USMLE Step 2 CK Exam Practice
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Rationale 2026 Q&A| Instant Download
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1. A 54-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG shows ST elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
This presentation indicates an inferior myocardial infarction, most
commonly due to occlusion of the right coronary artery supplying the
inferior wall of the heart.
2. A 23-year-old woman presents with fever, dysuria, and flank pain.
Urinalysis shows leukocyte esterase and nitrites. What is the most
likely organism?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Proteus mirabilis
D. Enterococcus faecalis
, Escherichia coli is the most common cause of acute uncomplicated
pyelonephritis and cystitis in young women.
3. A 67-year-old man with COPD presents with worsening dyspnea and
purulent sputum. Which organism is most commonly implicated?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae
D. Klebsiella pneumoniae
Haemophilus influenzae is a frequent cause of acute exacerbations of
COPD.
4. A newborn fails to pass meconium within 48 hours and has abdominal
distension. What is the most likely diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Intussusception
D. Necrotizing enterocolitis
Hirschsprung disease results from absence of ganglion cells in the
distal colon, causing functional obstruction.
5. A 32-year-old woman presents with episodic palpitations, headache,
and sweating. Which lab finding is expected?
A. Low serum cortisol
B. Elevated urinary metanephrines
C. Low TSH
D. Elevated calcium
Pheochromocytoma produces excess catecholamines, leading to
elevated metanephrines in urine.
6. A patient presents with cirrhosis and ascites. Which diuretic is first-line
for ascites management?
A. Furosemide
, B. Spironolactone
C. Hydrochlorothiazide
D. Mannitol
Spironolactone antagonizes aldosterone, which is elevated in
cirrhosis-related ascites.
7. A 5-year-old child presents with parvovirus B19 infection. What
complication is most concerning in sickle cell disease?
A. Hemolytic crisis
B. Aplastic crisis
C. Splenic sequestration
D. Stroke
Parvovirus B19 suppresses erythropoiesis, causing aplastic crisis in
sickle cell patients.
8. A patient presents with painless hematuria and a smoking history.
What is the most likely diagnosis?
A. Renal cell carcinoma
B. Bladder transitional cell carcinoma
C. Prostate cancer
D. Wilms tumor
Bladder cancer commonly presents with painless gross hematuria,
especially in smokers.
9. A woman presents with tremor, weight loss, and heat intolerance. Labs
show low TSH and high T4. Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Graves disease is an autoimmune hyperthyroidism characterized by
low TSH and elevated T4.
Questions And Correct
Answers (Verified Answers) Plus
Rationale 2026 Q&A| Instant Download
1. A 54-year-old man presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG shows ST elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
This presentation indicates an inferior myocardial infarction, most
commonly due to occlusion of the right coronary artery supplying the
inferior wall of the heart.
2. A 23-year-old woman presents with fever, dysuria, and flank pain.
Urinalysis shows leukocyte esterase and nitrites. What is the most
likely organism?
A. Staphylococcus saprophyticus
B. Escherichia coli
C. Proteus mirabilis
D. Enterococcus faecalis
, Escherichia coli is the most common cause of acute uncomplicated
pyelonephritis and cystitis in young women.
3. A 67-year-old man with COPD presents with worsening dyspnea and
purulent sputum. Which organism is most commonly implicated?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae
D. Klebsiella pneumoniae
Haemophilus influenzae is a frequent cause of acute exacerbations of
COPD.
4. A newborn fails to pass meconium within 48 hours and has abdominal
distension. What is the most likely diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Intussusception
D. Necrotizing enterocolitis
Hirschsprung disease results from absence of ganglion cells in the
distal colon, causing functional obstruction.
5. A 32-year-old woman presents with episodic palpitations, headache,
and sweating. Which lab finding is expected?
A. Low serum cortisol
B. Elevated urinary metanephrines
C. Low TSH
D. Elevated calcium
Pheochromocytoma produces excess catecholamines, leading to
elevated metanephrines in urine.
6. A patient presents with cirrhosis and ascites. Which diuretic is first-line
for ascites management?
A. Furosemide
, B. Spironolactone
C. Hydrochlorothiazide
D. Mannitol
Spironolactone antagonizes aldosterone, which is elevated in
cirrhosis-related ascites.
7. A 5-year-old child presents with parvovirus B19 infection. What
complication is most concerning in sickle cell disease?
A. Hemolytic crisis
B. Aplastic crisis
C. Splenic sequestration
D. Stroke
Parvovirus B19 suppresses erythropoiesis, causing aplastic crisis in
sickle cell patients.
8. A patient presents with painless hematuria and a smoking history.
What is the most likely diagnosis?
A. Renal cell carcinoma
B. Bladder transitional cell carcinoma
C. Prostate cancer
D. Wilms tumor
Bladder cancer commonly presents with painless gross hematuria,
especially in smokers.
9. A woman presents with tremor, weight loss, and heat intolerance. Labs
show low TSH and high T4. Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Graves disease is an autoimmune hyperthyroidism characterized by
low TSH and elevated T4.
