Exam (elaborations)
USMLE STEP 2 CK DECK QUESTIONS AND ANSWERS
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USMLE STEP 2 CK DECK QUESTIONS AND ANSWERS
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USMLE STEP 2 CK DECK QUESTIONS AND ANSWERSTreatment for Wolff-Parkinson-White syndrome who develop atrial fibrillation with rapid
ventricular response - Answers-Cardioversion or antiarrhythmics (eg, procainamide);
avoid AV nodal blockers as the increase conuction through the accessory pathway
Which antiarrhythmic agents increase QRS duration - Answers-Class I (particularly IC,
such as flecainide and propafenone) cause a progressive lengthing of the QRS with
increased rates
Initial treatment for chronic venous insufficiency - Answers-Conservative measures such
as leg elevation, exercise, and compression therapy
Components of dual antiplatelet therapy (DAPT) - Answers-Aspirin + P2y12 receptor
blocker; leades to reduction in MI death in comparison to aspirin alone in patients with
NSTEMI, and reduces the risk of stent thrombosis following DES placement
Persistent ST-segment elevation, deep Q waves - Answers-Ventricular aneurysm; late
complication of STEMI
How does amiodarone affect serum levels of digoxin - Answers-Increases serum levels
of digoxin; can cause toxicity that presents as GI symptoms acutely or neuro/vision
symptoms chronically
Causes of syncope in patients with HOCM - Answers-Outflow obstruction, arrhythmia,
ischemia, and ventricular baroreceptor response that causes vasodilation
How do AVF causes high-output cardiac failure - Answers-Blood shunted from arterial to
venous side > increases cardiac preload > circulation unable to meet demand of
peripheral tissues
Initial test for diagnosis and risk stratification in most patients with suspected stable
ischemic heart disease - Answers-Exercise stress ECG
Mainstay of therapy in patient with alcoholic cardiomyopathy - Answers-Complete
cessation of alcohol consumption
Serum marker with high sensitivity for the diagnosis of CHF - Answers-Elevated plasma
brain natiuretic peptide (BNP) levels
Initial management for pulmonary HTN secondary to LV dysfunction - Answers-Loop
diuretics, ACE/ARB
Specific finding for digitalis toxicity - Answers-Increased ectopy + increased vagal tone >
atrial tachycardia with AV block
, Signs of cholesterol embolization following cardiac catheterization - Answers-
Multisystem involvement; renal faiure, skin manifestations (livedo reticularis, blue to
syndrome), cerebral ischemia, and Hollenhorst plaques
Screening in patients with new-onset atrial fibrillation - Answers-TSH and free T4 levels
to screen for occult hyperthyroidism
Initial management for right ventricular MI - Answers-IV saline bolus to increase RV
preload and improve CO
Medications to be avoided in patients with right ventricular MI - Answers-Preload-
reducing medications such as nitrates and diuretics
Characteristics of scleroderma renal crisis - Answers-Acute renal failure, malignant
hypertension, proteinuria, and schistocytes
Effect of acetaminophen, NSAIDs, amiodarone, and antibiotics on warfarin - Answers-
Potentiate anticoagulant effects of warfarin > increased risk of bleeding
Electrical alternans, enlargement of cardiac silhouette - Answers-Pericardial effusion
Management of ventricular fibrillation and pulseless ventricular tachycardia - Answers-
Immediate defibrillation
Management of hemodynamic instability due to narrow or wide QRS complex
tachyarrhythmia (eg, a fib, a flutter, VT with a pulse) - Answers-Synchronized
cardioversion
First-line therapy for symptom control in patients with stable angina - Answers-Beta
blockers; consider calcium channel blockers or long-acting nitrates if contraindicated
Heart sound associated with left venticular hypertropy from prolonged hypertension -
Answers-S4 > low frequency sound that is heart at the end of diastole
Treatment for patients age 40-75 with diabetes - Answers-Statin + lifestyle modification
+ glucose control
Unexplained CHF, proteinuria, LVH in the absence of HTN - Answers-Amyloid
cardiomyopathy > form of restrictive cardiomyopathy
Treatment for uremic pericarditis - Answers-Hemodialysis; patients present with
retrosternal chest pain, friction rub, and renal failure
Side effects of aspirin and beta blockers in patients with athsma - Answers-
Bronchoconstriction > cardioselective beta blockers are preferred
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