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Step 2 Practice Q’s
USMLERx Step 2 QBank Question #21005
Sep 1st
A 2-year-old boy is brought to the clinic for evaluation after 2 days of low-grade tactile fever, irritability, and decreased activity. His mother reports that on waking him this morning, his pillow was stained with a small amount of yellow fluid. His heart rate is 92/min, blood pressure is 104/70 mm Hg, respiratory rate is 22/min, and temperature is 38.8°C (101.°F). His external ear canal is normal, and his otoscopic examination is shown in the image. Which of the following is the most likely bacterial pathogen implicated in this condition?
A. Neisseria meningitidis
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Haemophilus influenzae type B
E. Streptococcus pneumoniae
Step 2 Wed – USMLERx Step 2CK Question #21223
Aug 4th
A 53-year-old woman with a history of polycystic kidney disease undergoes a renal transplant from a cadaveric donor. She experiences several bouts of acute rejection that are controlled by appropriate increases in immunosuppression during the first year posttransplant. During her fourth posttransplant year her creatinine is rising gradually. Transcutaneous biopsy reveals architectural distortion and sclerosis of the renal tubules. What is the most likely outcome of the patient’s condition?
A. Development of lymphoproliferative tumors requiring decreased immunosuppression
B. Gradual onset of renal failure and return to dialysis
C. Requirement of chronic antibiotic prophylaxis against urinary tract infection
D. Response to increased chronic immunosuppression
E. Response to a short course of high-dose steroids
Step 2 Wed – USMLERx Step 2CK Question #21018
Jul 28th
A 30-year-old woman presents to a primary care physician for a new patient visit. She reports recurrent episodes of pneumonia, bronchitis, and otitis over the past 4 years. Although her vaccinations were up to date, she developed tetanus following a foot laceration last year. Her lymph nodes and tonsils are enlarged. Laboratory testing reveals low IgG, IgA, and IgM levels. After referral to a hematologist, who rules out other acquired and genetic causes of her hypogammaglobulinemia, she is diagnosed with common variable immunodeficiency. This woman is at the highest risk of developing which of the following condition?
A. Cardiovascular disease
B. Lymphoma
C. Miscarriage
D. Renal disease
E. Splenic autoinfarction
Step 2 Wed – USMLERx Step 2CK Question #23176
Jul 21st
A 30-year-old man has episodes of wheezing and shortness of breath two to three times per week. Approximately every 2 weeks he awakens at night due to cough and difficulties breathing. He reports having similar symptoms since he was a child, but believes that they are worsening somewhat now. His symptoms are worsened by cold air and exercise and are improved by rest. Which of the following is the most appropriate treatment?
A. Daily high-dose inhaled corticosteroid and ?-agonist when needed
B. Daily high-dose inhaled corticosteroid with oral steroids for exacerbations and short-acting ?-agonist when needed
C. Daily low-dose inhaled corticosteroid and short-acting ?-agonist when needed
D. Daily oral steroids and long-acting ?-agonist
E. Short-acting ?-agonist when needed
Step 2 Wed – USMLERx Step 2CK Question #21376
Jul 14th
A 26-year-old woman who is 32 weeks’ pregnant with her first child presents to her obstetrician for a routine visit. Her pregnancy has been uneventful and she has been feeling well, although somewhat anxious over the arrival of her first child. She has blood drawn for glucose levels following a 1-hour glucose tolerance test, but the laboratory mistakenly runs the sample for thyroid hormones; testing reveals the following values:
Total thyroxine: 20.5 µg/dL
Free thyroxine: 7.0 ng/dL
Total triiodothyronine: 280 ng/dL
Thyroid-stimulating hormone: 2.2 µU/mL
Given her thyroid hormone levels, what is the most appropriate next step in management?
A. Nothing; this woman does not have hyperthyroidism
B. Nothing; asymptomatic hyperthyroidism does not require treatment during pregnancy
C. Treatment with propylthiouracil because hyperthyroidism can have deleterious effects on the developing fetus
D. Treatment with surgery because hyperthyroidism can have deleterious effects on the developing fetus
E. Treatment with thyroxine because hyperthyroidism can have deleterious effects on the developing fetus
Step 2 Wed – USMLERx Step 2CK Question #21316
Jul 7th
A 31-year-old woman is brought to the emergency department after a motor vehicle crash. According to the paramedics, her left arm was pinned between the steering wheel and the door, so extrication was prolonged. The patient is fully oriented and complaining of severe pain in her upper arm. She is holding her arm in a protected position and is refusing a physical examination. X-ray of the left arm reveals a humeral shaft fracture. Which of the following signs of neurologic injury would this patient most likely have?
A. Claw hand
B. Deltoid paralysis
C. Intrinsic hand weakness
D. Waiter’s tip
E. Winged scapula
F. Wrist Drop
Step 2 Wed – USMLERx Step 2CK Question #21489
Jun 30th
A 63-year-old postmenopausal woman is referred to the gynecologic clinic by her primary care physician for evaluation of genital pruritus of 1 months’ duration. She has a remote history of human papillomavirus infection. She denies changes in vaginal discharge or vaginal bleeding. She also denies constitutional symptoms or weight loss. On examination she is in no apparent distress and heart rate is 70/min, blood pressure is 100/58 mm Hg, and respiratory rate is 10/min. Genital examination reveals an ulcerative white lesion approximately 1 cm in diameter on her labia majora. What is the most appropriate next step in management?
A. Obtain a biopsy of the lesion
B. Prescribe estrogen cream to be applied to area
C. Treat with acyclovir
D. Treat with cryotherapy
E. Treat with fluconazole
F. Treat with metronidazole
USMLE Step 2CK Testimonial
Apr 16th
Hi, I’m a fourth-year medical student who recently took the Step 2 CK exam. I waited until the very end of the year to take it, which kind of ruined the holidays for me. So my advice is to take the exam a little earlier rather than later, although we know that isn’t always possible.
I thought CK was a very reasonable test. It was easier to me than Step 1 was. This perhaps is due to the strength of the clinical training that I’ve received in my third and fourth years. My school doesn’t ask us to take one of those prepackaged preclinical exams. However, we do take shelf exams during our clinical years, and the Step 2 CK exam was very much like a very long shelf exam.
For the most part everything on the exam was very clinical. I had one question on a basic mechanism of action of a drug, but that could have been one of the questions the NBME throws in there that isn’t counted toward your score. My approach was, I did the first block, second block, 5-minute break, third block, 10-minute break, fourth block, lunch, fifth block, sixth block, 5-minute break, seventh block, 5-minute break, then the last block.
I saw a ton of peds and ob/gyn questions. There were a few questions with audio and video, for example I had to listen to heart sounds with an interactive chest. There were normal heart sounds in a few of the questions, so don’t necessarily expect pathology when presented with the auscultative chest. One video I had was a child development question.
There did seem to be a few kinks they need to work out with the new audiovisual questions. I had a microphone error box appear during my lunch break. And at the very end of my exam I got an error screen that said, “fatal error,” which I found out later has happened to more than one person even at my own school. It may be a quirk with the new FRED interface, I don’t know; but according to all the people I’ve talked to with a similar situation, the exam was transmitted before the error occurred. Whew!
The FRED v2 interface is pretty nice, it beats FRED v1. I would say you don’t have to devote as much time for Step 2 CK as for Step 1. Pick a question bank, do the questions. I didn’t do much reading except in the areas where the question bank indicated I needed a brush-up. Again, the experience was like taking a longer shelf exam than usual and in more than one subject. Having experience with real patients and real clinical situations during the third and fourth years makes the Step 2 CK a unique exam because you do draw upon more than just book knowledge as you take it.
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