USMLE Step 2 CK High-Yield

ACEIs

Cough, Rash, Proteinuria, angioedema, taste changes, teratogenic effects.

Amantadine

Ataxia, livedo reticularis

Aminoglycosides

Ototoxicity, nephrotoxicity (atn)

amiodarone

pulmonary fibrosis, peripheral deposition -> bluish discoloration, arrhythmias, hypo/hyperthyroidism, corneal deposition

amphotericin

fever/chills, nephrotoxicity, bone marrow suppresion, anemia

antipsychotics

sedation, acute dystonic reaction, akathisia, parkinsonism, tardive dyskinesia, nms

Azoles (fluconazole)

p-450 inhibition

azt

thrombocytopenia, megaloblastic anemia

b-blockers

asthma exacerbation, masking of hypoglycemia, impotence, bradycardia, av block, chf

benzos

sedation, dependence, respiratory depression

bile acid resins

gi upset, malabsorption of vitamins and medications

calcium channel blockers

peripheral edema, constipation, cardiac depression

carbemazepine

p-450 inducer, agranulocytosis, aplastic anemia, liver tox

chloramphenicol

gray baby syndrome, aplastic anemia

cisplatin

nephro, acoustic nerve damage

clonidine

dry mouth, sever rebound headache and hypertension

clozapine

agranulocytosis

corticosteroids

mania, immunosuppression, bone mineral loss, thinning of skin, easy bruising, myopathy, cataracts

cyclophosphamide

myelosuppresion, hemorrhagic cystitis

digoxin

gi disturbance, yellow visual changes, arrhythmias (svt)

doxorubicin

cardiomyopathy

ethyl alcohol

renal dysfunction

gemfibrozil

myositis, reversible LFT increase

halothane

hepatotox, malignant hyperthermia

HCTZ

hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, hypercalcemia

HMG-Coa reductase inhibitors

myositis, reversible LFT increase

hydralazine

drug induced sle

hydroxychloroquine

retinopathy

inh

peripheral neuropathy (prevent with pyridoxine/B6), hepatotox, seizure with overdose, hemolysis if g6pd def.

MAOIs

hypertensive tyramine reaction, serotonin syndrome (with meperidine)

methanol

blindness

methotrexate

hepatic fibrosis, pneumonitis, anemia

methyldopa

+coombs test, drug induced sle

metronidazole

vestibular dysfunction, metallic tase

niacin

cutaneous flushing

nitroglycerin

hypotension, tachy, headache, tolerance

penicillamine

SLE

PCN

hypersensitivity

phenytoin

nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, teratogenic effects

prazosin (a1 blocker)

first dose hypotension

procainamide

SLE

propothyouracil

agranulocytosis, aplastic anemia

quinidine

cinchonism (headache, tinnitus), thrombocytopenia, arrhythmias (torsades)

reserpine

depression

rifampin

p-450 induction, orange-red body secretions

salicylates

fever, hypervent with resp alk and met acid, dehydration, diaphoresis, hemorrhagic gastritis

SSRIs

anxiety, sexual dysfunction, serotonin syndrome (with MAOI)

succinylcholine

malignant hyperthermia, hyperkalemia

TCAs

sedation, coma, anticholinergic effects, seizures and arrhythmias (QRS increase), hypotension

tetracyclines

tooth discoloration, photosensitivity, fanconis syndrome, GI distress

trimethoprim

megaloblastic anemia, leukopenia, granulocytosis

valproic acid

teratogenicity (neural tube defects), rare fatal hepatotox

vancomycin

nephro, oto, redman syndrome (histamine release)

vinblastine

severe myelosuppression

vincristine

peripheral neuropathy, paralytic ileus

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