USMLE STEP 2 CK EXAM ACTUAL PAPER 2026
QUESTIONS WITH SOLUTIONS GRADED A
PLUS COMPLETE REVIEW SET 400 ITEMS
◉ Chronic myeloid leukemia.
Answer: Patient has leukocyte count often >100k, low LAP score,
fewer metamyelocytes than myelocytes, absolute basophilia
◉ Cyclosporine.
Answer: Drug that inhibits transcription of IL-2, causes
nephrotoxicity, htn, neurotoxicity, glucose intolerance, infection,
malignancy, gingival hypertrophy and hirsutism
◉ Tacrolimus.
Answer: Drug that inhibits transcription of IL-2 but does not cause
hirsutism or gum hypertrophy
◉ Mycophenolate.
Answer: Drug that is a reversible inhibitor of inosine
monophosphate dehydrogenase (rate-limiting enzyme in de novo
purine synthesis), causes bone marrow suppression
◉ Vertebral osteomyelitis.
,Answer: IV drug user presents with tenderness to gentle percussion
over spinous process, labs show thrombocytosis
◉ Acute pericarditis.
Answer: Patient presents with sharp, pleuritic chest pain that is
relieved by leaning forward
◉ Diabetic ketoacidosis.
Answer: Patient with DM presents with hyperventilation, glucose
250-500, bicarb <18, elevated anion gap, serum osmolality <320
◉ Hyperosmolar hyperglycemic state.
Answer: Patient with DM presents with altered mentation, glucose
>600, bicarb >18, normal anion gap, serum osmolality >320
◉ Hyperglycemia, ketonemia and anion gap metabolic acidosis.
Answer: DKA Triad
◉ Protein C deficiency.
Answer: Underlying hereditary cause of transient hypercoagulable
state in first few days of warfarin therapy, leading to warfarin-
induced skin necrosis
, ◉ Autoantibodies to platelet factor 4.
Answer: Genetic susceptibility to heparin-induced
thrombocytopenia
◉ Cholesterol embolism.
Answer: Patient with history of comorbid conditions presents with
livedo reticularis, Hollenhorst plaques (eyes), eosinophilia, renal
injury after cardiac catheterization
◉ Statin.
Answer: Drug used in therapy for patient with estimated 10-year
ASCVD risk >=7.5%
◉ Triglycerides.
Answer: Lipid level reduced by use of fish oil
◉ Niacin.
Answer: Drug that is effective in raising HDL and has a modest effect
of lowering VLDL and LDL
◉ Aortic regurgitation.
Answer: Murmur in which patient presents with mild exertional SOB
and "pounding" of heart, aware of heartbeat while lying on L side,
QUESTIONS WITH SOLUTIONS GRADED A
PLUS COMPLETE REVIEW SET 400 ITEMS
◉ Chronic myeloid leukemia.
Answer: Patient has leukocyte count often >100k, low LAP score,
fewer metamyelocytes than myelocytes, absolute basophilia
◉ Cyclosporine.
Answer: Drug that inhibits transcription of IL-2, causes
nephrotoxicity, htn, neurotoxicity, glucose intolerance, infection,
malignancy, gingival hypertrophy and hirsutism
◉ Tacrolimus.
Answer: Drug that inhibits transcription of IL-2 but does not cause
hirsutism or gum hypertrophy
◉ Mycophenolate.
Answer: Drug that is a reversible inhibitor of inosine
monophosphate dehydrogenase (rate-limiting enzyme in de novo
purine synthesis), causes bone marrow suppression
◉ Vertebral osteomyelitis.
,Answer: IV drug user presents with tenderness to gentle percussion
over spinous process, labs show thrombocytosis
◉ Acute pericarditis.
Answer: Patient presents with sharp, pleuritic chest pain that is
relieved by leaning forward
◉ Diabetic ketoacidosis.
Answer: Patient with DM presents with hyperventilation, glucose
250-500, bicarb <18, elevated anion gap, serum osmolality <320
◉ Hyperosmolar hyperglycemic state.
Answer: Patient with DM presents with altered mentation, glucose
>600, bicarb >18, normal anion gap, serum osmolality >320
◉ Hyperglycemia, ketonemia and anion gap metabolic acidosis.
Answer: DKA Triad
◉ Protein C deficiency.
Answer: Underlying hereditary cause of transient hypercoagulable
state in first few days of warfarin therapy, leading to warfarin-
induced skin necrosis
, ◉ Autoantibodies to platelet factor 4.
Answer: Genetic susceptibility to heparin-induced
thrombocytopenia
◉ Cholesterol embolism.
Answer: Patient with history of comorbid conditions presents with
livedo reticularis, Hollenhorst plaques (eyes), eosinophilia, renal
injury after cardiac catheterization
◉ Statin.
Answer: Drug used in therapy for patient with estimated 10-year
ASCVD risk >=7.5%
◉ Triglycerides.
Answer: Lipid level reduced by use of fish oil
◉ Niacin.
Answer: Drug that is effective in raising HDL and has a modest effect
of lowering VLDL and LDL
◉ Aortic regurgitation.
Answer: Murmur in which patient presents with mild exertional SOB
and "pounding" of heart, aware of heartbeat while lying on L side,
