USMLE Step 2 Question of the Day

Practice USMLE Step 2 with the production-style question-of-the-day selection for this public URL.

Question 1

A 55-year-old man with NSTEMI is started on aspirin, heparin, and ticagrelor. He also takes sildenafil. He is hypotensive and has ongoing chest pain. Which medication should be discontinued?

Discontinue aspirin because it increases bleeding risk and provides minimal benefit in acute coronary syndromes.
Discontinue ticagrelor because P2Y12 inhibitors are contraindicated in all patients with hypotension.
Discontinue heparin because anticoagulation is unnecessary unless ST elevation is present on ECG.
Avoid nitrates because recent PDE-5 inhibitor use increases risk of profound hypotension.
Discontinue high-intensity statin because it does not reduce early recurrent ischemic events in ACS.

Explanation: This question tests understanding and management of Acute Coronary Syndromes as per USMLE Step 2 CK standards. Acute Coronary Syndromes encompass conditions like STEMI, NSTEMI, and Unstable Angina, characterized by acute myocardial ischemia. In this scenario, the patient's symptoms and ECG findings are indicative of NSTEMI. The correct answer is D, which aligns with current management guidelines and addresses the patient's immediate needs. A common distractor, B, fails because it overlooks that P2Y12 inhibitors can be used in hypotension, leading to inadequate management. To approach similar questions, identify key symptoms and diagnostic markers such as ongoing pain and hypotension. Apply guideline-directed management, and avoid common pitfalls such as misinterpretation of drug contraindications.

Opening subject page...

Loading your content

USMLE Step 2

USMLE Step 2 Question of the Day

Practice USMLE Step 2 with the production-style question-of-the-day selection for this public URL.

Question 1

A 55-year-old man with NSTEMI is started on aspirin, heparin, and ticagrelor. He also takes sildenafil. He is hypotensive and has ongoing chest pain. Which medication should be discontinued?

Discontinue aspirin because it increases bleeding risk and provides minimal benefit in acute coronary syndromes.
Discontinue ticagrelor because P2Y12 inhibitors are contraindicated in all patients with hypotension.
Discontinue heparin because anticoagulation is unnecessary unless ST elevation is present on ECG.
Avoid nitrates because recent PDE-5 inhibitor use increases risk of profound hypotension.
Discontinue high-intensity statin because it does not reduce early recurrent ischemic events in ACS.

Explanation: This question tests understanding and management of Acute Coronary Syndromes as per USMLE Step 2 CK standards. Acute Coronary Syndromes encompass conditions like STEMI, NSTEMI, and Unstable Angina, characterized by acute myocardial ischemia. In this scenario, the patient's symptoms and ECG findings are indicative of NSTEMI. The correct answer is D, which aligns with current management guidelines and addresses the patient's immediate needs. A common distractor, B, fails because it overlooks that P2Y12 inhibitors can be used in hypotension, leading to inadequate management. To approach similar questions, identify key symptoms and diagnostic markers such as ongoing pain and hypotension. Apply guideline-directed management, and avoid common pitfalls such as misinterpretation of drug contraindications.