Best next diagnostic or management step for adult cardiac and pulmonary presentations tested on USMLE Step 2 CK, narrower than the general internal medicine deck.
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- Suspected STEMI on ECG, what is the best next step in management?
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Emergent reperfusion via primary PCI (door to balloon under 90 minutes)- Chest pain with a non-diagnostic initial ECG and suspected ACS, what is the next best step?
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Serial troponins and repeat ECG- Stable patient with new exertional chest pain and a normal resting ECG, what is the best next diagnostic test?
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Exercise or pharmacologic stress test- NSTEMI management, what combination of therapies is started immediately?
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Dual antiplatelet therapy plus anticoagulation- Patient with suspected acute pericarditis, what is the best next test to check for a complicating effusion?
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Transthoracic echocardiogram- Tearing chest pain radiating to the back with unequal blood pressures in both arms, what is the best next diagnostic step?
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CT angiography of the chest- Hemodynamically unstable patient with suspected aortic dissection who cannot be moved to CT, what imaging is used instead?
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Transesophageal echocardiogram- Fever with a new heart murmur and suspected infective endocarditis, what is the best next step before starting antibiotics?
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Draw three sets of blood cultures from different sites- New onset atrial fibrillation in a hemodynamically stable patient, what is the initial management priority?
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Rate control- In atrial fibrillation, what score is used to decide on anticoagulation?
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CHA2DS2-VASc score- Atrial fibrillation with hypotension and altered mental status, what is the immediate next step?
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Synchronized electrical cardioversion- Pulseless ventricular tachycardia, what is the immediate next step?
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Unsynchronized defibrillation- Young athlete with exertional syncope and a systolic murmur that increases with Valsalva, what is the best next diagnostic test?
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Echocardiogram- Patient with symptoms of heart failure, what is the best initial test to assess ejection fraction?
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Transthoracic echocardiogram- New holosystolic murmur several days after a myocardial infarction, what is the best next step?
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Echocardiogram to evaluate for papillary muscle rupture or ventricular septal defect
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