USMLE 2026/2027 Step 2 CK Complete StudyGuide with Verified
Questions, Correct Answers, and Detailed Explanations for
Students||Already Graded A+
1. A 65-year-old man presents with progressive shortness of breath and
lower extremity edema. Exam reveals jugular venous distension and an
S3 heart sound. Echocardiogram shows reduced ejection fraction. Which
is the first-line therapy?
A) Digoxin
B) ACE inhibitor
C) Calcium channel blocker
D) Beta-blocker
ACE inhibitors reduce morbidity and mortality in heart failure with reduced
ejection fraction by decreasing afterload and preventing cardiac remodeling.
2. A 24-year-old woman presents with fatigue, pallor, and spoon-shaped
nails. Labs show microcytic hypochromic anemia. What is the most likely
cause?
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folate deficiency
D) Hemolytic anemia
Iron deficiency is the most common cause of microcytic anemia, often due to
chronic blood loss or dietary insufficiency.
3. A 35-year-old woman presents with heat intolerance, weight loss, and
palpitations. Exam shows a diffusely enlarged thyroid and tremor. Which
antibody is most likely elevated?
A) Anti-thyroid peroxidase
, B) Anti-thyroglobulin
C) TSI (thyroid-stimulating immunoglobulin)
D) Anti-mitochondrial
TSI antibodies are characteristic of Graves’ disease, which causes
hyperthyroidism with diffuse goiter and ophthalmopathy.
4. A 70-year-old man with chronic kidney disease develops hyperkalemia
(K+ 6.5 mEq/L) and peaked T waves on ECG. What is the immediate
management?
A) Furosemide
B) IV calcium gluconate
C) Sodium bicarbonate orally
D) Hemodialysis tomorrow
IV calcium stabilizes the cardiac membrane and prevents arrhythmias; other
measures lower potassium but do not act immediately.
5. A 4-year-old boy presents with a barking cough, inspiratory stridor, and
low-grade fever. Which is the most likely pathogen?
A) Streptococcus pneumoniae
B) Parainfluenza virus
C) Haemophilus influenzae type B
D) Mycoplasma pneumoniae
Croup is most commonly caused by parainfluenza virus, presenting with a
barking cough and stridor.
6. A 55-year-old man presents with painless jaundice and weight loss. Labs
show elevated direct bilirubin and CA 19-9. Imaging reveals a mass at
the head of the pancreas. What is the most likely diagnosis?
A) Hepatocellular carcinoma
B) Pancreatic adenocarcinoma
C) Gallbladder carcinoma
D) Cholangiocarcinoma
Pancreatic adenocarcinoma often presents with painless jaundice due to
obstruction of the common bile duct, especially when located in the
pancreatic head.
7. A 28-year-old man presents with acute onset of right eye pain, redness,
and halos around lights. Intraocular pressure is 45 mmHg. What is the
, most likely diagnosis?
A) Conjunctivitis
B) Acute angle-closure glaucoma
C) Uveitis
D) Retinal detachment
Acute angle-closure glaucoma presents with sudden eye pain, halos, and
elevated intraocular pressure requiring urgent treatment to prevent vision
loss.
8. A 45-year-old woman presents with fatigue, constipation, and weight
gain. Exam shows dry skin and bradycardia. Labs reveal elevated TSH and
low free T4. Which is the most likely cause?
A) Graves disease
B) Subacute thyroiditis
C) Hashimoto thyroiditis
D) Iodine-induced hyperthyroidism
Hashimoto thyroiditis is an autoimmune hypothyroidism characterized by
elevated TSH, low T4, and positive anti-thyroid peroxidase antibodies.
9. A 30-year-old man presents with hematuria, flank pain, and a palpable
abdominal mass. Ultrasound shows a solid renal mass. What is the most
likely diagnosis?
A) Transitional cell carcinoma
B) Renal cell carcinoma
C) Wilms tumor
D) Oncocytoma
Renal cell carcinoma typically presents in adults with hematuria, flank pain,
and a palpable mass; classic triad is often incomplete.
10. A 60-year-old man presents with sudden-onset severe chest pain
radiating to the back. BP is 180/100 mmHg. Chest X-ray shows widened
mediastinum. What is the most appropriate next step?
A) ECG
B) CT angiography of the chest
C) Troponin levels
D) Echocardiogram
Questions, Correct Answers, and Detailed Explanations for
Students||Already Graded A+
1. A 65-year-old man presents with progressive shortness of breath and
lower extremity edema. Exam reveals jugular venous distension and an
S3 heart sound. Echocardiogram shows reduced ejection fraction. Which
is the first-line therapy?
A) Digoxin
B) ACE inhibitor
C) Calcium channel blocker
D) Beta-blocker
ACE inhibitors reduce morbidity and mortality in heart failure with reduced
ejection fraction by decreasing afterload and preventing cardiac remodeling.
2. A 24-year-old woman presents with fatigue, pallor, and spoon-shaped
nails. Labs show microcytic hypochromic anemia. What is the most likely
cause?
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folate deficiency
D) Hemolytic anemia
Iron deficiency is the most common cause of microcytic anemia, often due to
chronic blood loss or dietary insufficiency.
3. A 35-year-old woman presents with heat intolerance, weight loss, and
palpitations. Exam shows a diffusely enlarged thyroid and tremor. Which
antibody is most likely elevated?
A) Anti-thyroid peroxidase
, B) Anti-thyroglobulin
C) TSI (thyroid-stimulating immunoglobulin)
D) Anti-mitochondrial
TSI antibodies are characteristic of Graves’ disease, which causes
hyperthyroidism with diffuse goiter and ophthalmopathy.
4. A 70-year-old man with chronic kidney disease develops hyperkalemia
(K+ 6.5 mEq/L) and peaked T waves on ECG. What is the immediate
management?
A) Furosemide
B) IV calcium gluconate
C) Sodium bicarbonate orally
D) Hemodialysis tomorrow
IV calcium stabilizes the cardiac membrane and prevents arrhythmias; other
measures lower potassium but do not act immediately.
5. A 4-year-old boy presents with a barking cough, inspiratory stridor, and
low-grade fever. Which is the most likely pathogen?
A) Streptococcus pneumoniae
B) Parainfluenza virus
C) Haemophilus influenzae type B
D) Mycoplasma pneumoniae
Croup is most commonly caused by parainfluenza virus, presenting with a
barking cough and stridor.
6. A 55-year-old man presents with painless jaundice and weight loss. Labs
show elevated direct bilirubin and CA 19-9. Imaging reveals a mass at
the head of the pancreas. What is the most likely diagnosis?
A) Hepatocellular carcinoma
B) Pancreatic adenocarcinoma
C) Gallbladder carcinoma
D) Cholangiocarcinoma
Pancreatic adenocarcinoma often presents with painless jaundice due to
obstruction of the common bile duct, especially when located in the
pancreatic head.
7. A 28-year-old man presents with acute onset of right eye pain, redness,
and halos around lights. Intraocular pressure is 45 mmHg. What is the
, most likely diagnosis?
A) Conjunctivitis
B) Acute angle-closure glaucoma
C) Uveitis
D) Retinal detachment
Acute angle-closure glaucoma presents with sudden eye pain, halos, and
elevated intraocular pressure requiring urgent treatment to prevent vision
loss.
8. A 45-year-old woman presents with fatigue, constipation, and weight
gain. Exam shows dry skin and bradycardia. Labs reveal elevated TSH and
low free T4. Which is the most likely cause?
A) Graves disease
B) Subacute thyroiditis
C) Hashimoto thyroiditis
D) Iodine-induced hyperthyroidism
Hashimoto thyroiditis is an autoimmune hypothyroidism characterized by
elevated TSH, low T4, and positive anti-thyroid peroxidase antibodies.
9. A 30-year-old man presents with hematuria, flank pain, and a palpable
abdominal mass. Ultrasound shows a solid renal mass. What is the most
likely diagnosis?
A) Transitional cell carcinoma
B) Renal cell carcinoma
C) Wilms tumor
D) Oncocytoma
Renal cell carcinoma typically presents in adults with hematuria, flank pain,
and a palpable mass; classic triad is often incomplete.
10. A 60-year-old man presents with sudden-onset severe chest pain
radiating to the back. BP is 180/100 mmHg. Chest X-ray shows widened
mediastinum. What is the most appropriate next step?
A) ECG
B) CT angiography of the chest
C) Troponin levels
D) Echocardiogram
