USMLE COMPREHENSIVE STUDY GUIDE
2026 FULL QUESTIONS AND SOLUTIONS
GRADED A+
◍ 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.
2026 FULL QUESTIONS AND SOLUTIONS
GRADED A+
◍ 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.
