As the pressures increase in the pulmonary
vasculature, more so than the right ventricle, a shunt reversal occurs. This means that
deoxygenated blood will be shunted from the right ventricle to the left and out into the
systemic circulation.
A holosytolic murmur is heard that does not increase with respiration. Diagnosed with
echocardiogram. This will usually close without treatment, but surgical repair is done for
symptomatic children.
Stage 1
Systolic: 140-159
Diastolic: 90-100
Stage 2
Systolic: over 160
Diastolic: over 100
Etiology
Over 95% of hypertension is termed essential (meaning idiopathic or no one really knows
why). The other 5% are from secondary causes. The most common secondary cause is
from renal disease. If a person states they regularly have a normal BP at home, but ele-
vated in the oce, they might suer from white coat hypertension. The numbers at home
are valid.
Treatment
Secondary hypertension
So, who should undergo evaluation for secondary hypertension?
Clues to diagnosis:
HYPERTENSIVE URGENCY
Introduction
Severely elevated hypertension is considered to occur when the systolic is over 180
and/or when the diastolic is over 120.
Treatment
Do not bring down blood pressure rapidly, and do not use sublingual nifedipine (this is con-
HYPERTENSIVE EMERGENCY
Introduction
Severely elevated hypertension usually over 180/120.
Malignant hypertension will present with papiledema, exudates, retinal hemorrhage, acute
kidney injury (hematuria or proteinuria), and/or focal neurological findings. Encepalopathy
will present with cerebral edema: Headache, N/V, confusion, seizure, coma.
Diagnostic Testing
When there are focal neurological findings, an MRI should be done to rule out stroke.
Treatment
The goal is to decrease the diastolic pressure to 100 in 6 hours. After the blood
pressure has been controlled, begin oral therapy to bring the diastolic <90 over the
next couple of months. Again, no first line medication is currently recommended.
Etiology
The etiology will be anything that causes the heart to stop pumping eciently, but will usu-
ally occur from an MI.
Treatment
Always stabilize the patient before trying to attempt to find an etiology. This means aggres-
sive fluid resuscitation, followed by pressors (norepinephrine or dopamine) if needed.
Etiology
Medications, hypovolemia, anemia, heart disease, diabetes, and or Parkinsons disease.
Diagnostic Testing
Take the blood pressure lying down, then have the patient stand for a couple minutes,
and then repeat the blood pressure. The diagnosis is made if the systolic blood pressure
falls 20mmHg or if the diastolic falls 10mmHg or more. Order tilt table testing if suspicion
is high, but orthostatic vital signs are normal.
Treatment
Treat the underlying etiology. If none is found, attempt to increase fluid and sodium
intake. If no response, give fludrocortisone (mineralcorticoid) as first line medical therapy.
ATRIAL FIBRILLATION/FLUTTER
Introduction
Atrial fibrillation is the most common cardiac arrhythmia. Fibrillation can be thought of as
Diagnostic Testing
Diagnosed on ECG. Fibrillation will have an irregularly irregular rhythm without any P
waves. Atrial flutter will present as a regular rhythm with a saw tooth pattern. Flutter will
usually have an atrial rate of 300 and a ventricular rate of 150.
Treatment
Unstable patients are treated the same:
Cardioversion
If this is the first episode, order an echocardiogram to evaluate for thrombus formation.
Trans esophageal echo is more sensitive than trans thoracic. If the patient has been
symptomatic for less than two days, you may rate control or cardiovert (may be safely
done because it is too soon for a thrombus to form). If symptoms have been present for
more than 2 days, then the possibility of thrombus exists, and ideally you want to rate
control (beta blockers or calcium channel blockers) as the first line option. If a calcium
channel blocker is used, use the non dihyropyridines (verapamil or diltiazem).
If the patient requests cardioversion and symptoms have been present over 2 days, order
an echo to rule out a thrombus. If no thrombus exists, give heparin and cardiovert. If the
echo shows a thrombus, you must anticoagulate with warfarin for four weeks before car-
dioverting.
C-CHF (1point)
H-Hypertension (1point)
A-Age of 75 (1point)
D-Diabetes (1point)
S-Stroke or TIA in past (2 points given here)
Score:
0: Aspirin
1: Aspirin or warfarin
2: warfarin
HEART BLOCK
Note: If the diagnosis is thought to be WPW, the addition of adenosine will worsen the ar-
rhythmia and may lead to ventricular tachycardia and ventricular fibrillation.
PVC
Ectopic beats originating in ventricular foci. Patients are usually asymptomatic, but if
symptoms occur, they will present with palpitations. The EKG will show a wide complex
QRS without P waves. Following the wide complex QRS, there will usually be a
compensatory pause (the AV node will be blocked for a short period not allowing the sig-
nal from the SA node to reach the ventricle). The AV node then clears, and a normal p
wave and QRS complex are seen. Asymptomatic patients do not require treatment.
Those who are symptomatic may be given a beta blocker.
PAC
Ectopic beats originating from the atria outside the SA node. Patients are usually
asymptomatic, but if symptoms occur, they will present with palpitations. The EKG will
show a P wave before expected and will have a dierent morphology from the previous P
waves. The closer the ectopic foci is to the SA node, the more similar the P wave will
appear. Asymptomatic patients do not require therapy. If symptoms occur, treat with a
beta blocker.
Torsades de pointes:
This is a polymorphic ventricular tachycardia that arises from a prolonged QT interval. In
the technical sense, if the baseline QT interval was normal, it is simply referred to as poly-
morphic ventricular tachycardia.
Treatment: withdraw the oending drugs, correct electrolyte abnormalities, and cardiac
pacing. Magnesium sulfate may be oered in the acute setting for drug induced torsades.
VENTRICULAR FIBRILLATION
No organized electrical activity.
Cardioversion immediately -> cpr->shock->epinephrine->shock->amiodarone
Diagnostic Testing
The ECG will be normal in stable angina. The ECG in prinzmetal angina will show ST
segment elevations that will return to baseline immediately after the episode (usually 5-15
min). Neither will have elevated cardiac enzymes (STEMI will have elevated enzymes,
and will not have the ST segment return to baseline so quickly).
If the diagnosis is unclear, refer the patient for stress testing. Stress testing (either with
medication or treadmill) will increase oxygen demand, and will demonstrate ischemia
on ECG.
Treatment
Treat with lifestyle modifications (same as those in the hypertension section). Also, make
sure to control hypertension, diabetes, and hyperlipidemia. All patients are treated with an
aspirin and beta blocker. The beta blocker will be used to slow the heart, allow increased
ventricular filling, and reduce oxygen demand. The patient will also be given nitroglycerin
(decreases pre load) to be used on an as needed basis for chest pain. Those who cannot
be controlled with medication should be referred for angiography and revascularization.
Only use calcium channel blockers when beta blockers are contraindicated, or as an ad-
junct to beta blockers.
Diagnostic Testing
ECG: Unstable angina and NSTEMI will have signs of ischemia (ST depression or T wave
inversion). STEMI will have ST elevation of 1mm or more in at least two contiguous leads
Remember to repeat the EKG every 10 minutes if ACS is suspected, as the initial EKG
may be normal. The first EKG abnormality usually seen with infarction will be hyperacute
T waves. Remember, that a new left bundle branch block should be treated as an
infarction.
Cardiac enzymes:
CK-MB will rise after 4 hours, and will stay elevated for a couple days.
Troponins (Preferred cardiac marker and troponin-I is most specific) rises after 4 hours
but will stay elevated for up to two weeks. Most patients with negative enzymes can be
excluded by 6 hours, but for those high risk patients, you should continue serial labs for
12 hours. Reinfarction is diagnosed if troponin increases over 20%. CK-MB can also be
Treatment
All patients presenting with ACS should immediately be given morphine, oxygen, nitrates
(avoid if the patient is on phosphodiesterase-5 inhibitors as this will cause hypotension),
and aspirin (chewed). Caveat: If patient has inferior MI, and suspected involvement of the
right ventricle, avoid nitrates as this can cause a severe drop in blood pressure. All
patients should also receive a beta blocker (metoprolol or atenolol) and a statin
(atorvastatin) immediately if no contraindication exists.
STEMI: Everyone gets heparin. PCI is the preferred to thrombolytics. PCI must be done
within 90 minutes of arrival. If PCI is unavailable, or if unable to get to a center in 90
minutes, give thrombolytics. Thrombolytics are only indicated if chest pain has been
present under 12 hours and lacks contraindications (coagulation disorder, severe
hypertension, internal bleeding, or history of hemorrhagic stroke).
NSTEMI and unstable angina are managed identical to STEMI with the following excep-
tions:
Post STEMI/NSTEMI: all patients should be continued on aspirin, beta blocker (metoprolol
or atenolol), ACE, and statin. Clopidogrel is used for those with aspirin allergy.
Cocaine associated MI should be treated the same as those with other forms of ACS with
the following modifications: Avoid beta blockers and give benzodiazepines.
Dissection will present in an older man with sudden severe tearing chest pain or in-
terscapular back pain.
Diagnostic Testing
AAA is diagnosed on ultrasound. Dissection may have a blood pressure dierential be-
tween both arms. Widened mediastinum will be present on chest Xray. CT, MRI, and TEE
are more specific than CXR.
Treatment
AAA:
Under 3 cm: No further workup
3cm-3.9cm require repeat ultrasound in 2-3 years
4cm-5.4cm require repeat ultrasound in 6 months
Over 5.5 cm should be surgically repaired.
Dissection:
Type A = Ascending aorta=surgery
Type B = Descending aorta= beta blocker. Surgery is indicated if complete rupture or end
organ damage.
ARTERIAL EMBOLISM/THROMBOSIS
The majority will originate in the heart secondary to MI or AFIB, and will travel to the lower
extremities. These emboli will lodge in areas of excess plaque formation or where there
are bifurcations; the femoral artery being the most prevalent. Acute ischemia may cause
pain, weakness, or numbness; however, the majority are from chronic plaque formation, al-
lowing enough collateral circulation, to render the patient asymptomatic. Treatment for an
acute embolism includes anticoagulant therapy.
Asymptomatic
patients are not
treated. Those with
Patients are usually symptoms are
Murmur:
The main etiology asymptomatic, but given vasodilators.
holosystolic
is mitral valve may have dyspnea If severe,
Mitral Regurgitation murmur. Heard
prolapse and and fatigue. worsening, or no
best over apex and
coronary disease. improvement in
radiates to axilla.
symptoms with
medications, the
next step Is
surgery.
Murmur: Has a
This is usually
mid-systolic click,
asymptomatic, but
with a possible late
may cause chest
Mitral Valve systolic murmur
pain, palpitations, Beta Blockers
Prolapse depending on the
and anxiety.
severity of
Usually present in
regurgitation
women
present.
Murmur: Diuretics are used
Symptoms are non-
holosystolic for symptoms. For
specific, might be
Most commonly murmur. Heard those with heart
those of right sided
Tricuspid from dilation of best left mid sternal failure, therapy
heart failure if
Regurgitation right atrium and border. When should be aimed at
present.
ventricle regurgitation is that. For severe
severe, the murmur disease, surgery is
will fade. performed.
25
DIASTOLIC MURMURS
Treatment is with
Dilation of aortic Asymptomatic. Blowing quality.
surgery for those
root or congenital Will present with Will become
who are
bicuspid valve. wide pulse holosystolic as the
Aortic symptomatic, or
Outside the US the pressure (water regurgitation
Regurgitation those with
most common hammer pulse). worsens. Heard
progressive
cause is rheumatic best at the left
enlargement if
disease sternal border.
asymptomatic.
Decrescendo
Pulmonic Pulmonic murmur. Identical
Regurgitation hypertension to aortic
regurgitation.
Shortness of
Treatment is with
breath. Pregnancy
balloon valvotomy
will exacerbate
Low pitch rumble. or surgery.
symptoms, or
Mitral Stenosis Rheumatic disease Best heard at the Diuretics and beta
cause initial
apex. blockers may be
symptoms in those
used for symptom
who were
control only.
asymptomatic
Ace inhibitors and
Heard best at 4th diuretics may be
Rheumatic
Symptoms are intercostal space used for symptom
disease. Will
Tricuspid Stenosis similar to other at the lower left control. If no
occur with other
valvular disorders. sternal border. improvement
valve abnormality
balloon valvotomy
or surgery is done.
This is a thrombus in a superficial vein, most commonly the saphenous vein, causing in-
flammation of the surrounding tissue. This usually develops in those with varicose veins.
The patient will present with pain, tenderness, and erythema. A palpable cord
(thrombus) will be felt. This is a clinical diagnosis, but a duplex ultrasound is done to rule
out DVT. Treat with elevation, warm compress, compression stockings, and NSAIDs.
Those with concomitant DVT or at high risk for DVT, should be treated with anticoagulation
(low molecular weight heparin or warfarin) for four weeks instead of supportive therapy.
27
PhysicianAssistantBoards.com Andrew Reid PA-C
Diagnostic Testing
Begin with wells criteria; if the patient has a score under 2 (meaning low probability) order
a D-DIMER. A normal D-dimer virtually excludes all DVTs. An elevated D-dimer or a well
score over 2 requires duplex ultrasound.
Treatment
Heparin and warfarin are started together. You must overlap the two medications for 5
days, as it takes a few days for warfarin to take eect. Also, warfarin inhibits protein C
and S initially, and therefore might increase risk for clot formation the first few days.
Continue warfarin for 3-6 months (INR should be 2-3). Those who have unprovoked DVT
should be kept on warfarin indefinitely as long as there arent any contraindications.
VARICOSE VEINS
Defined as veins that become dilated over 3mm. Faulty valves causing blood to pool is
the most common cause leading to dilation of the vein. Patients will often feel leg pain
and swelling. Duplex ultrasound is done to evaluate reflux. Compression hose stockings
and leg elevation are first line treatment followed by sclerotherapy.
VALVULAR DISEASE
The boards want you to know the murmur associated with these valvular disorders. A
defi-nite diagnosis for all is reached with echocardiogram. Most symptoms are similar to
that of CHF: shortness of breath and chest discomfort. Certain maneuvers will aect mur-
mur intensity - know them:
Inspiration increases right ventricular filling, but decreases left ventricular filling.
Right sided murmurs Increase with Inspiration.
Left sided murmurs increase with expiration.
Systolic Murmur
Asymptomatic
patients arent
treated. Those with
The main etiology is
Asymptomatic. May Holosystolic murmur symptoms are given
mitral valve prolapse
Mitral Regurgitation have dyspnea and heard best over apex vasodilators. If
and coronary
fatigue and radiates to axilla severe, worsening,
disease
or no improvement
with meds, the next
step is surgery.
Asymptomatic. But,
Mid systolic click
may cause
with possible late
palpitations, chest Treat with beta
Mitral Valve Prolapse systolic murmur
pain, and anxiety. blockers
depending on the
Usually present in
severity
women.
Treatment is with
Blowing quality. Will
Dilation of aortic surgery for those
Asymptomatic. Will become
root or congenital who are
present with wide holosystolic as the
bicuspid valve. symptomatic, or
pulse pressure regurgitation
Aortic Regurgitation Outside the US the those with
(water hammer worsens. Heard
most common progressive
pulse). best at the left
cause is rheumatic enlargement if
sternal border.
disease asymptomatic.
Decrescendo
Pulmonic
Pulmonic murmur. Identical to
hypertension
Regurgiation aortic regurgitation.
Shortness of
Treatment is with
breath. Pregnancy
balloon valvotomy
will exacerbate
Low pitch rumble. or surgery.
symptoms, or
Rheumatic disease Best heard at the Diuretics and beta
Mitral Stenosis cause initial
apex. blockers may be
symptoms in those
used for symptom
who were
control only.
asymptomatic
Etiology
Streptococci viridans is the most common bacteria in prosthetic and native valves.
Staphylococcus aureus is the most common bacteria in those who are injection drug us-
ers (vegetation will appear on the right).
Diagnostic Testing
The first thing to do is to obtain blood cultures (three separated by one hour). Make sure
to obtain the blood cultures before antibiotics are given. Next, order an echocardiogram.
DUKE CRITERIA:
Two major, or one major and three minor, or 5 minor:
Major: Positive blood culture, vegetations on echocardiogram, new regurgitant murmur
Minor: Fever, vascular phenomenom (emboli to organs), immunologic phenomenon (roth,
osler,jane), or positive cultures of uncommon pathogen.
Treatment
Treat empirically with [ceftriaxone or vancomycin] AND gentamicin until cultures return.
Then, treat according to the culture.
Prophylaxis against endocarditis is done with amoxicillin and is indicated for those with
PERICARDITIS
Introduction
Inflammation of the pericardium (two layers that cover the heart). The most common
etiologies are idiopathic and viral.
Diagnostic Testing
The EKG will show diuse ST elevations with PR depressions. The chest xray will show an
enlarged cardiac silhouette. Troponins will be elevated, but do not signify infarction. An
echocardiogram can distinguish between an MI and pericarditis. Pericarditis will have
pericardial eusion and will not have wall motion abnormalities.
CARDIAC TAMPONADE
Introduction
This is a result of excess pericardial fluid, which exerts pressure onto the heart, leading to
filling and hemodynamic compromise.
Diagnostic Testing
The EKG will show electrical alternans (QRS complexes alternate in amplitude). The
chest Xray will show an enlarged cardiac silhouette and clear lung fields. The
echocardiogram will show pericardial eusion and chamber collapse. Definitive
diagnosis and treatment is done with pericardiocentesis.
1. How will the ejection fraction dier in diastolic and systolic heart failure?
3. What is the first test that should be ordered in the evaluation of CHF?
8. What classic x-ray finding will you see in coarctation of the aorta?
13.What are the first line medications for hypertension in patients who are otherwise
healthy?
19.What are the medications of choice for patients with stable angina?
22.Why should you proceed with caution in administering nitrates in patients with an
inferior MI?
25.Why should steroids be given to a patient with suspected GCA before doing a bi-
opsy?
26.What is the only medication with proven benefit in peripheral artery disease?
27.What is the most common vein aected in patients with superficial thrombophlebi-
tis?
31.What are the most common symptoms in a patient with aortic stenosis?
1.How will the ejection fraction dier in diastolic and systolic heart failure?
Diastolic dysfunction will have a normal ejection fraction. The problem here is poor
relaxation leading to impaired filling. Systolic dysfunction will have a decreased ejec-
tion fraction. The problem here is poor contraction.
3. What is the first test that should be ordered in the evaluation of CHF?
Echocardiogram. Remember, this is a clinical diagnosis, but the echocardiogram
is used to give added information, such as: estimatating ventricular size and
ejection fraction. It is NOT used to diagnose CHF.
13.What are the first line medications for hypertension in patients who are other-
wise healthy?
Diuretics, ACE/ARBs, or Amlodipine (long acting dihydropyridine).
17.What will happen if a patient who presents with WPW is accidentally given
adenosine?
This may place the patient into ventricular tachycardia or fibrillation.
19.What are the medications of choice for patients with stable angina?
All patients should receive a beta blocker, aspirin, and nitroglycerin. The beta
blocker will increase filling time and decrease oxygen demand. The
nitroglycerin is used on an as needed bases for chest pain relief.
25.Why should steroids be given to a patient with suspected GCA before doing a
biopsy?
Optic nerve ischemia can develop leading to blindness. Saving the patients eye
sight is more important then confirming the diagnosis.
26.What is the only medication with proven benefit in peripheral artery disease?
Cilostazol
27.What is the most common vein aected in patients with superficial thrombo-
phlebitis?
Saphenous vein
31.What are the most common symptoms in a patient with aortic stenosis?
Dyspnea, angina, and dizziness.
CONDITION FACT/ASSOCIATION
Atrial Septal
Fixed wide splitting of S2
Defect
Coarctation of
X-Ray: Rib notching, 3 sign
Aorta
Tetralogy of
Cyanosis with crying or feeding
Fallot
Cardiogenic
Hypotensive, cool, clammy skin
Shock
Third Degree
Independent P wave and QRS complex
Block
Paroxysmal
Supraventricular Narrow complex tachycardia
Tachycardia
PhysicianAssistantBoards.com
Andrew Reid PA-C 43
CONDITION FACT/ASSOCIATION
Cocaine Induced
NO betablockers, give benzodiazepines
MI
Superficial
Palpable Cord
Thrombophlebitis
Aortic
Wide pulse pressure. Water hammer pulse
Regurgitation