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USMLE
USMLE Step 2 Cardiology Exam
Questions with Correct Verified
Answers Latest Update
(2024/2025) Guaranteed Pass
1. Infective endocarditis tx - ANS ✓-IV* abx based on culture result
for 4-6 wks.
-or empiric penicillin or vanc plus aminoglycoside
2. Endocarditis prophy - ANS ✓amoxicillin
3. Left ventricular infarct vs right ventricular infarct - ANS ✓LV
infarct:
-*pulmonary edema,* hypotension
-O2, *nitroglycerin,* blocker, aspirin, morphine, ACEI, IV heparin
RV infarct:
-inferior ECG changes (II, III, avf)
-hypotension, *elevated JVP, hepatomegaly, clear lungs*
-give IV fluids and *NO NITRATES
4. Aortic dissection complications - ANS ✓-dissection extends to
pericardium --> cardiac tamponade
--coronary arteries--> MI
USMLE Step 2 Cardiology
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USMLE
--carotid arteries--> stroke
1. Stroke (carotid arteries)
2. Acute aortic regurge (AV)
3. Horners s/d (superior cervical ganglion)
4. Acute MI (coronary artery)
5. Pericardial effustion or tamponade
6. Hemothorax
7. Lower extremity weakness or ischemia (spinal or common iliac arteries)
8. Abdominal pain (mesenteric arteries)
5. Unstable angina/NSTEMI acute vs long term tx - ANS ✓acute
medical tx: (thrombolytics t-Pa and ccbs NOT helpful)
-aspirin
-bblockers
-LMWH or unfractionated heparin (enoxaparin)
-nitrates
-glycoprotein iib/iiia inhib (abciximab, tirofiban), helpful
-acute surgical tx: cardiac catheterization/revascularization
Long term tx:
-aspirin + clopidogrel* (1 yr)
-bblockers
-ACEI
-Statin
USMLE Step 2 Cardiology
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USMLE
6. Bps in Aortic dissection vs Coarctation of aorta - ANS ✓aortic
dissection: asym bps in extremities
Coarc: upper extremititis BP> lower extremities
7. Pulsus paradoxus - ANS ✓-exaggerated decrease in arterial P
during inspiration (>10mmhg)
-pulse gets strong during expiration, weak during inspiration
-distal pulses disapper on inspiration
-tamponade, pericardial effusion, pulm d/s (tension PNX, severe asthma)
8. MCC aortic stenosis - ANS ✓-*aortic sclerosis:* calcification of
tricuspid aortic valve in elderly
-calcification bicuspid aortic valve
-rheum fever
-congential unileaflet
9. Acute Atrial fibrillation tx - ANS ✓-acute Afib, unstable pt:
immediate electrical cardioversion to sinus rhythm
-acute Afib stable pt:
1. Rate control: CCB> B-Blocker; if lvsys dysfxn, digoxin, amio
2. Duration of A-fib > 48 hrs?
Yes: TEE--> if thrombus then anticoagulate for 3 wks then Cardioversion --
> if no thrombus, cardioversion
No: Cardioversion
3. Cardioversion to sinus rhythm: electrical> pharm (ibulitide,
procainamide, sotalol, amiodarone)
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USMLE
10. CHADS2 and A fib - ANS ✓-stroke prevention with
anticoagulation
-CHF 1 point
-HTN 1 point
-Age >=75 1 point
-DM 1 point
-h/o Stroke 2 points
CHADS2 score 1-2, aspirin or anticoag but >3, anticoag
11. Acute pericarditis post MI - ANS ✓-tx is aspirin; nsaids and
corticosteroids CI, may hinder myocardial scar formation
VS
-acute pericarditis NOT post MI
-tx: nsaids
12. Sick Sinus Syndrome (sx, ECG, tx) - ANS ✓-sinus node
dysfunction, spontaneous sinus bradycardia
-recurrent dizziness, syncope, fatigue, confusion, CHF
-long PR, long QRS interval (vs long QT interval is tachyarrythmia,
torsades)
-mc reason for pacemaker
13. Cardiogenic shock (features, CO, SVR, PCWP, tx) - ANS ✓-
h/o MI, angina, heart disease
-*JVD present*
USMLE Step 2 Cardiology
