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USMLE Step 2 CK – High-Yield Clinical Practice Test (2026 | 2027 Style) Questions and
Answers with Rationales | Updated | 100% Correct
Domain 1: Internal Medicine – Cardiology
1. A 62-year-old male with a history of hypertension and diabetes presents to
the emergency department with acute onset of severe, crushing chest pain
radiating to his left arm. He is diaphoretic and nauseous. His blood pressure is
150/90 mmHg, heart rate is 110 bpm. An ECG shows ST-segment elevation in
leads V1-V4. What is the most appropriate immediate management?
A) Administer sublingual nitroglycerin and aspirin, and prepare for emergent
percutaneous coronary intervention (PCI) or thrombolysis.
B) Administer oral beta-blockers and discharge home.
C) Administer a calcium channel blocker and schedule an outpatient stress test.
D) Administer a diuretic and monitor for fluid overload.
Answer: A
Rationale: The patient is presenting with an acute ST-elevation myocardial
infarction (STEMI). Immediate management
includes: aspirin (antiplatelet), nitroglycerin (vasodilation), and reperfusion
therapy (PCI or thrombolytics) within the 90-minute window.
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2. A 70-year-old male with a history of heart failure presents with worsening
shortness of breath, orthopnea, and 2+ pitting edema in the lower extremities.
He has crackles in the lung bases. His blood pressure is 160/95 mmHg. Which of
the following is the most appropriate initial pharmacologic therapy?
A) An ACE inhibitor and a loop diuretic (e.g., lisinopril and furosemide).
B) A beta-blocker only.
C) A calcium channel blocker only.
D) An aldosterone antagonist only.
Answer: A
Rationale: The patient is experiencing an acute exacerbation of heart failure with
fluid overload. First-line therapy includes a loop diuretic (to relieve fluid overload)
and an ACE inhibitor (to reduce afterload and prevent further progression).
3. A 55-year-old male presents with a 3-week history of intermittent, substernal
chest pain that is relieved by rest. He reports that the pain occurs after climbing
stairs or carrying heavy groceries. His ECG is normal. What is the most likely
diagnosis?
A) Stable angina
B) Unstable angina
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C) Acute MI
D) Aortic dissection
Answer: A
Rationale: Stable angina is characterized by exertional chest pain that is relieved
by rest. The ECG is typically normal at rest. Management includes antiplatelet
therapy (aspirin), statins, and lifestyle modifications.
4. A 75-year-old female with a history of hypertension is found to have a blood
pressure of 155/92 mmHg on three separate visits. According to JNC 8
guidelines, what is the target blood pressure for this patient?
A) < 140/90 mmHg
B) < 150/90 mmHg (JNC 8 target for patients ≥ 60 years old)
C) < 130/80 mmHg
D) < 120/80 mmHg
Answer: B
Rationale: According to the JNC 8 guidelines, the target blood pressure for patients
aged 60 and older is < 150/90 mmHg.
Domain 2: Internal Medicine – Pulmonology
USMLE Step 2 CK – High-Yield Clinical Practice Test (2026 | 2027 Style) Questions and
Answers with Rationales | Updated | 100% Correct
Domain 1: Internal Medicine – Cardiology
1. A 62-year-old male with a history of hypertension and diabetes presents to
the emergency department with acute onset of severe, crushing chest pain
radiating to his left arm. He is diaphoretic and nauseous. His blood pressure is
150/90 mmHg, heart rate is 110 bpm. An ECG shows ST-segment elevation in
leads V1-V4. What is the most appropriate immediate management?
A) Administer sublingual nitroglycerin and aspirin, and prepare for emergent
percutaneous coronary intervention (PCI) or thrombolysis.
B) Administer oral beta-blockers and discharge home.
C) Administer a calcium channel blocker and schedule an outpatient stress test.
D) Administer a diuretic and monitor for fluid overload.
Answer: A
Rationale: The patient is presenting with an acute ST-elevation myocardial
infarction (STEMI). Immediate management
includes: aspirin (antiplatelet), nitroglycerin (vasodilation), and reperfusion
therapy (PCI or thrombolytics) within the 90-minute window.
, Page |2
2. A 70-year-old male with a history of heart failure presents with worsening
shortness of breath, orthopnea, and 2+ pitting edema in the lower extremities.
He has crackles in the lung bases. His blood pressure is 160/95 mmHg. Which of
the following is the most appropriate initial pharmacologic therapy?
A) An ACE inhibitor and a loop diuretic (e.g., lisinopril and furosemide).
B) A beta-blocker only.
C) A calcium channel blocker only.
D) An aldosterone antagonist only.
Answer: A
Rationale: The patient is experiencing an acute exacerbation of heart failure with
fluid overload. First-line therapy includes a loop diuretic (to relieve fluid overload)
and an ACE inhibitor (to reduce afterload and prevent further progression).
3. A 55-year-old male presents with a 3-week history of intermittent, substernal
chest pain that is relieved by rest. He reports that the pain occurs after climbing
stairs or carrying heavy groceries. His ECG is normal. What is the most likely
diagnosis?
A) Stable angina
B) Unstable angina
, Page |3
C) Acute MI
D) Aortic dissection
Answer: A
Rationale: Stable angina is characterized by exertional chest pain that is relieved
by rest. The ECG is typically normal at rest. Management includes antiplatelet
therapy (aspirin), statins, and lifestyle modifications.
4. A 75-year-old female with a history of hypertension is found to have a blood
pressure of 155/92 mmHg on three separate visits. According to JNC 8
guidelines, what is the target blood pressure for this patient?
A) < 140/90 mmHg
B) < 150/90 mmHg (JNC 8 target for patients ≥ 60 years old)
C) < 130/80 mmHg
D) < 120/80 mmHg
Answer: B
Rationale: According to the JNC 8 guidelines, the target blood pressure for patients
aged 60 and older is < 150/90 mmHg.
Domain 2: Internal Medicine – Pulmonology
