USMLE Step 2 CK High-Yield

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

A painful, recurrent vesicular eruption of mucocutaneous surfaces

Herpes simplex

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women

Lichen sclerosus

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer

Squamous cell carcinoma

The most common cause of hypothyroidism

Hashimoto's thyroiditis

Lab findings in Hashimotos' thyroiditis

High TSH, low T4, anti-TPO antibodies

Exophthalmos, pretibial myxedema, and decreased TSH

Graves' disease

The most common cause of Cushing's syndrome

Iatrogenic corticosteroid administration. The second most common cause is Cushing's disease

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH

Hypoparathyroidism

Stones, bones, groans, psychic overtones

Signs and symptoms of hypercalcemia

A patient complains of HA, weakness and polyuria; exam reveals HTN and tetany. Labs show hypernatremia, hypokalemia and metabolic alk

Primary hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)

A patient p/w tachycardia, wild swings in BP, HA, diaphoresis, AMS and sense of panic

Pheo

Which should be used first in treating pheo, alpha or beta-antagonists?

Alpha (phentolamine and phenoxybenzamine)

A patient with h/o lithium use p/w copious amounts of dilute urine

Nephrogenic DI

Treatment of central DI

Administration of DDAVP and free-water restriction

A postop patient with significant pain p/w hyponatremia and normal volume status

SIADH due to stress

An antidiabetic agent a/w lactic acidosis

Metformin

A patient p/w weakness, n/v, weight loss and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

Primary adrenal insufficiency (Addison's). Treat with glucocorticoids, mineralocorticoids and IVF

Goal HbA1c for patient with DM

<7.0

Treatment of DKA

Fluids, insulin, and electrolute repletion (eg K+)

Why are beta-blockers contraindicated in diabetics?

Can mask symptoms of hypoglycemia

Bias introduced into a study when a clinician is aware of the patient's treatment type

Observational bias

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death

Lead-time bias

If you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a ______

Confounding variable

The proportion of people who have the disease and test + is the

Sensitivity

Sensitive tests have few false negatives and are used to rule ___ a disease

Out

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a positive PPD. Highly sensitivie or specific?

Sensitive. Screening tests with high sensitivity are good for diseases with low prevalence

Chronic diseases such as SLE - higher prevalence or incidence?

Higher prevalence

Epidemics such as influenza - higher prevalence or incidence?

Higher incidence

What is the difference between incidence and prevalence?

Prevalence is the precentage of cases of disease in a population at one snapshot in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk

Cross-sectional survey - incidence or prevalence?

Prevalence

Cohort study - incidence or prevalence?

Incidence and prevalence

Case-control study - incidence or prevalence?

Neither

Describe a test that consistently gives identical results, but the results are wrong

High reliability (precision), low validity (accuracy)

Difference between a cohort and a case-control study

Cohort studies can be used to calculate RR< incidence and/or odds ratio. Case-control studies can be used to calculate an OR< which is an estimate of RR when the disease prevalence is low

Attributable risk?

The difference in risk in the exposed and unexposed groups (ie, the risk that is attributable to exposure)

Relative risk?

Incidence in the exposed group divided by the incidence in the nonexposed group

The results of a hypothetical study found an association between ASA intake and risk of heart dz. How do you interpret an RR of 1.5?

In patients who took ASA, the risk of heart dz was 1.5 times that of patients who did not take ASA

Odds ratio?

In cohort studies, the odds of developing the disease in the expose group divided by the odds of developing the disease in the nonexposed group. In case-control studies, the odds that the cases were exposed divided by the odds that the controls were exposed. In cross-sectional studies, the odds that the exposed group has the disease divided by the odds that the nonexposed group has the disease

The results of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an OR of 1.5?

In patients who took ASA, the odds of acquiring heart disease were 1.5 times those of patients who did not take ASA