USMLE Step 2 CK High-Yield 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) USMLE Step 2 CK High-Yield 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) USMLE Step 2 CK High-Yield 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 STsegment 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 USMLE Step 2 CK High-Yield 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>