USMLE Step 2 CK Medical Prep Exam Questions & Answers 2026 (11–20)

✓ Correct answer: B. Emergency coronary angiography with primary PCI

This patient is presenting with an anterior wall ST-elevation myocardial infarction (STEMI). The preferred reperfusion strategy is emergency coronary angiography with primary percutaneous coronary intervention (PCI) if available within 90 minutes of first medical contact. This offers better outcomes than thrombolytic therapy when timely access is available.

✓ Correct answer: A. Exercise stress test with myocardial perfusion imaging

For a diabetic patient with increasing frequency of exertional chest pain (suggestive of unstable angina), exercise stress testing with myocardial perfusion imaging provides greater sensitivity and specificity than exercise ECG alone. Adding imaging is particularly valuable in patients with diabetes who have higher risk of coronary artery disease.

✓ Correct answer: D. Acute mitral regurgitation due to papillary muscle rupture

The sudden onset of hemodynamic compromise with a new apical holosystolic murmur in a patient with history of MI is consistent with acute mitral regurgitation due to papillary muscle rupture. This is a mechanical complication of myocardial infarction that typically occurs 2-7 days post-MI and represents a surgical emergency.

✓ Correct answer: C. Sublingual nitroglycerin

This patient has stable angina, characterized by exertional chest pain that resolves with rest and ECG changes consistent with ischemia. Sublingual nitroglycerin is the most appropriate initial pharmacotherapy for symptomatic relief of angina attacks. It acts by dilating coronary arteries and reducing preload.

✓ Correct answer: B. Mitral stenosis

The combination of a diastolic rumble at the apex with an opening snap in a patient with a history of rheumatic fever is characteristic of mitral stenosis. Rheumatic heart disease is the most common cause of mitral stenosis, which typically presents with fatigue, dyspnea, and signs of heart failure.

✓ Correct answer: A. 2.0-3.0

For patients with atrial fibrillation on warfarin anticoagulation, the target INR range is 2.0-3.0. This range provides effective stroke prevention while minimizing bleeding risk. A higher target range (2.5-3.5) would only be indicated for mechanical heart valves.

✓ Correct answer: D. Systemic thrombolytic therapy

This patient has a massive pulmonary embolism with hemodynamic instability (hypotension, tachycardia). Systemic thrombolytic therapy is indicated for massive PE with hemodynamic compromise to rapidly restore pulmonary blood flow. Anticoagulation alone would be insufficient for this high-risk presentation.

✓ Correct answer: C. Pulmonary arterial hypertension

This patient has findings consistent with pulmonary arterial hypertension (PAH), which can be associated with HIV infection. The echocardiogram shows right ventricular dilation and elevated pulmonary pressures with normal left heart function, which is characteristic of PAH rather than pulmonary hypertension due to left heart disease.

✓ Correct answer: B. Oral antihypertensive medication with gradual blood pressure reduction

This patient has severely elevated blood pressure but without symptoms or evidence of end-organ damage, which is classified as hypertensive urgency rather than emergency. The appropriate management is oral antihypertensive medication with gradual blood pressure reduction over 24-48 hours. Rapid reduction may cause harm.

✓ Correct answer: A. Mitral regurgitation

The clinical findings of a holosystolic murmur at the apex that radiates to the axilla and intensifies with handgrip, along with echocardiographic evidence of posterior leaflet prolapse, are diagnostic of mitral regurgitation. Mitral valve prolapse is a common cause of primary mitral regurgitation.