UWORLD STEP 2 CK| FROM QUESTION TO PERFECTION|
STUDY WITH CONFIDENCE!
Course Code:
Course Title: UWORLD STEP 2CK
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,Congenital dermal melocytosis, benign, flat blue-grey patches on the lower back and buttocks
that is common in African, Asian, Hispanic, and Native American ethnicity. Answer:
Mongolian spots -> usually fade spontaneously
-> document these as they can be mistaken for bruises
What is the most common cause of acute, unilateral lymphadenitis in children? Answer: Staph
aureus followed by group A strep
Pts w/ bacterial lymphadenitis usually < 5 y/o and nontoxic, tender lymph node, warm,
erythematous, 3-6 cm in size Unilateral acute cervical lymphadenitis
All sexually active women < 24 should undergo which screening? Answer: Chlamydia
trachomatis and Neisseria gonorrhoea
-> recommended for any person with new partner in past 2 mo., multiple partners, history STI,
illicit drug use, incarceration, contact with sex workers
-> cervicitis asymptomatic often can lead to PID -> infertility, ectopic pregnancy, chronic pelvic
pain
Best screening test for Chlamydia trachomatis and Neisseria gonorrhoeae by? Answer: Nucleic
acid amplification testing which has high sensitivity and specificity
-> can be done urine, endocervical, vaginal, or urethral specimens
Can sit momentarily on propped hands, transfer objects from hand to hand, and respond to
name. Stranger anxiety develops at this age. Answer: healthy 6 mo. old
Pts with Sickle cell anemia suffer from chronic extravascular and intravascular hemolysis.
Characteristic lab findings include? Answer: Mild to moderate anemia w/ reticulocytosis +
unconjugated hyperbilirubinemia, INC lactate dehydrogenase, low to absent serum haptoglobin
-> Acute worsening of anemia can occur from splenic sequestration with manifests as
splenomegaly and INC fatigue
___ are the antibiotics of choice for pertussis treatment and post-exposure prophylaxis. All close
contacts should be given this antibiotic regardless of age, immunization status or symptoms.
Answer: Macrolides
Age < 1 mo. = Azithromycin 5 days
Age > 1 mo. = Azithromycin x 5 days/Clarithromycin x 7 days/ Erythromycin x 14 days
Lethargy, fever, poor oral intake, vomiting presentation, nuchal rigidity of bacterial meningitis
in infant what should be performed next? Answer: Lumbar puncture before antibiotics
Infants critically ill (status epilepticus, septic shock) antibiotics before lumbar puncture
Head CT -> comatose infants
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,Indications for imaging prior to LP for bacterial meningitis suspected in children > 1 mo.
Answer: Hx hydrocephalus or neurosurgical procedure
Hx head trauma
Coma or focal neuro findings
Tx Bacterial meningitis in children age > 1 mo. Answer: IV Vanco & Ceftriaxone
OR
Cefotaxime
Dexamethasone for H. influenzae type b meningitis
Fever, toxicity, gray-white pharyngitis, sandpaper-like rash, circumoral pallor. Answer: Scarlet
fever -> strawberry tongue
Group A strep erythrogenic exotoxin
tx: Penicillin V
What is herpangina? Answer: Throat infection caused by enteroviruses such as Cox A, high
fever, sore throat complete inability to swallow, ulcerative lesions palate, tonsils, pharynx
palms and sole rash, hand-foot-mouth disease
The most important risk factors for respiratory distress syndrome (RDS) is? Answer:
Prematurity
-> male sex, prenatal asphyxia, maternal diabetes, cesarean section
Maternal diabetes -> INC incidence by delaying maturation of pulmonary surfactant production
(high levels insulin in fetus inhibits cortisol and blocks maturation sphingomyelin)
Tx RDS Answer: Antenatal prevention w/ corticosteroids and postnatal tx w/ exogenous
surfactant
Space occupying lesion in the parietal lobe in a child what is the most common tumor type?
Answer: CNS tumors most common solid tumors => Astrocytoma most common supratentorial
and infratentorial groups
In pediatric population, infratentorial tumors are more common than supratentorial tumors,
benign astrocytomas are the most common histo type
Define primary amenorrhea. Answer: Absence of menarche by age 15
What is the first step in the evaluation of primary amenorrhea? Answer: Pelvic exam determine
ovaries, uterus, and vagina are present or absent
US is preferred imaging modality to evaluate anatomy of repro tract
What does US show for Turner syndrome? Answer: One of the most common causes of
primary amenorrhea
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, -> primary ovarian failure gonadal dysgenesis followed by early menopause and infertility ->
pelvic US show an infantile uterus and "streak ovaries"
True/False: Human milk protein absorbs better and improves gastric emptying. Answer: TRUE
- ideal form of nutrition for term infants until 6 mo. age the major protein source is whey, which
is more easily digested than casein and helps to improve gastric empty
Polyhydramnios fetus, excessive drooling as well as chocking, coughing and regurgitation with
initial feeding attempts seen immediately after birth. Enteric tube in the proximal esophagus on
X-ray. Dx. Answer: Esophageal atresia + tranesophageal fistula
-> gastric fluid can relaxes into the distal esophagus through the fistula and into the trachea and
lungs, causing aspiration pneumonia
Obese child 10-16 years common disorder hip overweight adolescents. Urgent surgical fixation
is required to prevent avascular necrosis of the hip.
Hip held passive external rotation and DEC internal rotation. Dx AP + flog-leg X-ray. Answer:
Slipped capital femoral epiphysis -> displacement of capital femoral epiphysis from femoral
neck
Risk: endocrinopathies (hypothyroidism, GH deficiency), renal failure, radiation history
X-linked disorder characterized by the triad of thrombocytopenia, eczema, and recurrent
bacterial infections. Thrombocytopenia is caused by DEC platelet production and few platelets
that exist are typically quite small. Answer: Wiskott-Aldrich syndrome (WAS)
- infection due to step. pneumoniae, n. meningitidis, and h. influezae
thrombocytopenia -> minor petechiae or purpura to life-threatening bleeding such intracranial
hemorrhage, hematemesis or hematochezia
Fever, exudative pharyngitis, tender anterior cervical lymphadenopathy. Group A streptococcus
is suspected. Tonsillar erythema is present, abrupt onset sore throat in child 5-15 with poor oral
intake and malaise.
What is the gold standard dx and tx? Answer: Throat culture + empiric Penicillin
Penicillin antibiotic of choice for confirmed or highly suspected step pharyngitis as it hastens
recovery, prevents transmission, and reduces risk RF
What is the most common cause of urinary tract obstruction in a newborn? Answer: Posterior
urethral valves
- progressive dilation of bladder, ureters, kidneys
- US shows bladder distention, B/L hydroureters, B/L hydronephrosis
Dx: Premature adrenarche/pubarche, severe cystic acne resistant to tx, accelerate linear growth,
advanced bone age, normal electrolytes. Normal testicular volume for age. LH levels low at
baseline and do not increase after stimulation w/ GnRH agonist. Answer: Gonadotropin-
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
STUDY WITH CONFIDENCE!
Course Code:
Course Title: UWORLD STEP 2CK
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,Congenital dermal melocytosis, benign, flat blue-grey patches on the lower back and buttocks
that is common in African, Asian, Hispanic, and Native American ethnicity. Answer:
Mongolian spots -> usually fade spontaneously
-> document these as they can be mistaken for bruises
What is the most common cause of acute, unilateral lymphadenitis in children? Answer: Staph
aureus followed by group A strep
Pts w/ bacterial lymphadenitis usually < 5 y/o and nontoxic, tender lymph node, warm,
erythematous, 3-6 cm in size Unilateral acute cervical lymphadenitis
All sexually active women < 24 should undergo which screening? Answer: Chlamydia
trachomatis and Neisseria gonorrhoea
-> recommended for any person with new partner in past 2 mo., multiple partners, history STI,
illicit drug use, incarceration, contact with sex workers
-> cervicitis asymptomatic often can lead to PID -> infertility, ectopic pregnancy, chronic pelvic
pain
Best screening test for Chlamydia trachomatis and Neisseria gonorrhoeae by? Answer: Nucleic
acid amplification testing which has high sensitivity and specificity
-> can be done urine, endocervical, vaginal, or urethral specimens
Can sit momentarily on propped hands, transfer objects from hand to hand, and respond to
name. Stranger anxiety develops at this age. Answer: healthy 6 mo. old
Pts with Sickle cell anemia suffer from chronic extravascular and intravascular hemolysis.
Characteristic lab findings include? Answer: Mild to moderate anemia w/ reticulocytosis +
unconjugated hyperbilirubinemia, INC lactate dehydrogenase, low to absent serum haptoglobin
-> Acute worsening of anemia can occur from splenic sequestration with manifests as
splenomegaly and INC fatigue
___ are the antibiotics of choice for pertussis treatment and post-exposure prophylaxis. All close
contacts should be given this antibiotic regardless of age, immunization status or symptoms.
Answer: Macrolides
Age < 1 mo. = Azithromycin 5 days
Age > 1 mo. = Azithromycin x 5 days/Clarithromycin x 7 days/ Erythromycin x 14 days
Lethargy, fever, poor oral intake, vomiting presentation, nuchal rigidity of bacterial meningitis
in infant what should be performed next? Answer: Lumbar puncture before antibiotics
Infants critically ill (status epilepticus, septic shock) antibiotics before lumbar puncture
Head CT -> comatose infants
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,Indications for imaging prior to LP for bacterial meningitis suspected in children > 1 mo.
Answer: Hx hydrocephalus or neurosurgical procedure
Hx head trauma
Coma or focal neuro findings
Tx Bacterial meningitis in children age > 1 mo. Answer: IV Vanco & Ceftriaxone
OR
Cefotaxime
Dexamethasone for H. influenzae type b meningitis
Fever, toxicity, gray-white pharyngitis, sandpaper-like rash, circumoral pallor. Answer: Scarlet
fever -> strawberry tongue
Group A strep erythrogenic exotoxin
tx: Penicillin V
What is herpangina? Answer: Throat infection caused by enteroviruses such as Cox A, high
fever, sore throat complete inability to swallow, ulcerative lesions palate, tonsils, pharynx
palms and sole rash, hand-foot-mouth disease
The most important risk factors for respiratory distress syndrome (RDS) is? Answer:
Prematurity
-> male sex, prenatal asphyxia, maternal diabetes, cesarean section
Maternal diabetes -> INC incidence by delaying maturation of pulmonary surfactant production
(high levels insulin in fetus inhibits cortisol and blocks maturation sphingomyelin)
Tx RDS Answer: Antenatal prevention w/ corticosteroids and postnatal tx w/ exogenous
surfactant
Space occupying lesion in the parietal lobe in a child what is the most common tumor type?
Answer: CNS tumors most common solid tumors => Astrocytoma most common supratentorial
and infratentorial groups
In pediatric population, infratentorial tumors are more common than supratentorial tumors,
benign astrocytomas are the most common histo type
Define primary amenorrhea. Answer: Absence of menarche by age 15
What is the first step in the evaluation of primary amenorrhea? Answer: Pelvic exam determine
ovaries, uterus, and vagina are present or absent
US is preferred imaging modality to evaluate anatomy of repro tract
What does US show for Turner syndrome? Answer: One of the most common causes of
primary amenorrhea
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, -> primary ovarian failure gonadal dysgenesis followed by early menopause and infertility ->
pelvic US show an infantile uterus and "streak ovaries"
True/False: Human milk protein absorbs better and improves gastric emptying. Answer: TRUE
- ideal form of nutrition for term infants until 6 mo. age the major protein source is whey, which
is more easily digested than casein and helps to improve gastric empty
Polyhydramnios fetus, excessive drooling as well as chocking, coughing and regurgitation with
initial feeding attempts seen immediately after birth. Enteric tube in the proximal esophagus on
X-ray. Dx. Answer: Esophageal atresia + tranesophageal fistula
-> gastric fluid can relaxes into the distal esophagus through the fistula and into the trachea and
lungs, causing aspiration pneumonia
Obese child 10-16 years common disorder hip overweight adolescents. Urgent surgical fixation
is required to prevent avascular necrosis of the hip.
Hip held passive external rotation and DEC internal rotation. Dx AP + flog-leg X-ray. Answer:
Slipped capital femoral epiphysis -> displacement of capital femoral epiphysis from femoral
neck
Risk: endocrinopathies (hypothyroidism, GH deficiency), renal failure, radiation history
X-linked disorder characterized by the triad of thrombocytopenia, eczema, and recurrent
bacterial infections. Thrombocytopenia is caused by DEC platelet production and few platelets
that exist are typically quite small. Answer: Wiskott-Aldrich syndrome (WAS)
- infection due to step. pneumoniae, n. meningitidis, and h. influezae
thrombocytopenia -> minor petechiae or purpura to life-threatening bleeding such intracranial
hemorrhage, hematemesis or hematochezia
Fever, exudative pharyngitis, tender anterior cervical lymphadenopathy. Group A streptococcus
is suspected. Tonsillar erythema is present, abrupt onset sore throat in child 5-15 with poor oral
intake and malaise.
What is the gold standard dx and tx? Answer: Throat culture + empiric Penicillin
Penicillin antibiotic of choice for confirmed or highly suspected step pharyngitis as it hastens
recovery, prevents transmission, and reduces risk RF
What is the most common cause of urinary tract obstruction in a newborn? Answer: Posterior
urethral valves
- progressive dilation of bladder, ureters, kidneys
- US shows bladder distention, B/L hydroureters, B/L hydronephrosis
Dx: Premature adrenarche/pubarche, severe cystic acne resistant to tx, accelerate linear growth,
advanced bone age, normal electrolytes. Normal testicular volume for age. LH levels low at
baseline and do not increase after stimulation w/ GnRH agonist. Answer: Gonadotropin-
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
