USMLE Step 2 CK High-Yield with complete solution
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 and pruritus
Niacin
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 sternal border. Treatment?
Treat existing heart failure and replace tricuspid valve
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 aneurysm
>5.5cm, rapidly enlarging, symptomatic, ruptured
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 angina can exercise to 85% of
maximum predicted heart rate
Exercise stress treadmill with ECG
Appropriate diagnostic test: 65yo female with LBBB and severe OA has unstable angina
Pharmacologic stress test (e.g. dobutamine echo)
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 elevation with normal cardiac
enzymes
Prinzmetal's angina
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 and dies while exercising
Hypertrophic cardiomyopathy
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
Figure 3 sign
Aortic coarctation
Water-bottle shaped heart
Pericardial effusion, look for pulsus paradoxus
"Stuck-on" appearance
Seborrheic keratosis
Red plaques with silvery-white scales and sharp margins
Psoriasis
The most common type of skin cancer; lesion is pearly-colored papule with translucent
surface and telangiectasias
Basal cell carcinoma
Honey-crusted lesions
Impetigo
A febrile patient with h/o diabetes presents with red, swollen, painful lower extremity
Cellulitis
Positive Nikolsky's sign
Pemphigus vulgaris
Negative Nikolsky's sign
Bullous pemphigoid
A 55yo obese patient presents with dirty, velvety patches on the back of the neck
Acanthosis nigricans. Check FBG to r/o diabetes
Dermatomal distribution
Varicella zoster
Flat-topped papules
Lichen planus
Iris-like target lesions
Erythema multiforme
A lesion characteristically occurring in a linear pattern in areas where skin comes into
contact with clothing or jewelry
Contact dermatitis
Presents with a herald patch, Christmas-tree pattern
Pityriasis rosea
Pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-
meatballs" appearance
Tinea versicolor
Four characteristics of a nevus suggestive of melanoma
Asymmetry, border irregularity, color variation, and large diameter
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
"Dewdrops on a rose petal"
Lesions of primary varicella
"Cradle cap"
Seborrheic dermatitis. Treat conservatively with bathing and moisturizing agents
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
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 and pruritus
Niacin
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 sternal border. Treatment?
Treat existing heart failure and replace tricuspid valve
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 aneurysm
>5.5cm, rapidly enlarging, symptomatic, ruptured
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 angina can exercise to 85% of
maximum predicted heart rate
Exercise stress treadmill with ECG
Appropriate diagnostic test: 65yo female with LBBB and severe OA has unstable angina
Pharmacologic stress test (e.g. dobutamine echo)
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 elevation with normal cardiac
enzymes
Prinzmetal's angina
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 and dies while exercising
Hypertrophic cardiomyopathy
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
Figure 3 sign
Aortic coarctation
Water-bottle shaped heart
Pericardial effusion, look for pulsus paradoxus
"Stuck-on" appearance
Seborrheic keratosis
Red plaques with silvery-white scales and sharp margins
Psoriasis
The most common type of skin cancer; lesion is pearly-colored papule with translucent
surface and telangiectasias
Basal cell carcinoma
Honey-crusted lesions
Impetigo
A febrile patient with h/o diabetes presents with red, swollen, painful lower extremity
Cellulitis
Positive Nikolsky's sign
Pemphigus vulgaris
Negative Nikolsky's sign
Bullous pemphigoid
A 55yo obese patient presents with dirty, velvety patches on the back of the neck
Acanthosis nigricans. Check FBG to r/o diabetes
Dermatomal distribution
Varicella zoster
Flat-topped papules
Lichen planus
Iris-like target lesions
Erythema multiforme
A lesion characteristically occurring in a linear pattern in areas where skin comes into
contact with clothing or jewelry
Contact dermatitis
Presents with a herald patch, Christmas-tree pattern
Pityriasis rosea
Pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-
meatballs" appearance
Tinea versicolor
Four characteristics of a nevus suggestive of melanoma
Asymmetry, border irregularity, color variation, and large diameter
A premalignant lesion from sun exposure that can lead to squamous cell carcinoma
Actinic keratosis
"Dewdrops on a rose petal"
Lesions of primary varicella
"Cradle cap"
Seborrheic dermatitis. Treat conservatively with bathing and moisturizing agents
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
