2025 VERIFIED CLINICAL KNOWLEDGE
EXAM GUIDE – EXPERT-REVIEWED,
COMPREHENSIVE, AND UP-TO-DATE
STUDY MATERIAL FOR EXCELLING IN YOUR
MEDICAL CERTIFICATION
, CONTENTS
USMLE Step 2 CK Test Question Formats......................................................................3
Introduction to USMLE Step 2 CK Sample Test Questions...........................................9
USMLE Laboratory Values..............................................................................................10
USMLE Step 2 CK Sample Test Questions......................................................................13
Block 1, Items 1–40............................................................................................13
Block 2, Items 41–80..........................................................................................27
Block 3, Items 81–120........................................................................................42
Answer Form for USMLE Step 2 CK Sample Test Questions.........................................57
Answer Key for USMLE Step 2 CK Sample Test Questions............................................58
, USMLE STEP 2 CK TEST QUESTION FORMATS
The following are strategies for answering one-best-answer items:
Read each question carefully. It is important to understand what is being asked.
Try to generate an answer and then look for it in the response option list.
Alternatively, read each response option carefully, eliminating those that are clearly incorrect.
Of the remaining response options, select the one that is most correct.
If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong
answers.
Patient Scenario Formats
Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette (paragraph) format, or in
Chart/Tabular format. Test items using the chart/tabular format are designed to resemble patient charts
but are not intended to be an exact representation of a patient chart. Questions written in Chart/Tabular
format will contain relevant patient information in list form, organized in clearly marked sections for ease of review.
Familiar medical abbreviations may be used within Chart/Tabular format questions.
Single-Item Questions
A single patient-centered vignette is associated with one question followed by four or more response options. The
response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial
materials. You are required to select the best answer to the question. Other options may be partially correct, but there
is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the
examination.
Example Question 1
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not
yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%,
and mean corpuscular volume is 94 μm 3. A blood smear shows normochromic, normocytic cells. Which of the following
is the most likely cause?
(A) Acute blood loss (F) Microangiopathic hemolysis
(B) Chronic lymphocytic leukemia (G) Polycythemia vera
(C) Erythrocyte enzyme deficiency (H) Sickle cell disease
(D) Erythropoietin deficiency (I) Sideroblastic anemia
(E) Immunohemolysis (J) β-Thalassemia trait
(Answer: D)
, Example Question 2
Patient Information
Age: 18 years
Gender: F, self-identified
Ethnicity: unspecified
Site of Care: emergency department
History
Chief Complaint: "My roommate took a lot of pills and said she wanted to die."
History of Present Illness:
• patient brought by ambulance 2 hours after a suspected acetaminophen overdose
• roommate had returned to their dorm and found the patient distraught; patient was holding an empty bottle of
acetaminophen and said, "I just want to die."
• roommate estimates patient consumed 20 to 30 tablets of 500-mg acetaminophen
Past Medical History:
• generalized anxiety disorder
• major depressive disorder
Medications:
• citalopram
Allergies:
• no known drug allergies
Family History:
• noncontributory
Psychosocial History:
• college freshman; parents live 8 hours away
Physical Examination
Temp Pulse Resp BP O2 Sat Ht Wt BMI
36.8°C 89/min 16/min 108/59 mm Hg 99% 170 cm 63 kg 22 kg/m2
(98.2°F) on RA (5 ft 7 in) (140 lb)
• Appearance: awake and alert but distraught and fearful; patient says, "This was totally stupid."
• Pulmonary: clear lung fields
• Cardiac: regular rhythm; S1 and S2, with an early systolic murmur
• Abdominal: soft and nontender; liver and spleen cannot be palpated
• Neurologic: no abnormalities; fully oriented
Question: In addition to obtaining serum acetaminophen concentration, which of the following is the most
appropriate next step in management?
(A) Administer N-acetylcysteine
(B) Arrange hemodialysis
(C) Gastric lavage
(D) Initiate sodium bicarbonate infusion
(Answer: A)
EXAM GUIDE – EXPERT-REVIEWED,
COMPREHENSIVE, AND UP-TO-DATE
STUDY MATERIAL FOR EXCELLING IN YOUR
MEDICAL CERTIFICATION
, CONTENTS
USMLE Step 2 CK Test Question Formats......................................................................3
Introduction to USMLE Step 2 CK Sample Test Questions...........................................9
USMLE Laboratory Values..............................................................................................10
USMLE Step 2 CK Sample Test Questions......................................................................13
Block 1, Items 1–40............................................................................................13
Block 2, Items 41–80..........................................................................................27
Block 3, Items 81–120........................................................................................42
Answer Form for USMLE Step 2 CK Sample Test Questions.........................................57
Answer Key for USMLE Step 2 CK Sample Test Questions............................................58
, USMLE STEP 2 CK TEST QUESTION FORMATS
The following are strategies for answering one-best-answer items:
Read each question carefully. It is important to understand what is being asked.
Try to generate an answer and then look for it in the response option list.
Alternatively, read each response option carefully, eliminating those that are clearly incorrect.
Of the remaining response options, select the one that is most correct.
If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong
answers.
Patient Scenario Formats
Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette (paragraph) format, or in
Chart/Tabular format. Test items using the chart/tabular format are designed to resemble patient charts
but are not intended to be an exact representation of a patient chart. Questions written in Chart/Tabular
format will contain relevant patient information in list form, organized in clearly marked sections for ease of review.
Familiar medical abbreviations may be used within Chart/Tabular format questions.
Single-Item Questions
A single patient-centered vignette is associated with one question followed by four or more response options. The
response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial
materials. You are required to select the best answer to the question. Other options may be partially correct, but there
is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the
examination.
Example Question 1
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not
yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%,
and mean corpuscular volume is 94 μm 3. A blood smear shows normochromic, normocytic cells. Which of the following
is the most likely cause?
(A) Acute blood loss (F) Microangiopathic hemolysis
(B) Chronic lymphocytic leukemia (G) Polycythemia vera
(C) Erythrocyte enzyme deficiency (H) Sickle cell disease
(D) Erythropoietin deficiency (I) Sideroblastic anemia
(E) Immunohemolysis (J) β-Thalassemia trait
(Answer: D)
, Example Question 2
Patient Information
Age: 18 years
Gender: F, self-identified
Ethnicity: unspecified
Site of Care: emergency department
History
Chief Complaint: "My roommate took a lot of pills and said she wanted to die."
History of Present Illness:
• patient brought by ambulance 2 hours after a suspected acetaminophen overdose
• roommate had returned to their dorm and found the patient distraught; patient was holding an empty bottle of
acetaminophen and said, "I just want to die."
• roommate estimates patient consumed 20 to 30 tablets of 500-mg acetaminophen
Past Medical History:
• generalized anxiety disorder
• major depressive disorder
Medications:
• citalopram
Allergies:
• no known drug allergies
Family History:
• noncontributory
Psychosocial History:
• college freshman; parents live 8 hours away
Physical Examination
Temp Pulse Resp BP O2 Sat Ht Wt BMI
36.8°C 89/min 16/min 108/59 mm Hg 99% 170 cm 63 kg 22 kg/m2
(98.2°F) on RA (5 ft 7 in) (140 lb)
• Appearance: awake and alert but distraught and fearful; patient says, "This was totally stupid."
• Pulmonary: clear lung fields
• Cardiac: regular rhythm; S1 and S2, with an early systolic murmur
• Abdominal: soft and nontender; liver and spleen cannot be palpated
• Neurologic: no abnormalities; fully oriented
Question: In addition to obtaining serum acetaminophen concentration, which of the following is the most
appropriate next step in management?
(A) Administer N-acetylcysteine
(B) Arrange hemodialysis
(C) Gastric lavage
(D) Initiate sodium bicarbonate infusion
(Answer: A)
