Exam (elaborations)
USMLE STEP 2 CK HIGH-YIELD
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USMLE STEP 2 CK HIGH-YIELD
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USMLE STEP 2 CK HIGH-YIELDClassic EKG finding in atrial flutter - Answers-"Sawtooth" p waves
Definition of unstable angina - Answers-Angina that is new, is worsening, or occurs at
rest
Antihypertensive for a diabetic patient with proteinuria - Answers-ACEI
Beck's triad for cardiac tamponade - Answers-Hypotension, distant heart sounds, and
JVD
Treatment for ventricular fibrillation - Answers-Immediate cardioversion
Dressler's syndrome - Answers-An autoimmune reaction with fever, pericarditis and
increased ESR occurring 2-4 weeks post-MI
IV drug use with JVD and holosystolic murmur at left sternal border. Treatment? -
Answers-Treat existing heart failure and replace tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy - Answers-Echocardiogram (showing a
thickened left ventricular wall and outflow obstruction)
Pulsus paradoxus - Answers-A decrease in systolic BP of > 10 mmHg with inspiration;
seen in cardiac tamponade
Classic ECG finding in pericarditis - Answers-Low-voltage, diffuse ST-segment elevation
Definition of hypertension - Answers-BP > 140/90 on 3 separate occasions 2 weeks
apart
Eight surgically correctable causes of HTN - Answers-Renal artery stenosis, coarc of
aorta, pheo, Conn's, Cushing's syndrome, unilateral renal parenchymal dz,
hyperthyroid, hyperparathyroid
Evaluation of pulsatile abdominal mass and bruit - Answers-Abdominal U/S and CT
Indications for surgical repair of abdominal aortic aneurysm - Answers->5.5cm, rapidly
enlarging, symptomatic, ruptured
Treatment for acute coronary syndrome - Answers-ASA, heparin, clopidogrel, morphine,
oxygen, sublingual nitro, IV beta-blockers
Metabolic syndrome - Answers-Abdominal obesity, high triglycerides, low HDL,
hypertension, insulin resistance, prothrombotic or proinflammatory states
,Appropriate diagnostic test: 50yo male with stable angina can exercise to 85% of
maximum predicted heart rate - Answers-Exercise stress treadmill with ECG
Appropriate diagnostic test: 65yo female with LBBB and severe OA has unstable angina
- Answers-Pharmacologic stress test (e.g. dobutamine echo)
Target LDL in a patient with diabetes - Answers-<70mg/dL
Signs of active ischemia during stress testing - Answers-Angina, ST-segment changes
on ECG or decreased BP
ECG findings suggestive of MI - Answers-ST-segment elevation (depression means
ischemia), flattened T waves, Q waves
Coronary territories in MI - Answers-Anterior wall (LAD/diagonal), inferior (PDA),
posterior (left circumflex/oblique, RCA/marginal), septum (LAD/diagonal)
A young patient with angina at rest and ST-segment elevation with normal cardiac
enzymes - Answers-Prinzmetal's angina
Common symptoms associated with silent MIs - Answers-CHF, shock, AMS
Diagnostic test for PE - Answers-Spiral CT with contrast
Protamine - Answers-Reverses effects of heparin
Prothrombin time - Answers-Coagulation paramter affected by warfarin
Drugs that slow heart rate - Answers-Beta-blockers, CCBs, digoxin, amiodarone
Hypercholesterolemia treatment that leads to flushing and pruritus - Answers-Niacin
Murmur - aortic stenosis - Answers-A systolic crescendo/decrescendo murmur that
radiates to the neck; increases with increased preload (i.e. squatting)
Murmur - mitral regurgitation - Answers-A holosystolic murmur that radiates to the
axillar; increases with increased afterload (handgrip)
Murmur - mitral stenosis - Answers-A diastolic, mid to late, low-pitched murmur
preceded by an opening snap
Murmur - hypertrophic obstructive cardiomyopathy - Answers-A systolic ejection murmur
heard along the lateral sternal border that increases with decreased preload (i.e.
Valsalva maneuver)
, Murmur - aortic insufficiency - Answers-Austin Flint murmur, a diastolic, decrescendo,
low-pitched, blowing murmur that is best heard sitting up; increases with increased
afterload (i.e. handgrip)
Treatment for atrial fibrillation and atrial flutter - Answers-If unstable, cardiovert. If stable
or chronic, rate control with CCBs or beta-blockers
A young patient with FHx of sudden death collapses and dies while exercising -
Answers-Hypertrophic cardiomyopathy
Endocarditis prophylaxis regimens - Answers-Oral surgery - amoxicillin for certain
situations; GI or GU procedures - not recommended
Virchow's triad - Answers-Stasis, hypercoagulability, endothelial damage
The most common cause of HTN in young women - Answers-OCPs
The most common cause of HTN in young men - Answers-Excessive EtOH
Figure 3 sign - Answers-Aortic coarctation
Water-bottle shaped heart - Answers-Pericardial effusion, look for pulsus paradoxus
"Stuck-on" appearance - Answers-Seborrheic keratosis
Red plaques with silvery-white scales and sharp margins - Answers-Psoriasis
The most common type of skin cancer; lesion is pearly-colored papule with translucent
surface and telangiectasias - Answers-Basal cell carcinoma
Honey-crusted lesions - Answers-Impetigo
A febrile patient with h/o diabetes presents with red, swollen, painful lower extremity -
Answers-Cellulitis
Positive Nikolsky's sign - Answers-Pemphigus vulgaris
Negative Nikolsky's sign - Answers-Bullous pemphigoid
A 55yo obese patient presents with dirty, velvety patches on the back of the neck -
Answers-Acanthosis nigricans. Check FBG to r/o diabetes
Dermatomal distribution - Answers-Varicella zoster
Flat-topped papules - Answers-Lichen planus
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