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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#1 (reveal difficulty score)
A 72-year-old man is hospitalized because of ...
Cor pulmonale ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pulm

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submitted by โˆ—gh889(154)
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โ€ข Perivascular changes secondary to recurrent small PE โ†’ โ†‘ pulmonary vascular resistance โ†’ โ†‘ pressure in the pulmonary circuit โ†’ โ†‘ RV afterload โ†’ dilatation and/or hypertrophy of the right heart

โ€ข Will present as pure right sided HF (JVD, dyspnea, ascites, LE pitting edema, cardiomegaly but NO pulmonary edema (pulmonary edema is associated with left sided HF)

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submitted by โˆ—step_prep5(246)
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  • Patient with progressive dyspnea with signs of right-sided heart failure (JVD, ascites, pitting edema but no pulmonary edema) and a history of DVT/PE, most consistent with cor pulmonale secondary to Group 4 pulmonary hypertension
  • Group 1 pulmonary hypertension = Pulmonary arterial hypertension (pre-capillary) [familial, toxins, connective tissue disease, etc.]
  • Group 2 PH: Left-sided heart failure
  • Group 3 PH: Chronic lung disease (COPD, OSA, asthma, etc.)
  • Group 4 PH: Chronic thromboembolic disease
  • Group 5 PH: Other causes [anemia, sarcoidosis, etc.]
  • Aortic stenosis or Mitral regurgitation = Systolic murmur on exam
  • Ischemic heart disease = Chest pain vs heart failure (pulmonary edema on chest x-ray)
  • Viral cardiomyopathy = Acute dyspnea, chest pain, fever

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