I was tasked with writing "board style questions" after giving a series of lectures. A lot of people have asked that I publish these on my blog and give answers and explanations. The questions are written in USMLE/Comlex Step 2 and 3 format, and may also be found on Internal Medicine In-Service exams. Here are the first few questions in a "Board Review Series".
1. A 56 year old male was mowing the lawn and began having chest pain. The pain radiated down his left arm and he became nauseous and lightheaded. He sat down to take a break and then pain slightly improved but was still there. It was a dull achy, squeezing pain that was a 6-8 out of 10. His wife activated EMS and an ambulance brought him to the hospital. Upon arrival his vitals were pulse of 92, respirations of 22, blood pressure of 155/88, and SpO2 of 100% on room air. On exam he was alert and oriented X3, in mild to moderate distress, No JVD, Lungs were clear, Heart was regular, No murmurs, No S3 or S4, Abdomen was soft and obese, extremities were not edematous. An EKG was performed by the ED staff and demonstrated Sinus Rhythm and ST elevations of 3-4mm in leads V2-V4. The ED staff has placed him on O2, given him 325mg of chewable Asprin, and placed an inch of nitro paste on him. In addition to activating the cardiac catheterization team, what would be the next best step?
A. Start a IIb/IIIa inhibitor
B. Give him clopidigrel
C. Start an ACE Inhibitor
D. Start a Beta Blocker
E. Start Insulin
2. In the cath lab, which vessel was the most likely stenosed vessel in the above patient?
A. Left Circumflex
B. Posterior Descending
C. Right Coronary
D. Left Anterior Descending
E. Right Posterior Lateral
3. Upon discharge, all AMI patients (not just the previous patient) should be on which combination of medications?
A. Statin, Asprin, ACE Inhibitor, Beta Blocker
B. Statin, Asprin, Clopidigrel, Beta Blocker
C. Statin, Asprin, ACE Inhibitor, Calcium Channel Blocker
D. Asprin, Beta Blocker, Spironolactone, ACE Inhibitor
E. Asprin, Nitroglycerin, Beta Blocker, Statin
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