USMLE Step 2 CK – Comprehensive Clinical Knowledge Review with
High-Yield Topics and Practice Questions
What is the best diagnostic procedure for a patient who presents with Dysphagia/Odynophagia,
Weight Loss, Anemia, and Heme-Positive Stool? - correct answer Endoscopy
What is the name for the inability of the Lower Esophageal Sphincter to relax due to loss of
nerve plexus within the lower esophagus? - correct answer Achalasia
What is the most likely diagnosis for a person who has new onset odynophagia after recent
travel to South America? - correct answer Chagas Disease (Trypanosoma cruzi)
What is the most accurate test for differentiating between Nutcracker Esophagus of Diffuse
Esophageal Spasm? - correct answer Esophageal Manometry
If an AIDS patient has pain on swallowing and a CD4 count under 50, what empiric treatment
modality is likely to correct this condition? - correct answer Oral Fluconazole (Assuming this is
Thrush/Candida)
A patient with Esophageal Candidiasis that is resistant to Oral Fluconazole treatment should be
treated with what? - correct answer Intravenous Amphoteracin B
Which virus is likely to cause large mucosal ulcerations of the esophagus in an HIV+ patient with
a CD4 count under 100? - correct answer Cytomegalovirus (CMV)
Which virus is likely to cause multiple, small, shallow ulcerations of the esophagus in an HIV+
patient with a CD4 count under 100? - correct answer Herpes Simplex Virus
What is the name for a scarring/stricture in the distal esophagus due to acid reflux and
associated with hiatal hernia? - correct answer Schatzki Ring
What is the name for the triad of Dysphagia/Esophageal Webs, Iron Deficiency Anemia, and
Glossitis? - correct answer Plummer Vinson Syndrome
What is the treatment for Plummer Vinson Syndrome? - correct answer Iron Replacement
What is the name for an outpouching of the posterior pharyngeal muscles which leads to
regurgitation of undigested food, bad breath, and halitosis? - correct answer Zenker's
Diverticulum
What is the most effective test to diagnosis Zenker's Diverticulum? - correct answer Barium
Swallow Study (Barium Esophogram)
What is the most effective treatment of Zenker's Diverticulum? - correct answer Surgical
Excision of Diverticulum
,What is the most effective treatment for Scleroderma? - correct answer Proton Pump Inhibitors
Hammen's Sign (Subcutaneous Crepitus) in an alcoholic patient means the patient should be
immediately investigated for what diagnosis requiring emergency surgery? - correct answer
Boerhaave's Syndrome
What are the three aspects of Charcot's Triad for Cholangitis? - correct answer Right Upper
Quadrant Pain, Fever, Jaundice
Which condition involves Left Upper Quadrant Pain shortly after eating in a patient who has
Irritable Bowel Syndrome? - correct answer Splenic Flexure Syndrome (Gas distention swells
the splenic capsule after eating)
Epigastric Tenderness in a patient with previous gallstones : Most Likely Diagnosis? - correct
answer Pancreatitis
Bad Taste in the mouth, cough, hoarseness, and pain related to position: Most Likely Diagnosis?
- correct answer GERD
Diabetic patient with bloating, epigastric tenderness: Most Likely Diagnosis? - correct answer
Gastroparesis
Burns, Trauma, Sepsis, Intubation, or Multi Organ Failure resulting in Uremia can all result in
which condition? - correct answer Stress Ulcers
Which condition is defined by large ulcers (greater than 1cm) past the third portion of the
duodenum and presents with diarrhea, abdominal pain, anemia, and heme positive stools? -
correct answer Zollinger-Ellison Syndrome (Gastrinoma)
What is the treatment for a diabetic patient with intermittent nausea, constipation, bloating
and a succussion splash on physical examination? - correct answer Erythromycin (Increases
Gastric Motility)
GET SMASHED - Pancreatitis Mnemonic - correct answer Gallstones
Ethanol
Trauma
Scorpions
Mumps
AutoImmune
Steroids
Hyperlipidemia
,ERCP
Drugs
What is the most common cause of Upper GI Bleeding? - correct answer Ulcers
What is the most common cause of Lower GI Bleeding? - correct answer Diverticulosis
What percentage of blood has likely been lost by the time a patient exhibits a 10 point rise in
pulse and 20 point decrease in systolic blood pressure when going from supine to sitting
(Orthostasis) - correct answer 20%
What percentage of blood has likely been lost by the time a patient exhibits tachycardia (BPM >
100) or hypotension (Systolic BP <100)? - correct answer 30%
When treating which condition is it ABSOLUTELY NECESSARY to give alpha blockers before beta
blockers in order to avoid a massive spike in the patient's (already elevated) blood pressure? -
correct answer Pheochromocytoma (acute episode of pheo or cocaine overdose)
A patient with Paroxysmal Supraventricular Tachycardia can be treated with vagal maneuvers
(carotid massage, cold water immersion, or valsava) because these maneuvers decrease
conductivity at which point in the heart? - correct answer AV Node (Increasing vagal tone
results in a decrease in conductivity at the AV node, possibly breaking the disturbed rhythm)
Potentially Reversible Causes of Urinary Incontinence in the Elderly: DIAPPERS Mnemonic: -
correct answer Delirium
Infection
Atrophic Urethritis/Vaginitis
Pharmaceuticals (Alpha Blockers, Diuretics)
Psychological (Depression)
Excessive Urine Output (CHF, Diabetes)
Restricted Mobility (Post-Op)
Stool Impaction
Increasing calcium intake and fluid intake while decreasing protein, oxalate, and sodium intake
are the dietary regulations for patients with which condition? - correct answer Renal Calculi
Which antipsychotic extrapyramidal effect is characterized by sudden sustained contraction of
the neck, mouth, tongue, and/or eye muscles and is treated with Benztropine or
Diphenhydramine? - correct answer Acute Dystonic Reaction
, One month after starting Risperidone a patient develops gradual onset tremor, rigidity, and
bradykinesia. What is this condition called? - correct answer Secondary Parkinsonism
This condition can occur due to papillary muscle displacement in patients with an acute
myocardial infarction and leads to abrupt and excessive volume overload of the atrium and
ventricle, thus increasing their filling pressures. - correct answer Acute Mitral Regurgitation
(Realize the difference here from chronic MR. Acute MR shows no changes to size of the heart)
A 19 year old man presents with blood in his stool and is found to have hundreds of colonic
polyps on colonscopy. What is the most appropriate treatment for this condition (Familial
Colonic Polyposis) - correct answer Procto-Colectomy (Patients with familial colonic polyps
have a 100% chance of developing cancer if left untreated)
Of the Calf Veins, Renal Veins, Iliofemoral Veins, Upper Extremity Veins, and Clots in the heart,
which location is most likely to result in a pulmonary embolism? - correct answer Iliofemoral
veins (Proximal deep leg veins like the iliofemoral are common sources of symptomatic
pulmonary embolism)
Prolonged use of Proton Pump Inhibitors or Histamine 2 Receptor Antagonists commonly leads
to which diarrheal condition? - correct answer Clostridium Dificile Colitis
Which condition is associated with a migratory rash with central clearing and eroded borders,
weight loss, and vague GI Symptoms in a diabetic patient? - correct answer Glucagonoma
A patient that presents with an extremely painful spreading skin infection that shows gas under
the skin on xray likely has which condition? - correct answer Necrotizing Fasciitis
An elderly man with known BPH has experienced continually increasing urinary frequency,
urgency, hesitation, and nocturia over the last several months. His PSA is normal and prostate is
enlarged but smooth, firm, and symmetrical. What imaging should be done? - correct answer
Renal Ultrasound (Worsening BPH can cause urinary obstruction leading to renal failure. Alpha
blockers like Tamsulosin or 5-a-Reductase Inhibitors like Finasteride can help improve urinary
symptoms. )
An elderly patient with major shoulder stiffness associated with mild to moderate pain that has
reduced range of motion both actively and passively with no traumatic history likely has which
condition? - correct answer Adhesive Capsulitis (Think of this as a differential for shoulder
stiffness/pain. All that is shoulder is not rotator cuff.)
What are the recommended screening guidelines for breast cancer? - correct answer Women
aged 50-75: Mammogram every 2 years
What are the recommended screening guidelines for cervical cancer? - correct answer Women
aged 21-65: Pap Smear every 3 years
High-Yield Topics and Practice Questions
What is the best diagnostic procedure for a patient who presents with Dysphagia/Odynophagia,
Weight Loss, Anemia, and Heme-Positive Stool? - correct answer Endoscopy
What is the name for the inability of the Lower Esophageal Sphincter to relax due to loss of
nerve plexus within the lower esophagus? - correct answer Achalasia
What is the most likely diagnosis for a person who has new onset odynophagia after recent
travel to South America? - correct answer Chagas Disease (Trypanosoma cruzi)
What is the most accurate test for differentiating between Nutcracker Esophagus of Diffuse
Esophageal Spasm? - correct answer Esophageal Manometry
If an AIDS patient has pain on swallowing and a CD4 count under 50, what empiric treatment
modality is likely to correct this condition? - correct answer Oral Fluconazole (Assuming this is
Thrush/Candida)
A patient with Esophageal Candidiasis that is resistant to Oral Fluconazole treatment should be
treated with what? - correct answer Intravenous Amphoteracin B
Which virus is likely to cause large mucosal ulcerations of the esophagus in an HIV+ patient with
a CD4 count under 100? - correct answer Cytomegalovirus (CMV)
Which virus is likely to cause multiple, small, shallow ulcerations of the esophagus in an HIV+
patient with a CD4 count under 100? - correct answer Herpes Simplex Virus
What is the name for a scarring/stricture in the distal esophagus due to acid reflux and
associated with hiatal hernia? - correct answer Schatzki Ring
What is the name for the triad of Dysphagia/Esophageal Webs, Iron Deficiency Anemia, and
Glossitis? - correct answer Plummer Vinson Syndrome
What is the treatment for Plummer Vinson Syndrome? - correct answer Iron Replacement
What is the name for an outpouching of the posterior pharyngeal muscles which leads to
regurgitation of undigested food, bad breath, and halitosis? - correct answer Zenker's
Diverticulum
What is the most effective test to diagnosis Zenker's Diverticulum? - correct answer Barium
Swallow Study (Barium Esophogram)
What is the most effective treatment of Zenker's Diverticulum? - correct answer Surgical
Excision of Diverticulum
,What is the most effective treatment for Scleroderma? - correct answer Proton Pump Inhibitors
Hammen's Sign (Subcutaneous Crepitus) in an alcoholic patient means the patient should be
immediately investigated for what diagnosis requiring emergency surgery? - correct answer
Boerhaave's Syndrome
What are the three aspects of Charcot's Triad for Cholangitis? - correct answer Right Upper
Quadrant Pain, Fever, Jaundice
Which condition involves Left Upper Quadrant Pain shortly after eating in a patient who has
Irritable Bowel Syndrome? - correct answer Splenic Flexure Syndrome (Gas distention swells
the splenic capsule after eating)
Epigastric Tenderness in a patient with previous gallstones : Most Likely Diagnosis? - correct
answer Pancreatitis
Bad Taste in the mouth, cough, hoarseness, and pain related to position: Most Likely Diagnosis?
- correct answer GERD
Diabetic patient with bloating, epigastric tenderness: Most Likely Diagnosis? - correct answer
Gastroparesis
Burns, Trauma, Sepsis, Intubation, or Multi Organ Failure resulting in Uremia can all result in
which condition? - correct answer Stress Ulcers
Which condition is defined by large ulcers (greater than 1cm) past the third portion of the
duodenum and presents with diarrhea, abdominal pain, anemia, and heme positive stools? -
correct answer Zollinger-Ellison Syndrome (Gastrinoma)
What is the treatment for a diabetic patient with intermittent nausea, constipation, bloating
and a succussion splash on physical examination? - correct answer Erythromycin (Increases
Gastric Motility)
GET SMASHED - Pancreatitis Mnemonic - correct answer Gallstones
Ethanol
Trauma
Scorpions
Mumps
AutoImmune
Steroids
Hyperlipidemia
,ERCP
Drugs
What is the most common cause of Upper GI Bleeding? - correct answer Ulcers
What is the most common cause of Lower GI Bleeding? - correct answer Diverticulosis
What percentage of blood has likely been lost by the time a patient exhibits a 10 point rise in
pulse and 20 point decrease in systolic blood pressure when going from supine to sitting
(Orthostasis) - correct answer 20%
What percentage of blood has likely been lost by the time a patient exhibits tachycardia (BPM >
100) or hypotension (Systolic BP <100)? - correct answer 30%
When treating which condition is it ABSOLUTELY NECESSARY to give alpha blockers before beta
blockers in order to avoid a massive spike in the patient's (already elevated) blood pressure? -
correct answer Pheochromocytoma (acute episode of pheo or cocaine overdose)
A patient with Paroxysmal Supraventricular Tachycardia can be treated with vagal maneuvers
(carotid massage, cold water immersion, or valsava) because these maneuvers decrease
conductivity at which point in the heart? - correct answer AV Node (Increasing vagal tone
results in a decrease in conductivity at the AV node, possibly breaking the disturbed rhythm)
Potentially Reversible Causes of Urinary Incontinence in the Elderly: DIAPPERS Mnemonic: -
correct answer Delirium
Infection
Atrophic Urethritis/Vaginitis
Pharmaceuticals (Alpha Blockers, Diuretics)
Psychological (Depression)
Excessive Urine Output (CHF, Diabetes)
Restricted Mobility (Post-Op)
Stool Impaction
Increasing calcium intake and fluid intake while decreasing protein, oxalate, and sodium intake
are the dietary regulations for patients with which condition? - correct answer Renal Calculi
Which antipsychotic extrapyramidal effect is characterized by sudden sustained contraction of
the neck, mouth, tongue, and/or eye muscles and is treated with Benztropine or
Diphenhydramine? - correct answer Acute Dystonic Reaction
, One month after starting Risperidone a patient develops gradual onset tremor, rigidity, and
bradykinesia. What is this condition called? - correct answer Secondary Parkinsonism
This condition can occur due to papillary muscle displacement in patients with an acute
myocardial infarction and leads to abrupt and excessive volume overload of the atrium and
ventricle, thus increasing their filling pressures. - correct answer Acute Mitral Regurgitation
(Realize the difference here from chronic MR. Acute MR shows no changes to size of the heart)
A 19 year old man presents with blood in his stool and is found to have hundreds of colonic
polyps on colonscopy. What is the most appropriate treatment for this condition (Familial
Colonic Polyposis) - correct answer Procto-Colectomy (Patients with familial colonic polyps
have a 100% chance of developing cancer if left untreated)
Of the Calf Veins, Renal Veins, Iliofemoral Veins, Upper Extremity Veins, and Clots in the heart,
which location is most likely to result in a pulmonary embolism? - correct answer Iliofemoral
veins (Proximal deep leg veins like the iliofemoral are common sources of symptomatic
pulmonary embolism)
Prolonged use of Proton Pump Inhibitors or Histamine 2 Receptor Antagonists commonly leads
to which diarrheal condition? - correct answer Clostridium Dificile Colitis
Which condition is associated with a migratory rash with central clearing and eroded borders,
weight loss, and vague GI Symptoms in a diabetic patient? - correct answer Glucagonoma
A patient that presents with an extremely painful spreading skin infection that shows gas under
the skin on xray likely has which condition? - correct answer Necrotizing Fasciitis
An elderly man with known BPH has experienced continually increasing urinary frequency,
urgency, hesitation, and nocturia over the last several months. His PSA is normal and prostate is
enlarged but smooth, firm, and symmetrical. What imaging should be done? - correct answer
Renal Ultrasound (Worsening BPH can cause urinary obstruction leading to renal failure. Alpha
blockers like Tamsulosin or 5-a-Reductase Inhibitors like Finasteride can help improve urinary
symptoms. )
An elderly patient with major shoulder stiffness associated with mild to moderate pain that has
reduced range of motion both actively and passively with no traumatic history likely has which
condition? - correct answer Adhesive Capsulitis (Think of this as a differential for shoulder
stiffness/pain. All that is shoulder is not rotator cuff.)
What are the recommended screening guidelines for breast cancer? - correct answer Women
aged 50-75: Mammogram every 2 years
What are the recommended screening guidelines for cervical cancer? - correct answer Women
aged 21-65: Pap Smear every 3 years
