USMLE Step 2 CK High-Yield 2023 Exam with Complete Solutions

USMLE Step 2 CK High-Yield 2023 Exam with Complete Solutions Classic EKG finding in atrial flutter - ANSWER-"Sawtooth" p waves Definition of unstable angina - ANSWER-Angina that is new, is worsening, or occurs at rest Antihypertensive for a diabetic patient with proteinuria - ANSWER-ACEI Beck's triad for cardiac tamponade - ANSWER-Hypotension, distant heart sounds, and JVD Drugs that slow heart rate - ANSWER-Beta-blockers, CCBs, digoxin, amiodarone Hypercholesterolemia treatment that leads to flushing and pruritus - ANSWER-Niacin Murmur - hypertrophic obstructive cardiomyopathy - ANSWER-A systolic ejection murmur heard along the lateral sternal border that increases with decreased preload (i.e. Valsalva maneuver) Murmur - aortic insufficiency - ANSWER-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 - ANSWER-A systolic crescendo/decrescendo murmur that radiates to the neck; increases with increased preload (i.e. squatting) Murmur - mitral regurgitation - ANSWER-A holosystolic murmur that radiates to the axillar; increases with increased afterload (handgrip) Murmur - mitral stenosis - ANSWER-A diastolic, mid to late, low-pitched murmur preceded by an opening snap Treatment for atrial fibrillation and atrial flutter - ANSWER-If unstable, cardiovert. If stable or chronic, rate control with CCBs or beta-blockers Treatment for ventricular fibrillation - ANSWER-Immediate cardioversion Dressler's syndrome - ANSWER-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? - ANSWER-Treat existing heart failure and replace tricuspid valve Diagnostic test for hypertrophic cardiomyopathy - ANSWER-Echocardiogram (showing a thickened left ventricular wall and outflow obstruction) Pulsus paradoxus - ANSWER-A decrease in systolic BP of > 10 mmHg with inspiration; seen in cardiac tamponade Classic ECG finding in pericarditis - ANSWER-Low-voltage, diffuse ST-segment elevation Definition of hypertension - ANSWER-BP > 140/90 on 3 separate occasions 2 weeks apart Eight surgically correctable causes of HTN - ANSWER-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 - ANSWER-Abdominal U/S and CT Indications for surgical repair of abdominal aortic aneurysm - ANSWER->5.5cm, rapidly enlarging, symptomatic, ruptured Treatment for acute coronary syndrome - ANSWER-ASA, heparin, clopidogrel, morphine, oxygen, sublingual nitro, IV beta-blockers Metabolic syndrome - ANSWER-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 - ANSWER-Exercise stress treadmill with ECG Appropriate diagnostic test: 65yo female with LBBB and severe OA has unstable angina - ANSWER-Pharmacologic stress test (e.g. dobutamine echo) Target LDL in a patient with diabetes - ANSWER-<70mg/dL Signs of active ischemia during stress testing - ANSWER-Angina, ST-segment changes on ECG or decreased BP ECG findings suggestive of MI - ANSWER-ST-segment elevation (depression means ischemia), flattened T waves, Q waves Coronary territories in MI - ANSWER-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 - ANSWER-Prinzmetal's angina Common symptoms associated with silent MIs - ANSWER-CHF, shock, AMS Diagnostic test for PE - ANSWER-Spiral CT with contrast Protamine - ANSWER-Reverses effects of heparin Prothrombin time - ANSWER-Coagulation paramter affected by warfarin A young patient with FHx of sudden death collapses and dies while exercising - ANSWER-Hypertrophic cardiomyopathy Endocarditis prophylaxis regimens - ANSWER-Oral surgery - amoxicillin for certain situations; GI or GU procedures - not recommended Virchow's triad - ANSWER-Stasis, hypercoagulability, endothelial damage The most common cause of HTN in young women - ANSWER-OCPs The most common cause of HTN in young men - ANSWER-Excessive EtOH Figure 3 sign - ANSWER-Aortic coarctation Water-bottle shaped heart - ANSWER-Pericardial effusion, look for pulsus paradoxus "Stuck-on" appearance - ANSWER-Seborrheic keratosis Red plaques with silvery-white scales and sharp margins - ANSWER-Psoriasis The most common type of skin cancer; lesion is pearly-colored papule with translucent surface and telangiectasias - ANSWER-Basal cell carcinoma Honey-crusted lesions - ANSWER-Impetigo A febrile patient with h/o diabetes presents with red, swollen, painful lower extremity - ANSWER-Cellulitis Positive Nikolsky's sign - ANSWER-Pemphigus vulgaris Negative Nikolsky's sign - ANSWER-Bullous pemphigoid A 55yo obese patient presents with dirty, velvety patches on the back of the neck - ANSWER-Acanthosis nigricans. Check FBG to r/o diabetes Dermatomal distribution - ANSWER-Varicella zoster Flat-topped papules - ANSWER-Lichen planus Iris-like target lesions - ANSWER-Erythema multiforme A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry - ANSWER-Contact dermatitis Presents with a herald patch, Christmas-tree pattern - ANSWER-Pityriasis rosea Pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-meatballs" appearance - ANSWER-Tinea versicolor Four characteristics of a nevus suggestive of melanoma - ANSWER-Asymmetry, border irregularity, color variation, and large diameter A premalignant lesion from sun exposure that can lead to squamous cell carcinoma - ANSWER-Actinic keratosis "Dewdrops on a rose petal" - ANSWER-Lesions of primary varicella "Cradle cap" - ANSWER-Seborrheic dermatitis. Treat conservatively with bathing and moisturizing agents Associated with Propionibacterium acnes and changes in androgen levels - ANSWER-Acne vulgaris A painful, recurrent vesicular eruption of mucocutaneous surfaces - ANSWER-Herpes simplex Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women - ANSWER-Lichen sclerosus Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer - ANSWER-Squamous cell carcinoma The most common cause of hypothyroidism - ANSWER-Hashimoto's thyroiditis Lab findings in Hashimotos' thyroiditis - ANSWER-High TSH, low T4, anti-TPO antibodies Exophthalmos, pretibial myxedema, and decreased TSH - ANSWER-Graves' disease The most common cause of Cushing's syndrome - ANSWER-Iatrogenic corticosteroid administration. The second most common cause is Cushing's disease A patient presents with signs of hypocalcemia, high phosphorus, and low PTH - ANSWER-Hypoparathyroidism Stones, bones, groans, psychic overtones - ANSWER-Signs and symptoms of hypercalcemia A patient complains of HA, weakness and polyuria; exam reveals HTN and tetany. Labs show hypernatremia, hypokalemia and metabolic alk - ANSWER-Primary hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) A patient p/w tachycardia, wild swings in BP, HA, diaphoresis, AMS and sense of panic - ANSWER-Pheo Which should be used first in treating pheo, alpha or beta-antagonists? - ANSWER-Alpha (phentolamine and phenoxybenzamine) A patient with h/o lithium use p/w copious amounts of dilute urine - ANSWER-Nephrogenic DI Treatment of central DI - ANSWER-Administration of DDAVP and free-water restriction A postop patient with significant pain p/w hyponatremia and normal volume status - ANSWER-SIADH due to stress An antidiabetic agent a/w lactic acidosis - ANSWER-Metformin A patient p/w weakness, n/v, weight loss and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment? - ANSWER-Primary adrenal insufficiency (Addison's). Treat with glucocorticoids, mineralocorticoids and IVF Goal HbA1c for patient with DM - ANSWER-<7.0 Treatment of DKA - ANSWER-Fluids, insulin, and electrolute repletion (eg K+) Why are beta-blockers contraindicated in diabetics? - ANSWER-Can mask symptoms of hypoglycemia Bias introduced into a study when a clinician is aware of the patient's treatment type - ANSWER-Observational bias Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death - ANSWER-Lead-time bias If you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a ______ - ANSWER-Confounding variable The proportion of people who have the disease and test + is the - ANSWER-Sensitivity Sensitive tests have few false negatives and are used to rule ___ a disease - ANSWER-Out PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a positive PPD. Highly sensitivie or specific? - ANSWER-Sensitive. Screening tests with high sensitivity are good for diseases with low prevalence Chronic diseases such as SLE - higher prevalence or incidence? - ANSWER-Higher prevalence Epidemics such as influenza - higher prevalence or incidence? - ANSWER-Higher incidence What is the difference between incidence and prevalence? - ANSWER-Prevalence is the precentage of cases of disease in a population at one snapshot in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk Cross-sectional survey - incidence or prevalence? - ANSWER-Prevalence Cohort study - incidence or prevalence? - ANSWER-Incidence and prevalence Case-control study - incidence or prevalence? - ANSWER-Neither Describe a test that consistently gives identical results, but the results are wrong - ANSWER-High reliability (precision), low validity (accuracy) Difference between a cohort and a case-control study - ANSWER-Cohort studies can be used to calculate RR< incidence and/or odds ratio. Case-control studies can be used to calculate an OR< which is an estimate of RR when the disease prevalence is low Attributable risk? - ANSWER-The difference in risk in the exposed and unexposed groups (ie, the risk that is attributable to exposure) Relative risk? - ANSWER-Incidence in the exposed group divided by the incidence in the nonexposed group The results of a hypothetical study found an association between ASA intake and risk of heart dz. How do you interpret an RR of 1.5? - ANSWER-In patients who took ASA, the risk of heart dz was 1.5 times that of patients who did not take ASA Odds ratio? - ANSWER-In cohort studies, the odds of developing the disease in the expose group divided by the odds of developing the disease in the nonexposed group. In case-control studies, the odds that the cases were exposed divided by the odds that the controls were exposed. In cross-sectional studies, the odds that the exposed group has the disease divided by the odds that the nonexposed group has the disease The results of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an OR of 1.5? - ANSWER-In patients who took ASA, the odds of acquiring heart disease were 1.5 times those of patients who did not take ASA In which patients do you initiate colorectal cancer screening early? - ANSWER-Patients with IBD, those with familial adenomatous polyposis/hereditary nonpolyposis colorectal cancer, and those who have first-degree relatives with adenomatous polyps (<60 yoa) or colorectal cancer The most common cancer in men and the most common cause of death from cancer in men - ANSWER-Prostate cancer is the most common cancer in men, but lung CA causes more deaths The percentage of cases within 1 SD of the mean? Two SDs? Three SDs? - ANSWER-68%, 95%, 99.7% Birth rate? - ANSWER-Number of live births per 1000 population in 1 year Mortality rate? - ANSWER-Number of deaths per 1000 population in 1 year Neonatal mortality rate? - ANSWER-Number of deaths frombirth to 28 days per 1000 live births in 1 year Infant mortality rate? - ANSWER-Number of deaths from birth to 1 year of age per 1000 live births (neonatal + postnatal mortality) in 1 year Maternal mortality rate? - ANSWER-Number of deaths during pregnancy to 90 days postpartum per 100,000 live births in 1 year True or false: once patients sign a statement giving consent they must continue treatment - ANSWER-False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity A 15yo pregnant girl requires hospitalization for preeclampsia. Is parental consent required? - ANSWER-No. Parental consent is not necessary for the medical treatment of pregnant minors A doctor refers a patient for an MRI at a facility he/she owns - ANSWER-Conflict of interest Involuntary psychiatric hospitalization can be undertaken for which 3 reasons? - ANSWER-The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs) True or false: it is more difficult to justify the withdrawal of futile care than to have withheld the treatment in the first place - ANSWER-False. Withdrawing a nonbeneficial treatment is ethically similar to withholding a nonindicated one A mother refuses to allow her child to be vaccinated - ANSWER-A parent has the right to refuse treatment for his/her child as long as it does not pose a serious threat to the well-being of the child When can a physician refuse to continue treating a patient on the grounds of futility? - ANSWER-When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care An 8-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present - ANSWER-Treat immediately. Consent is implied in emergency situations A 15yo girl seeking treatment for an STD asks that her parents not be told about her condition - ANSWER-Minors may consent to care for STDs without parental consent or knowledge Conditions in which confidentiality must be overridden - ANSWER-Real threat of harm to third parties; suicidal intentions; certain contagious diseases, elder and child abuse Involuntary commitment or isolation for medical treatment may be undertaken for what reason? - ANSWER-When treatment noncompliance represents a serious danger to public health (eg TB) A 10yo child presents in status epilepticus, but her parents refuse treatment on religious grounds - ANSWER-Treat because the disease represents an immediate threat to the child's life. Then seek a court order A son asks that his mother not be told about her recently discovered cancer - ANSWER-A physician can withhold information from the patient only in the rare case of therapeutic privilege or if the patient requests not to be told. A patient's family cannot require the physician to withhold information from the patient