USMLE Step 2 CK: ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS
| UPDATED PER LATEST GUIDELINES |
GRADED A+
Core Clinical Specialties (Internal Medicine, Surgery, Pediatrics)
Question 1.
A 65-year-old man with a history of hypertension and type 2 diabetes presents to the
emergency department with acute onset of severe, substernal chest pain that radiates to his left
arm. He is diaphoretic and nauseated. An ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate management?
A) Aspirin and sublingual nitroglycerin
B) Percutaneous coronary intervention (PCI)
C) Thrombolytic therapy
D) Oxygen and morphine
Answer: B) Percutaneous coronary intervention (PCI)
Rationale: This is an anteroseptal ST-elevation myocardial infarction (STEMI). The gold-standard
treatment is emergent PCI to reperfuse the occluded artery. PCI is preferred over thrombolytics
if it can be performed within 90 minutes of arrival. Aspirin and nitroglycerin are important initial
steps but are not definitive.
Question 2.
A 55-year-old woman presents to her primary care physician with progressive dyspnea on
,exertion, orthopnea, and bilateral lower extremity edema. Physical examination reveals an S3
gallop and crackles at the lung bases. Which of the following findings is most consistent with
heart failure with reduced ejection fraction (HFrEF)?
A) Ejection fraction of 45%
B) Ejection fraction of 30%
C) Ejection fraction of 55%
D) Ejection fraction of 60%
Answer: B) Ejection fraction of 30%
Rationale: Heart failure with reduced ejection fraction (HFrEF) is defined as an ejection fraction
(EF) of ≤40%. The patient's symptoms of dyspnea, orthopnea, edema, and an S3 gallop are
classic for HFrEF. An EF of 55% or higher would be considered normal or heart failure with
preserved ejection fraction (HFpEF).
Question 3.
A 45-year-old man with a history of chronic alcohol use presents with jaundice, ascites, and
confusion. On physical exam, he has a flapping tremor of his hands. This tremor is best
described as:
A) Intention tremor
B) Resting tremor
C) Asterixis
D) Essential tremor
Answer: C) Asterixis
Rationale: The patient is presenting with hepatic encephalopathy secondary to cirrhosis.
Asterixis (a flapping tremor) is a classic sign of hepatic encephalopathy. It is caused by the
accumulation of ammonia and other neurotoxins in the brain due to decreased hepatic
clearance. This is a key high-yield association for Step 2 CK.
Question 4.
A 32-year-old woman with no significant medical history presents with a painless lump in her
right breast. On examination, the mass is firm, mobile, and well-circumscribed. Which of the
following is the most appropriate next step in management?
A) Ultrasound of the breast
B) Mammogram
,C) Fine-needle aspiration
D) Excisional biopsy
Answer: A) Ultrasound of the breast
Rationale: In a young patient (<40 years old), ultrasound is the initial imaging modality of choice
for a palpable breast mass. If the ultrasound shows a simple cyst or a benign-appearing
fibroadenoma, further intervention may not be needed. A mammogram is typically reserved for
patients over 40.
Question 5.
A 70-year-old man with a 40-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. A chest X-ray reveals a 4 cm mass in the right upper lobe. Which of
the following is the most likely diagnosis?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Small cell lung cancer
D) Carcinoid tumor
Answer: A) Squamous cell carcinoma
Rationale: While all types of lung cancer can present with these symptoms, squamous cell
carcinoma is the most strongly associated with smoking, often presents centrally, and is known
to cause hemoptysis. Small cell lung cancer is also strongly linked to smoking but is often more
aggressive. Adenocarcinoma is more common in non-smokers.
Question 6.
A 28-year-old woman with a history of systemic lupus erythematosus (SLE) presents with
pleuritic chest pain and shortness of breath. A CT angiography of the chest is negative for
pulmonary embolism but shows a small pleural effusion. Which of the following is the most
likely cause of her symptoms?
A) Lupus pneumonitis
B) Pleuritis
C) Pulmonary fibrosis
D) Pneumonia
Answer: B) Pleuritis
, Rationale: Pleuritis is a common manifestation of SLE and is a frequent cause of pleuritic chest
pain in these patients. The presence of a small pleural effusion without other signs of infection
or pulmonary embolism points toward serositis, which is a hallmark of SLE.
Question 7.
A 65-year-old woman with a history of osteoarthritis presents with pain and swelling in her right
knee. She reports no fever or chills. Joint aspiration reveals thin, yellow fluid with normal
viscosity. Which of the following is the most likely diagnosis?
A) Septic arthritis
B) Gout
C) Osteoarthritis
D) Rheumatoid arthritis
Answer: C) Osteoarthritis
Rationale: The presence of thin, yellow fluid with normal viscosity is characteristic of a non-
inflammatory joint effusion, which is consistent with osteoarthritis. The lack of fever also
supports this diagnosis. Gout would show urate crystals. Rheumatoid arthritis would show an
inflammatory effusion with high white blood cell count.
Question 8.
A 60-year-old man with a history of benign prostatic hyperplasia (BPH) presents with acute
urinary retention. He is unable to void and has severe suprapubic pain. Which of the following is
the most appropriate initial management?
A) Alpha-blocker
B) 5-alpha-reductase inhibitor
C) Foley catheter placement
D) Surgical resection
Answer: C) Foley catheter placement
Rationale: Acute urinary retention is a medical emergency. The most appropriate initial
management is to decompress the bladder by placing a Foley catheter. This will relieve the
patient's pain and prevent further complications. Alpha-blockers can be started later to help
with voiding but are not the immediate treatment.
QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS
| UPDATED PER LATEST GUIDELINES |
GRADED A+
Core Clinical Specialties (Internal Medicine, Surgery, Pediatrics)
Question 1.
A 65-year-old man with a history of hypertension and type 2 diabetes presents to the
emergency department with acute onset of severe, substernal chest pain that radiates to his left
arm. He is diaphoretic and nauseated. An ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate management?
A) Aspirin and sublingual nitroglycerin
B) Percutaneous coronary intervention (PCI)
C) Thrombolytic therapy
D) Oxygen and morphine
Answer: B) Percutaneous coronary intervention (PCI)
Rationale: This is an anteroseptal ST-elevation myocardial infarction (STEMI). The gold-standard
treatment is emergent PCI to reperfuse the occluded artery. PCI is preferred over thrombolytics
if it can be performed within 90 minutes of arrival. Aspirin and nitroglycerin are important initial
steps but are not definitive.
Question 2.
A 55-year-old woman presents to her primary care physician with progressive dyspnea on
,exertion, orthopnea, and bilateral lower extremity edema. Physical examination reveals an S3
gallop and crackles at the lung bases. Which of the following findings is most consistent with
heart failure with reduced ejection fraction (HFrEF)?
A) Ejection fraction of 45%
B) Ejection fraction of 30%
C) Ejection fraction of 55%
D) Ejection fraction of 60%
Answer: B) Ejection fraction of 30%
Rationale: Heart failure with reduced ejection fraction (HFrEF) is defined as an ejection fraction
(EF) of ≤40%. The patient's symptoms of dyspnea, orthopnea, edema, and an S3 gallop are
classic for HFrEF. An EF of 55% or higher would be considered normal or heart failure with
preserved ejection fraction (HFpEF).
Question 3.
A 45-year-old man with a history of chronic alcohol use presents with jaundice, ascites, and
confusion. On physical exam, he has a flapping tremor of his hands. This tremor is best
described as:
A) Intention tremor
B) Resting tremor
C) Asterixis
D) Essential tremor
Answer: C) Asterixis
Rationale: The patient is presenting with hepatic encephalopathy secondary to cirrhosis.
Asterixis (a flapping tremor) is a classic sign of hepatic encephalopathy. It is caused by the
accumulation of ammonia and other neurotoxins in the brain due to decreased hepatic
clearance. This is a key high-yield association for Step 2 CK.
Question 4.
A 32-year-old woman with no significant medical history presents with a painless lump in her
right breast. On examination, the mass is firm, mobile, and well-circumscribed. Which of the
following is the most appropriate next step in management?
A) Ultrasound of the breast
B) Mammogram
,C) Fine-needle aspiration
D) Excisional biopsy
Answer: A) Ultrasound of the breast
Rationale: In a young patient (<40 years old), ultrasound is the initial imaging modality of choice
for a palpable breast mass. If the ultrasound shows a simple cyst or a benign-appearing
fibroadenoma, further intervention may not be needed. A mammogram is typically reserved for
patients over 40.
Question 5.
A 70-year-old man with a 40-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. A chest X-ray reveals a 4 cm mass in the right upper lobe. Which of
the following is the most likely diagnosis?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Small cell lung cancer
D) Carcinoid tumor
Answer: A) Squamous cell carcinoma
Rationale: While all types of lung cancer can present with these symptoms, squamous cell
carcinoma is the most strongly associated with smoking, often presents centrally, and is known
to cause hemoptysis. Small cell lung cancer is also strongly linked to smoking but is often more
aggressive. Adenocarcinoma is more common in non-smokers.
Question 6.
A 28-year-old woman with a history of systemic lupus erythematosus (SLE) presents with
pleuritic chest pain and shortness of breath. A CT angiography of the chest is negative for
pulmonary embolism but shows a small pleural effusion. Which of the following is the most
likely cause of her symptoms?
A) Lupus pneumonitis
B) Pleuritis
C) Pulmonary fibrosis
D) Pneumonia
Answer: B) Pleuritis
, Rationale: Pleuritis is a common manifestation of SLE and is a frequent cause of pleuritic chest
pain in these patients. The presence of a small pleural effusion without other signs of infection
or pulmonary embolism points toward serositis, which is a hallmark of SLE.
Question 7.
A 65-year-old woman with a history of osteoarthritis presents with pain and swelling in her right
knee. She reports no fever or chills. Joint aspiration reveals thin, yellow fluid with normal
viscosity. Which of the following is the most likely diagnosis?
A) Septic arthritis
B) Gout
C) Osteoarthritis
D) Rheumatoid arthritis
Answer: C) Osteoarthritis
Rationale: The presence of thin, yellow fluid with normal viscosity is characteristic of a non-
inflammatory joint effusion, which is consistent with osteoarthritis. The lack of fever also
supports this diagnosis. Gout would show urate crystals. Rheumatoid arthritis would show an
inflammatory effusion with high white blood cell count.
Question 8.
A 60-year-old man with a history of benign prostatic hyperplasia (BPH) presents with acute
urinary retention. He is unable to void and has severe suprapubic pain. Which of the following is
the most appropriate initial management?
A) Alpha-blocker
B) 5-alpha-reductase inhibitor
C) Foley catheter placement
D) Surgical resection
Answer: C) Foley catheter placement
Rationale: Acute urinary retention is a medical emergency. The most appropriate initial
management is to decompress the bladder by placing a Foley catheter. This will relieve the
patient's pain and prevent further complications. Alpha-blockers can be started later to help
with voiding but are not the immediate treatment.
