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