KAPLAN USMLE STEP 2 CK EXAM PRACTICE | COMPREHENSIVE STUDY GUIDE |
ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Internal Medicine — Cardiology, Pulmonology, Gastroenterology, Nephrology,
Endocrinology
ii. Surgery and Perioperative Medicine
iii. Pediatrics
iv. Obstetrics and Gynecology
v. Psychiatry and Behavioral Medicine
vi. Neurology
vii. Infectious Disease and Preventive Medicine
viii. Emergency Medicine, Ethics, and Patient Safety
INTRODUCTION
This advanced Kaplan USMLE Step 2 CK practice set emphasizes clinical reasoning,
diagnosis, management, risk stratification, and next-best-step decision-making
across the major disciplines tested on Step 2 CK. Questions are designed around
realistic clinical presentations requiring interpretation of history, physical
examination findings, laboratory studies, imaging, and treatment response. The set
emphasizes prioritization, evidence-based management, complications, preventive
care, ethics, and common clinical traps rather than simple factual recall. Expect
progressively difficult cases that require distinguishing closely related diagnoses
and selecting the most appropriate immediate intervention. The questions are
intended as a high-level study resource for learners preparing for contemporary
Step 2 CK-style clinical decision-making.
QUESTION 1
A 67-year-old man with a history of hypertension and hyperlipidemia presents with
45 minutes of substernal chest pressure radiating to his left arm. ECG demonstrates
ST-segment elevation in leads II, III, and aVF. Blood pressure is 86/58 mm Hg, and
jugular venous pressure is elevated. Lung examination reveals clear breath sounds.
Which intervention is most appropriate immediately?
,A. Intravenous furosemide
B. Intravenous nitroglycerin
C. Intravenous isotonic saline
D. Emergent administration of a beta blocker
🔴 Correct Answer: C. Intravenous isotonic saline.
🔵 Explanation: This patient has an inferior myocardial infarction complicated by
right ventricular infarction, suggested by hypotension, elevated JVP, and clear lungs.
Right ventricular preload dependence makes volume expansion the appropriate
immediate intervention. Nitrates and diuretics can worsen hypotension by reducing
preload.
QUESTION 2
A 58-year-old woman develops sudden dyspnea and pleuritic chest pain 5 days
after total knee replacement. She is tachycardic and mildly hypoxemic. CT
pulmonary angiography demonstrates a segmental pulmonary embolus. Her blood
pressure is 128/74 mm Hg, and there is no evidence of right ventricular dysfunction.
Which is the most appropriate treatment?
A. Systemic thrombolysis
B. Therapeutic anticoagulation
C. Inferior vena cava filter placement
D. Surgical pulmonary embolectomy
🔴 Correct Answer: B. Therapeutic anticoagulation.
🔵 Explanation: A hemodynamically stable patient with pulmonary embolism and no
evidence of significant right ventricular strain should receive therapeutic
anticoagulation. Thrombolysis or embolectomy is generally reserved for massive or
selected high-risk pulmonary embolism with hemodynamic compromise.
QUESTION 3
A 72-year-old man presents with progressive fatigue, weight loss, and painless
jaundice. Laboratory studies show a cholestatic pattern. CT reveals a mass in the
pancreatic head with dilation of both the common bile duct and pancreatic duct.
Which diagnosis is most likely?
,A. Chronic pancreatitis
B. Pancreatic adenocarcinoma
C. Pancreatic neuroendocrine tumor
D. Cholangiocarcinoma
🔴 Correct Answer: B. Pancreatic adenocarcinoma.
🔵 Explanation: An older adult with painless progressive jaundice and a pancreatic
head mass has classic features of pancreatic ductal adenocarcinoma. Simultaneous
dilation of the common bile duct and pancreatic duct is characteristic of obstruction
near the pancreatic head.
QUESTION 4
A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor,
and palpitations. Examination reveals diffuse thyroid enlargement and bilateral
exophthalmos. TSH is suppressed and free T4 is elevated. Which additional finding
is most likely?
A. Pretibial myxedema
B. Hyporeflexia
C. Bradycardia
D. Hypercalcemia due to PTH excess
🔴 Correct Answer: A. Pretibial myxedema.
🔵 Explanation: Graves disease causes diffuse thyroid stimulation through TSH-
receptor antibodies and may produce ophthalmopathy and pretibial myxedema.
Hyperthyroidism typically causes tremor, tachycardia, heat intolerance, weight loss,
and hyperreflexia.
QUESTION 5
A 45-year-old man with cirrhosis presents with hematemesis and hypotension. After
airway stabilization and intravenous access are established, which medication
should be administered while urgent endoscopic management is arranged?
A. Metoclopramide
B. Octreotide
C. Mesalamine
D. Loperamide
, 🔴 Correct Answer: B. Octreotide.
🔵 Explanation: Acute variceal hemorrhage requires resuscitation, vasoactive therapy
such as octreotide, prophylactic antibiotics, and urgent endoscopic intervention.
Octreotide decreases portal venous pressure and helps control bleeding while
definitive therapy is arranged.
QUESTION 6
A 63-year-old man with chronic kidney disease presents with weakness. ECG
demonstrates peaked T waves followed by widening of the QRS complex. Serum
potassium is 7.2 mEq/L. Which treatment should be administered first?
A. Sodium polystyrene sulfonate
B. Intravenous calcium gluconate
C. Intravenous furosemide
D. Insulin alone
🔴 Correct Answer: B. Intravenous calcium gluconate.
🔵 Explanation: Severe hyperkalemia with ECG abnormalities is immediately life-
threatening because of the risk of ventricular arrhythmia. Intravenous calcium
stabilizes the cardiac membrane and should be administered immediately. Insulin
with glucose shifts potassium intracellularly but does not directly stabilize the
myocardium.
QUESTION 7
A 34-year-old woman develops fever, flank pain, nausea, and dysuria. Examination
reveals costovertebral angle tenderness. Urinalysis demonstrates numerous white
blood cells and white blood cell casts. Which diagnosis is most likely?
A. Acute cystitis
B. Acute pyelonephritis
C. Acute interstitial nephritis
D. Nephrolithiasis
🔴 Correct Answer: B. Acute pyelonephritis.
🔵 Explanation: Fever, flank pain, urinary symptoms, and white blood cell casts
strongly indicate renal parenchymal infection. Acute cystitis generally lacks systemic
manifestations and urinary casts.
ADVANCED TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Internal Medicine — Cardiology, Pulmonology, Gastroenterology, Nephrology,
Endocrinology
ii. Surgery and Perioperative Medicine
iii. Pediatrics
iv. Obstetrics and Gynecology
v. Psychiatry and Behavioral Medicine
vi. Neurology
vii. Infectious Disease and Preventive Medicine
viii. Emergency Medicine, Ethics, and Patient Safety
INTRODUCTION
This advanced Kaplan USMLE Step 2 CK practice set emphasizes clinical reasoning,
diagnosis, management, risk stratification, and next-best-step decision-making
across the major disciplines tested on Step 2 CK. Questions are designed around
realistic clinical presentations requiring interpretation of history, physical
examination findings, laboratory studies, imaging, and treatment response. The set
emphasizes prioritization, evidence-based management, complications, preventive
care, ethics, and common clinical traps rather than simple factual recall. Expect
progressively difficult cases that require distinguishing closely related diagnoses
and selecting the most appropriate immediate intervention. The questions are
intended as a high-level study resource for learners preparing for contemporary
Step 2 CK-style clinical decision-making.
QUESTION 1
A 67-year-old man with a history of hypertension and hyperlipidemia presents with
45 minutes of substernal chest pressure radiating to his left arm. ECG demonstrates
ST-segment elevation in leads II, III, and aVF. Blood pressure is 86/58 mm Hg, and
jugular venous pressure is elevated. Lung examination reveals clear breath sounds.
Which intervention is most appropriate immediately?
,A. Intravenous furosemide
B. Intravenous nitroglycerin
C. Intravenous isotonic saline
D. Emergent administration of a beta blocker
🔴 Correct Answer: C. Intravenous isotonic saline.
🔵 Explanation: This patient has an inferior myocardial infarction complicated by
right ventricular infarction, suggested by hypotension, elevated JVP, and clear lungs.
Right ventricular preload dependence makes volume expansion the appropriate
immediate intervention. Nitrates and diuretics can worsen hypotension by reducing
preload.
QUESTION 2
A 58-year-old woman develops sudden dyspnea and pleuritic chest pain 5 days
after total knee replacement. She is tachycardic and mildly hypoxemic. CT
pulmonary angiography demonstrates a segmental pulmonary embolus. Her blood
pressure is 128/74 mm Hg, and there is no evidence of right ventricular dysfunction.
Which is the most appropriate treatment?
A. Systemic thrombolysis
B. Therapeutic anticoagulation
C. Inferior vena cava filter placement
D. Surgical pulmonary embolectomy
🔴 Correct Answer: B. Therapeutic anticoagulation.
🔵 Explanation: A hemodynamically stable patient with pulmonary embolism and no
evidence of significant right ventricular strain should receive therapeutic
anticoagulation. Thrombolysis or embolectomy is generally reserved for massive or
selected high-risk pulmonary embolism with hemodynamic compromise.
QUESTION 3
A 72-year-old man presents with progressive fatigue, weight loss, and painless
jaundice. Laboratory studies show a cholestatic pattern. CT reveals a mass in the
pancreatic head with dilation of both the common bile duct and pancreatic duct.
Which diagnosis is most likely?
,A. Chronic pancreatitis
B. Pancreatic adenocarcinoma
C. Pancreatic neuroendocrine tumor
D. Cholangiocarcinoma
🔴 Correct Answer: B. Pancreatic adenocarcinoma.
🔵 Explanation: An older adult with painless progressive jaundice and a pancreatic
head mass has classic features of pancreatic ductal adenocarcinoma. Simultaneous
dilation of the common bile duct and pancreatic duct is characteristic of obstruction
near the pancreatic head.
QUESTION 4
A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor,
and palpitations. Examination reveals diffuse thyroid enlargement and bilateral
exophthalmos. TSH is suppressed and free T4 is elevated. Which additional finding
is most likely?
A. Pretibial myxedema
B. Hyporeflexia
C. Bradycardia
D. Hypercalcemia due to PTH excess
🔴 Correct Answer: A. Pretibial myxedema.
🔵 Explanation: Graves disease causes diffuse thyroid stimulation through TSH-
receptor antibodies and may produce ophthalmopathy and pretibial myxedema.
Hyperthyroidism typically causes tremor, tachycardia, heat intolerance, weight loss,
and hyperreflexia.
QUESTION 5
A 45-year-old man with cirrhosis presents with hematemesis and hypotension. After
airway stabilization and intravenous access are established, which medication
should be administered while urgent endoscopic management is arranged?
A. Metoclopramide
B. Octreotide
C. Mesalamine
D. Loperamide
, 🔴 Correct Answer: B. Octreotide.
🔵 Explanation: Acute variceal hemorrhage requires resuscitation, vasoactive therapy
such as octreotide, prophylactic antibiotics, and urgent endoscopic intervention.
Octreotide decreases portal venous pressure and helps control bleeding while
definitive therapy is arranged.
QUESTION 6
A 63-year-old man with chronic kidney disease presents with weakness. ECG
demonstrates peaked T waves followed by widening of the QRS complex. Serum
potassium is 7.2 mEq/L. Which treatment should be administered first?
A. Sodium polystyrene sulfonate
B. Intravenous calcium gluconate
C. Intravenous furosemide
D. Insulin alone
🔴 Correct Answer: B. Intravenous calcium gluconate.
🔵 Explanation: Severe hyperkalemia with ECG abnormalities is immediately life-
threatening because of the risk of ventricular arrhythmia. Intravenous calcium
stabilizes the cardiac membrane and should be administered immediately. Insulin
with glucose shifts potassium intracellularly but does not directly stabilize the
myocardium.
QUESTION 7
A 34-year-old woman develops fever, flank pain, nausea, and dysuria. Examination
reveals costovertebral angle tenderness. Urinalysis demonstrates numerous white
blood cells and white blood cell casts. Which diagnosis is most likely?
A. Acute cystitis
B. Acute pyelonephritis
C. Acute interstitial nephritis
D. Nephrolithiasis
🔴 Correct Answer: B. Acute pyelonephritis.
🔵 Explanation: Fever, flank pain, urinary symptoms, and white blood cell casts
strongly indicate renal parenchymal infection. Acute cystitis generally lacks systemic
manifestations and urinary casts.
