Pulmonary Hypertension on the USMLE Step 2 CK exam

by / Thursday, 24 June 2010 / Published in Internal Medicine


Pulmonary hypertension is defined as hypertension that is greater than or equal to ¼ that of the systemic pressure.  Normally it should be approximately 1/8 that of the systemic pressure

  • Active pulmonary hypertension means it is primarily a disease of the lung
  • Passive pulmonary hypertension means it is secondary to a condition of the heart

Primary Disease:

  • Idiopathic, which occurs commonly in young women
  • Interstitial restrictive diseases
  • Obstructive pulmonary diseases

Secondary Disease:

  • Seen in heart disease
  • Commonly seen in patients with HIV/AIDS

Signs and Symptoms:

  • Tricuspid regurgitation
  • Loud P2
  • Right ventricular heave
  • Raynaud’s phenomenon


  • Best initial test is the TTE, which will show RVH and an enlarged right atrium
  • Most accurate test is right heart catheterization with increased pulmonary artery pressure
  • EKG will likely show right-axis deviation


  • 02
  • Prostaglandins

Endothelin inhibitors that prevent growth of the vasculature of the pulmonary system

2 Responses to “Pulmonary Hypertension on the USMLE Step 2 CK exam”

  1. Please assist me. I cant read the first bit of the page properly. Thats what I came here to read so please help me.

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