USMLE Step 2 CK Newest 2025- 2026 Updated
Practice Exam | 200 Actual Most Tested Questions
Collections & Verified Detailed Answers | Tutor
Verified Success Exam) Graded A+
1. A 62-year-old man with a history of hypertension presents with sudden
onset chest pain radiating to his left arm. ECG shows ST elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Correct Answer: Right coronary artery ✓
Inferior wall myocardial infarctions typically involve the right coronary
artery. Key concept: ECG localization of MI.
2. A 28-year-old woman presents with dysuria and urinary frequency.
Urinalysis shows leukocyte esterase and nitrites. What is the most
appropriate initial treatment?
A. Amoxicillin
B. Nitrofurantoin
C. Ciprofloxacin
D. Vancomycin
Correct Answer: Nitrofurantoin ✓
First-line therapy for uncomplicated cystitis is nitrofurantoin. Key concept:
UTI management guidelines.
3. A 70-year-old smoker presents with chronic cough and weight loss. Imaging
shows a central lung mass. Which is the most likely diagnosis?
A. Adenocarcinoma
, B. Small cell carcinoma
C. Large cell carcinoma
D. Bronchial carcinoid
Correct Answer: Small cell carcinoma ✓
Central lung masses in smokers are commonly small cell carcinoma. Key
concept: lung cancer classification.
4. A 45-year-old woman presents with fatigue and pruritus. Labs show
elevated alkaline phosphatase and antimitochondrial antibodies. Diagnosis?
A. Primary sclerosing cholangitis
B. Primary biliary cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
Correct Answer: Primary biliary cholangitis ✓
Antimitochondrial antibodies are specific for PBC. Key concept: cholestatic
liver disease markers.
5. A 60-year-old diabetic presents with foot ulcer probing to bone. Most likely
diagnosis?
A. Cellulitis
B. Osteomyelitis
C. Abscess
D. Necrotizing fasciitis
Correct Answer: Osteomyelitis ✓
Ulcers probing to bone suggest osteomyelitis. Key concept: diabetic foot
infections.
6. A patient develops hypotension and urticaria after penicillin administration.
What is the mechanism?
A. Type II hypersensitivity
B. Type III hypersensitivity
C. Type I hypersensitivity
D. Type IV hypersensitivity
, Correct Answer: Type I hypersensitivity ✓
IgE-mediated reactions cause anaphylaxis. Key concept: hypersensitivity
types.
7. A 34-year-old woman presents with exophthalmos and heat intolerance.
Most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Thyroid cancer
Correct Answer: Graves disease ✓
Exophthalmos is specific for Graves disease. Key concept: autoimmune
hyperthyroidism.
8. A newborn presents with projectile vomiting and palpable olive-shaped
mass. Diagnosis?
A. Duodenal atresia
B. Pyloric stenosis
C. Intussusception
D. Hirschsprung disease
Correct Answer: Pyloric stenosis ✓
Projectile vomiting and palpable mass indicate pyloric stenosis. Key
concept: neonatal GI disorders.
9. A patient presents with sudden unilateral facial paralysis including
forehead. Diagnosis?
A. Stroke
B. Bell palsy
C. Multiple sclerosis
D. Myasthenia gravis
Correct Answer: Bell palsy ✓
Peripheral facial nerve lesions affect the entire face. Key concept: cranial
nerve VII lesions.
, 10.A 50-year-old man presents with tremor at rest that improves with
movement. Diagnosis?
A. Essential tremor
B. Parkinson disease
C. Huntington disease
D. Cerebellar lesion
Correct Answer: Parkinson disease ✓
Resting tremor is characteristic of Parkinson disease. Key concept:
movement disorders.
11.A patient with cirrhosis develops confusion and asterixis. Cause?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Stroke
D. Uremia
Correct Answer: Hepatic encephalopathy ✓
Asterixis indicates hepatic encephalopathy. Key concept: ammonia toxicity.
12.A child presents with barking cough and stridor. Diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Correct Answer: Croup ✓
Barking cough is classic for croup. Key concept: pediatric airway infections.
13.A patient presents with severe headache, neck stiffness, and photophobia.
Likely diagnosis?
A. Migraine
B. Tension headache
C. Meningitis
D. Cluster headache
Practice Exam | 200 Actual Most Tested Questions
Collections & Verified Detailed Answers | Tutor
Verified Success Exam) Graded A+
1. A 62-year-old man with a history of hypertension presents with sudden
onset chest pain radiating to his left arm. ECG shows ST elevations in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Correct Answer: Right coronary artery ✓
Inferior wall myocardial infarctions typically involve the right coronary
artery. Key concept: ECG localization of MI.
2. A 28-year-old woman presents with dysuria and urinary frequency.
Urinalysis shows leukocyte esterase and nitrites. What is the most
appropriate initial treatment?
A. Amoxicillin
B. Nitrofurantoin
C. Ciprofloxacin
D. Vancomycin
Correct Answer: Nitrofurantoin ✓
First-line therapy for uncomplicated cystitis is nitrofurantoin. Key concept:
UTI management guidelines.
3. A 70-year-old smoker presents with chronic cough and weight loss. Imaging
shows a central lung mass. Which is the most likely diagnosis?
A. Adenocarcinoma
, B. Small cell carcinoma
C. Large cell carcinoma
D. Bronchial carcinoid
Correct Answer: Small cell carcinoma ✓
Central lung masses in smokers are commonly small cell carcinoma. Key
concept: lung cancer classification.
4. A 45-year-old woman presents with fatigue and pruritus. Labs show
elevated alkaline phosphatase and antimitochondrial antibodies. Diagnosis?
A. Primary sclerosing cholangitis
B. Primary biliary cholangitis
C. Autoimmune hepatitis
D. Hepatitis C
Correct Answer: Primary biliary cholangitis ✓
Antimitochondrial antibodies are specific for PBC. Key concept: cholestatic
liver disease markers.
5. A 60-year-old diabetic presents with foot ulcer probing to bone. Most likely
diagnosis?
A. Cellulitis
B. Osteomyelitis
C. Abscess
D. Necrotizing fasciitis
Correct Answer: Osteomyelitis ✓
Ulcers probing to bone suggest osteomyelitis. Key concept: diabetic foot
infections.
6. A patient develops hypotension and urticaria after penicillin administration.
What is the mechanism?
A. Type II hypersensitivity
B. Type III hypersensitivity
C. Type I hypersensitivity
D. Type IV hypersensitivity
, Correct Answer: Type I hypersensitivity ✓
IgE-mediated reactions cause anaphylaxis. Key concept: hypersensitivity
types.
7. A 34-year-old woman presents with exophthalmos and heat intolerance.
Most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Thyroid cancer
Correct Answer: Graves disease ✓
Exophthalmos is specific for Graves disease. Key concept: autoimmune
hyperthyroidism.
8. A newborn presents with projectile vomiting and palpable olive-shaped
mass. Diagnosis?
A. Duodenal atresia
B. Pyloric stenosis
C. Intussusception
D. Hirschsprung disease
Correct Answer: Pyloric stenosis ✓
Projectile vomiting and palpable mass indicate pyloric stenosis. Key
concept: neonatal GI disorders.
9. A patient presents with sudden unilateral facial paralysis including
forehead. Diagnosis?
A. Stroke
B. Bell palsy
C. Multiple sclerosis
D. Myasthenia gravis
Correct Answer: Bell palsy ✓
Peripheral facial nerve lesions affect the entire face. Key concept: cranial
nerve VII lesions.
, 10.A 50-year-old man presents with tremor at rest that improves with
movement. Diagnosis?
A. Essential tremor
B. Parkinson disease
C. Huntington disease
D. Cerebellar lesion
Correct Answer: Parkinson disease ✓
Resting tremor is characteristic of Parkinson disease. Key concept:
movement disorders.
11.A patient with cirrhosis develops confusion and asterixis. Cause?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Stroke
D. Uremia
Correct Answer: Hepatic encephalopathy ✓
Asterixis indicates hepatic encephalopathy. Key concept: ammonia toxicity.
12.A child presents with barking cough and stridor. Diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Asthma
Correct Answer: Croup ✓
Barking cough is classic for croup. Key concept: pediatric airway infections.
13.A patient presents with severe headache, neck stiffness, and photophobia.
Likely diagnosis?
A. Migraine
B. Tension headache
C. Meningitis
D. Cluster headache
