Podcast Episode 81: Internal Medicine EOR Cardiology Questions

Welcome to episode 81 of the Audio PANCE and PANRE PA Board Review Podcast. Join me as I cover ten internal medicine rotation EOR content blueprint questions from the Smarty PANCE physician assistant board and rotation review website. Special from today's episode: Check out the new Smarty PANCE Internal Medicine Rotation (EOR) Review Course Download your Free Trello Smarty PANCE PAEA Internal Medicine EOR Tracking Template Take the FREE Internal Medicine Rotation Cardiovascular Practice Exam View the interactive Smarty PANCE Internal Medicine Rotation (EOR) Topic List Below you will find an interactive exam to complement the podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of the PANCE and PANRE Academy and Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, on Google Play Music or Stitcher Radio. You can listen to the latest episode, take an interactive quiz and download more resources below. Listen Carefully Then Take The Practice Exam If you can't see the audio player click here to listen to the full episode. Podcast Episode 81: Ten Internal Medicine EOR Cardiology Questions The following questions are linked to PAEA Content Blueprint lessons from the Smarty PANCE and PANRE Board Review Website. If you are a member you will be able to log in and view this interactive video lesson. 1. 55-year-old woman is admitted to the hospital because she has shortness of breath and pain on both sides of her chest with deep breathing which has worsened over the past 5 days. In recent weeks, she has been feeling fatigued and has had low-grade fevers and night sweats, and was found to have a new cardiac murmur on examination. Her temperature is 38.1°C (100.6°F), pulse is 106/min, respirations are 26/min, and blood pressure is 136/88 mm Hg. She appears diaphoretic and is in mild respiratory distress. Cardiac auscultation reveals a faint systolic murmur heard over the lower left sternal border. Her neck veins are distended and abdominal examination shows hepatomegaly. Which of the following is the most likely cause of her clinical presentation? A. Fat embolism B. Infective endocarditis C. Myocardial infarction D. Rheumatic fever E. Small cell lung cancer Click here to see the answer Answer: B, Infective endocarditis Infective endocarditis (IE) is an infection of the endocardial surfaces of the heart, most commonly the heart valves. IE occurs when a microorganism begins to invade the heart valves causing an inflammatory reaction that damages the valve – sometimes leading to stenosis and sometimes leading to regurgitation. This patient developed a new cardiac murmur in recent weeks that is described as a faint systolic murmur heard over the lower left sternal border. This is most consistent with tricuspid regurgitation. She also has distended neck veins and hepatomegaly, both of which suggest right-sided heart failure which can result from tricuspid regurgitation. Small infectious emboli can break away from the primary lesion on the tricuspid valve and go into the pulmonary vasculature causing shortness of breath and pleuritic chest pain. Most cases of IE are caused by Staphylococcus aureus and Viridans streptococci, and diagnosis is confirmed by obtaining multiple blood cultures that show that there is continuous bacteremia. Fat embolism to the pulmonary circulation almost always occurs with major trauma, including surgical procedures like intramedullary nailing of long bones. Fat emboli can occlude the microvasculature, triggering a systemic inflammatory response. The woman did not have recent trauma, and a fat embolism would not explain her cardiac murmur. Clinical presentation of myocardial infarction most often includes substerna...