USMLE STEP 2 CK HIGH-YIELD UPDATED STUDY GUIDE
QUESTIONS AND CORRECT ANSWERS
C
Classic EKG finding in atrial flutter "Sawtooth" p waves
Definition of unstable angina Angina that is new, is worsening, or occurs at rest
Antihypertensive for a diabetic patient with proteinuria ACEI
Beck's triad for cardiac tamponade Hypotension, distant heart sounds, and JVD
Drugs that slow heart rate Beta-blockers, CCBs, digoxin, amiodarone
Hypercholesterolemia treatment that leads to flushing Niacin
and pruritus
Murmur - hypertrophic obstructive cardiomyopathy A systolic ejection murmur heard along the lateral sternal border that increases
with decreased preload (i.e. Valsalva maneuver)
Murmur - aortic insufficiency Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur
that is best heard sitting up; increases with increased afterload (i.e. handgrip)
Murmur - aortic stenosis A systolic crescendo/decrescendo murmur that radiates to the neck; increases
with increased preload (i.e. squatting)
Murmur - mitral regurgitation A holosystolic murmur that radiates to the axillar; increases with increased
afterload (handgrip)
Murmur - mitral stenosis A diastolic, mid to late, low-pitched murmur preceded by an opening snap
Treatment for atrial fibrillation and atrial flutter If unstable, cardiovert. If stable or chronic, rate control with CCBs or beta-
blockers
Treatment for ventricular fibrillation Immediate cardioversion
Dressler's syndrome 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 Treat existing heart failure and replace tricuspid valve
sternal border. Treatment?
Diagnostic test for hypertrophic cardiomyopathy Echocardiogram (showing a thickened left ventricular wall and outflow
obstruction)
Pulsus paradoxus A decrease in systolic BP of > 10 mmHg with inspiration; seen in cardiac
tamponade
Classic ECG finding in pericarditis Low-voltage, diffuse ST-segment elevation
Definition of hypertension BP > 140/90 on 3 separate occasions 2 weeks apart
, Eight surgically correctable causes of HTN 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 Abdominal U/S and CT
Indications for surgical repair of abdominal aortic >5.5cm, rapidly enlarging, symptomatic, ruptured
aneurysm
Treatment for acute coronary syndrome ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitro, IV beta-
blockers
Metabolic syndrome Abdominal obesity, high triglycerides, low HDL, hypertension, insulin
resistance, prothrombotic or proinflammatory states
Appropriate diagnostic test: 50yo male with stable Exercise stress treadmill with ECG
angina can exercise to 85% of maximum predicted
heart rate
Appropriate diagnostic test: 65yo female with LBBB and Pharmacologic stress test (e.g. dobutamine echo)
severe OA has unstable angina
Target LDL in a patient with diabetes <70mg/dL
Signs of active ischemia during stress testing Angina, ST-segment changes on ECG or decreased BP
ECG findings suggestive of MI ST-segment elevation (depression means ischemia), flattened T waves, Q waves
Coronary territories in MI 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 Prinzmetal's angina
elevation with normal cardiac enzymes
Common symptoms associated with silent MIs CHF, shock, AMS
Diagnostic test for PE Spiral CT with contrast
Protamine Reverses effects of heparin
Prothrombin time Coagulation paramter affected by warfarin
A young patient with FHx of sudden death collapses Hypertrophic cardiomyopathy
and dies while exercising
Endocarditis prophylaxis regimens Oral surgery - amoxicillin for certain situations; GI or GU procedures - not
recommended
Virchow's triad Stasis, hypercoagulability, endothelial damage
The most common cause of HTN in young women OCPs
The most common cause of HTN in young men Excessive EtOH
QUESTIONS AND CORRECT ANSWERS
C
Classic EKG finding in atrial flutter "Sawtooth" p waves
Definition of unstable angina Angina that is new, is worsening, or occurs at rest
Antihypertensive for a diabetic patient with proteinuria ACEI
Beck's triad for cardiac tamponade Hypotension, distant heart sounds, and JVD
Drugs that slow heart rate Beta-blockers, CCBs, digoxin, amiodarone
Hypercholesterolemia treatment that leads to flushing Niacin
and pruritus
Murmur - hypertrophic obstructive cardiomyopathy A systolic ejection murmur heard along the lateral sternal border that increases
with decreased preload (i.e. Valsalva maneuver)
Murmur - aortic insufficiency Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur
that is best heard sitting up; increases with increased afterload (i.e. handgrip)
Murmur - aortic stenosis A systolic crescendo/decrescendo murmur that radiates to the neck; increases
with increased preload (i.e. squatting)
Murmur - mitral regurgitation A holosystolic murmur that radiates to the axillar; increases with increased
afterload (handgrip)
Murmur - mitral stenosis A diastolic, mid to late, low-pitched murmur preceded by an opening snap
Treatment for atrial fibrillation and atrial flutter If unstable, cardiovert. If stable or chronic, rate control with CCBs or beta-
blockers
Treatment for ventricular fibrillation Immediate cardioversion
Dressler's syndrome 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 Treat existing heart failure and replace tricuspid valve
sternal border. Treatment?
Diagnostic test for hypertrophic cardiomyopathy Echocardiogram (showing a thickened left ventricular wall and outflow
obstruction)
Pulsus paradoxus A decrease in systolic BP of > 10 mmHg with inspiration; seen in cardiac
tamponade
Classic ECG finding in pericarditis Low-voltage, diffuse ST-segment elevation
Definition of hypertension BP > 140/90 on 3 separate occasions 2 weeks apart
, Eight surgically correctable causes of HTN 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 Abdominal U/S and CT
Indications for surgical repair of abdominal aortic >5.5cm, rapidly enlarging, symptomatic, ruptured
aneurysm
Treatment for acute coronary syndrome ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitro, IV beta-
blockers
Metabolic syndrome Abdominal obesity, high triglycerides, low HDL, hypertension, insulin
resistance, prothrombotic or proinflammatory states
Appropriate diagnostic test: 50yo male with stable Exercise stress treadmill with ECG
angina can exercise to 85% of maximum predicted
heart rate
Appropriate diagnostic test: 65yo female with LBBB and Pharmacologic stress test (e.g. dobutamine echo)
severe OA has unstable angina
Target LDL in a patient with diabetes <70mg/dL
Signs of active ischemia during stress testing Angina, ST-segment changes on ECG or decreased BP
ECG findings suggestive of MI ST-segment elevation (depression means ischemia), flattened T waves, Q waves
Coronary territories in MI 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 Prinzmetal's angina
elevation with normal cardiac enzymes
Common symptoms associated with silent MIs CHF, shock, AMS
Diagnostic test for PE Spiral CT with contrast
Protamine Reverses effects of heparin
Prothrombin time Coagulation paramter affected by warfarin
A young patient with FHx of sudden death collapses Hypertrophic cardiomyopathy
and dies while exercising
Endocarditis prophylaxis regimens Oral surgery - amoxicillin for certain situations; GI or GU procedures - not
recommended
Virchow's triad Stasis, hypercoagulability, endothelial damage
The most common cause of HTN in young women OCPs
The most common cause of HTN in young men Excessive EtOH
