USMLE Step 2 Rapid Review With Complete Solution
"Sawtooth" P waves
Classic ECG finding in atrial flutter.
Angina is new, is worsening, or occurs at rest
Definition of unstable angina.
ACEI
Antihypertensive for a diabetic patient with proteinuria.
Hypotension, distant heart sounds, and JVD
Beck's triad for cardiac tamponade.
β-blockers, digoxin, calcium channel blockers
Drugs that slow AV node transmission.
Niacin
Hypercholesterolemia treatment that → flushing and pruritus.
Anticoagulation, rate control, cardioversion
Treatment for atrial fibrillation.
Immediate cardioversion
Treatment for ventricular fibrillation.
Dressler's syndrome: fever, pericarditis, ↑ ESR
Autoimmune complication occurring 2-4 weeks post-MI.
Treat existing heart failure and replace the tricuspid valve
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Diagnostic test for hypertrophic cardiomyopathy.
Pulsus paradoxus (seen in cardiac tamponade)
A fall in systolic BP of > 10 mmHg with inspiration.
Low-voltage, diffuse ST-segment elevation
Classic ECG findings in pericarditis.
BP > 140/90 on three separate occasions two weeks apart
Definition of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome,
Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism,
hyperparathyroidism
Eight surgically correctable causes of hypertension.
Abdominal ultrasound and CT
Evaluation of a pulsatile abdominal mass and bruit.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
Indications for surgical repair of abdominal aortic aneurysm.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
Treatment for acute coronary syndrome.
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance,
prothrombotic or proinflammatory states
What is the metabolic syndrome?
Exercise stress treadmill with ECG
Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of
maximum predicted heart rate.
,Pharmacologic stress test (e.g., dobutamine echo)
Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and
severe osteoarthritis has unstable angina.
Angina, ST-segment changes on ECG, or ↓ BP
Signs of active ischemia during stress testing.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
ECG findings suggesting MI.
Prinzmetal's angina
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are
normal.
CHF, shock, and altered mental status
Common symptoms associated with silent MIs.
V/Q scan
The diagnostic test for pulmonary embolism.
Protamine
An agent that reverses the effects of heparin.
PT
The coagulation parameter affected by warfarin.
Hypertrophic cardiomyopathy
A young patient with a family history of sudden death collapses and dies while
exercising.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and
amoxicillin after
Endocarditis prophylaxis regimens.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
The 6 P's of ischemia due to peripheral vascular disease.
Stasis, hypercoagulability, endothelial damage
Virchow's triad.
OCPs
The most common cause of hypertension in young women.
Excessive EtOH
The most common cause of hypertension in young men.
Seborrheic keratosis
"Stuck-on" appearance.
Psoriasis
Red plaques with silvery-white scales and sharp margins.
Basal cell carcinoma
The most common type of skin cancer; the lesion is a pearly-colored papule with a
translucent surface and telangiectasias.
Impetigo
Honey-crusted lesions.
Cellulitis
A febrile patient with a history of diabetes presents with a red, swollen, painful lower
extremity.
Pemphigus vulgaris
+ Nikolsky's sign.
, Bullous pemphigoid
- Nikolsky's sign.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Varicella zoster
Dermatomal distribution.
Lichen planus
Flat-topped papules.
Erythema multiforme
Iris-like target lesions.
Contact dermatitis
A lesion characteristically occurring in a linear pattern in areas where skin comes into
contact with clothing or jewelry.
Pityriasis rosea
Presents with a herald patch, Christmas-tree pattern.
Alopecia areata (autoimmune process)
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Pityriasis versicolor
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-
meatballs" appearance.
Asymmetry, border irregularity, color variation, large diameter
Four characteristics of a nevus suggestive of melanoma.
Actinic keratosis
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Lesions of 1° varicella
"Dewdrop on a rose petal."
Seborrheic dermatitis. Treat with antifungals
"Cradle cap."
Acne vulgaris
Associated with Propionibacterium acnes and changes in androgen levels.
Herpes simplex
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Lichen sclerosus
Inflammation and epithelial thinning of the anogenital area, predominantly in
postmenopausal women.
Squamous cell carcinoma
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second
most common type of skin cancer.
Hashimoto's thyroiditis
The most common cause of hypothyroidism.
High TSH, low T4, antimicrosomal antibodies
Lab findings in Hashimoto's thyroiditis.
Graves' disease
Exophthalmos, pretibial myxedema, and ↓ TSH.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
The most common cause of Cushing's syndrome.
"Sawtooth" P waves
Classic ECG finding in atrial flutter.
Angina is new, is worsening, or occurs at rest
Definition of unstable angina.
ACEI
Antihypertensive for a diabetic patient with proteinuria.
Hypotension, distant heart sounds, and JVD
Beck's triad for cardiac tamponade.
β-blockers, digoxin, calcium channel blockers
Drugs that slow AV node transmission.
Niacin
Hypercholesterolemia treatment that → flushing and pruritus.
Anticoagulation, rate control, cardioversion
Treatment for atrial fibrillation.
Immediate cardioversion
Treatment for ventricular fibrillation.
Dressler's syndrome: fever, pericarditis, ↑ ESR
Autoimmune complication occurring 2-4 weeks post-MI.
Treat existing heart failure and replace the tricuspid valve
IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?
Echocardiogram (showing thickened left ventricular wall and outflow obstruction)
Diagnostic test for hypertrophic cardiomyopathy.
Pulsus paradoxus (seen in cardiac tamponade)
A fall in systolic BP of > 10 mmHg with inspiration.
Low-voltage, diffuse ST-segment elevation
Classic ECG findings in pericarditis.
BP > 140/90 on three separate occasions two weeks apart
Definition of hypertension.
Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome,
Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism,
hyperparathyroidism
Eight surgically correctable causes of hypertension.
Abdominal ultrasound and CT
Evaluation of a pulsatile abdominal mass and bruit.
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
Indications for surgical repair of abdominal aortic aneurysm.
Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin
Treatment for acute coronary syndrome.
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance,
prothrombotic or proinflammatory states
What is the metabolic syndrome?
Exercise stress treadmill with ECG
Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of
maximum predicted heart rate.
,Pharmacologic stress test (e.g., dobutamine echo)
Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and
severe osteoarthritis has unstable angina.
Angina, ST-segment changes on ECG, or ↓ BP
Signs of active ischemia during stress testing.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
ECG findings suggesting MI.
Prinzmetal's angina
A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are
normal.
CHF, shock, and altered mental status
Common symptoms associated with silent MIs.
V/Q scan
The diagnostic test for pulmonary embolism.
Protamine
An agent that reverses the effects of heparin.
PT
The coagulation parameter affected by warfarin.
Hypertrophic cardiomyopathy
A young patient with a family history of sudden death collapses and dies while
exercising.
Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and
amoxicillin after
Endocarditis prophylaxis regimens.
Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
The 6 P's of ischemia due to peripheral vascular disease.
Stasis, hypercoagulability, endothelial damage
Virchow's triad.
OCPs
The most common cause of hypertension in young women.
Excessive EtOH
The most common cause of hypertension in young men.
Seborrheic keratosis
"Stuck-on" appearance.
Psoriasis
Red plaques with silvery-white scales and sharp margins.
Basal cell carcinoma
The most common type of skin cancer; the lesion is a pearly-colored papule with a
translucent surface and telangiectasias.
Impetigo
Honey-crusted lesions.
Cellulitis
A febrile patient with a history of diabetes presents with a red, swollen, painful lower
extremity.
Pemphigus vulgaris
+ Nikolsky's sign.
, Bullous pemphigoid
- Nikolsky's sign.
Acanthosis nigricans. Check fasting blood sugar to rule out diabetes
A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.
Varicella zoster
Dermatomal distribution.
Lichen planus
Flat-topped papules.
Erythema multiforme
Iris-like target lesions.
Contact dermatitis
A lesion characteristically occurring in a linear pattern in areas where skin comes into
contact with clothing or jewelry.
Pityriasis rosea
Presents with a herald patch, Christmas-tree pattern.
Alopecia areata (autoimmune process)
A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.
Pityriasis versicolor
Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-
meatballs" appearance.
Asymmetry, border irregularity, color variation, large diameter
Four characteristics of a nevus suggestive of melanoma.
Actinic keratosis
Premalignant lesion from sun exposure that can → squamous cell carcinoma.
Lesions of 1° varicella
"Dewdrop on a rose petal."
Seborrheic dermatitis. Treat with antifungals
"Cradle cap."
Acne vulgaris
Associated with Propionibacterium acnes and changes in androgen levels.
Herpes simplex
A painful, recurrent vesicular eruption of mucocutaneous surfaces.
Lichen sclerosus
Inflammation and epithelial thinning of the anogenital area, predominantly in
postmenopausal women.
Squamous cell carcinoma
Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second
most common type of skin cancer.
Hashimoto's thyroiditis
The most common cause of hypothyroidism.
High TSH, low T4, antimicrosomal antibodies
Lab findings in Hashimoto's thyroiditis.
Graves' disease
Exophthalmos, pretibial myxedema, and ↓ TSH.
Iatrogenic steroid administration. The second most common cause is Cushing's disease
The most common cause of Cushing's syndrome.
