USMLE STEP 2 CK COMPREHENSIVE SCRIPT
2026 QUESTIONS AND SOLUTIONS
◉ A patient presents with signs of hypocalcemia, high phosphorus,
and low PTH. Answer: Hypoparathyroidism
◉ Stones, bones, groans, psychic overtones. Answer: Signs and
symptoms of hypercalcemia
◉ A patient complains of HA, weakness and polyuria; exam reveals
HTN and tetany. Labs show hypernatremia, hypokalemia and
metabolic alk. Answer: Primary hyperaldosteronism (due to Conn's
syndrome or bilateral adrenal hyperplasia)
◉ A patient p/w tachycardia, wild swings in BP, HA, diaphoresis,
AMS and sense of panic. Answer: Pheo
◉ Which should be used first in treating pheo, alpha or beta-
antagonists?. Answer: Alpha (phentolamine and
phenoxybenzamine)
◉ A patient with h/o lithium use p/w copious amounts of dilute
urine. Answer: Nephrogenic DI
,◉ Treatment of central DI. Answer: Administration of DDAVP and
free-water restriction
◉ A postop patient with significant pain p/w hyponatremia and
normal volume status. Answer: SIADH due to stress
◉ An antidiabetic agent a/w lactic acidosis. Answer: Metformin
◉ A patient p/w weakness, n/v, weight loss and new skin
pigmentation. Labs show hyponatremia and hyperkalemia.
Treatment?. Answer: Primary adrenal insufficiency (Addison's).
Treat with glucocorticoids, mineralocorticoids and IVF
◉ Goal HbA1c for patient with DM. Answer: <7.0
◉ Treatment of DKA. Answer: Fluids, insulin, and electrolute
repletion (eg K+)
◉ Why are beta-blockers contraindicated in diabetics?. Answer: Can
mask symptoms of hypoglycemia
◉ Bias introduced into a study when a clinician is aware of the
patient's treatment type. Answer: Observational bias
,◉ Bias introduced when screening detects a disease earlier and thus
lengthens the time from diagnosis to death. Answer: Lead-time bias
◉ If you want to know if geographical location affects infant
mortality rate but most variation in infant mortality is predicted by
socioeconomic status, then socioeconomic status is a ______. Answer:
Confounding variable
◉ The proportion of people who have the disease and test + is the.
Answer: Sensitivity
◉ Sensitive tests have few false negatives and are used to rule ___ a
disease. Answer: Out
◉ PPD reactivity is used as a screening test because most people
with TB (except those who are anergic) will have a positive PPD.
Highly sensitivie or specific?. Answer: Sensitive. Screening tests with
high sensitivity are good for diseases with low prevalence
◉ Chronic diseases such as SLE - higher prevalence or incidence?.
Answer: Higher prevalence
◉ Epidemics such as influenza - higher prevalence or incidence?.
Answer: Higher incidence
, ◉ What is the difference between incidence and prevalence?.
Answer: Prevalence is the precentage of cases of disease in a
population at one snapshot in time. Incidence is the percentage of
new cases of disease that develop over a given time period among
the total population at risk
◉ Cross-sectional survey - incidence or prevalence?. Answer:
Prevalence
◉ Cohort study - incidence or prevalence?. Answer: Incidence and
prevalence
◉ Case-control study - incidence or prevalence?. Answer: Neither
◉ Describe a test that consistently gives identical results, but the
results are wrong. Answer: High reliability (precision), low validity
(accuracy)
◉ Difference between a cohort and a case-control study. Answer:
Cohort studies can be used to calculate RR< incidence and/or odds
ratio. Case-control studies can be used to calculate an OR< which is
an estimate of RR when the disease prevalence is low
◉ Attributable risk?. Answer: The difference in risk in the exposed
and unexposed groups (ie, the risk that is attributable to exposure)
2026 QUESTIONS AND SOLUTIONS
◉ A patient presents with signs of hypocalcemia, high phosphorus,
and low PTH. Answer: Hypoparathyroidism
◉ Stones, bones, groans, psychic overtones. Answer: Signs and
symptoms of hypercalcemia
◉ A patient complains of HA, weakness and polyuria; exam reveals
HTN and tetany. Labs show hypernatremia, hypokalemia and
metabolic alk. Answer: Primary hyperaldosteronism (due to Conn's
syndrome or bilateral adrenal hyperplasia)
◉ A patient p/w tachycardia, wild swings in BP, HA, diaphoresis,
AMS and sense of panic. Answer: Pheo
◉ Which should be used first in treating pheo, alpha or beta-
antagonists?. Answer: Alpha (phentolamine and
phenoxybenzamine)
◉ A patient with h/o lithium use p/w copious amounts of dilute
urine. Answer: Nephrogenic DI
,◉ Treatment of central DI. Answer: Administration of DDAVP and
free-water restriction
◉ A postop patient with significant pain p/w hyponatremia and
normal volume status. Answer: SIADH due to stress
◉ An antidiabetic agent a/w lactic acidosis. Answer: Metformin
◉ A patient p/w weakness, n/v, weight loss and new skin
pigmentation. Labs show hyponatremia and hyperkalemia.
Treatment?. Answer: Primary adrenal insufficiency (Addison's).
Treat with glucocorticoids, mineralocorticoids and IVF
◉ Goal HbA1c for patient with DM. Answer: <7.0
◉ Treatment of DKA. Answer: Fluids, insulin, and electrolute
repletion (eg K+)
◉ Why are beta-blockers contraindicated in diabetics?. Answer: Can
mask symptoms of hypoglycemia
◉ Bias introduced into a study when a clinician is aware of the
patient's treatment type. Answer: Observational bias
,◉ Bias introduced when screening detects a disease earlier and thus
lengthens the time from diagnosis to death. Answer: Lead-time bias
◉ If you want to know if geographical location affects infant
mortality rate but most variation in infant mortality is predicted by
socioeconomic status, then socioeconomic status is a ______. Answer:
Confounding variable
◉ The proportion of people who have the disease and test + is the.
Answer: Sensitivity
◉ Sensitive tests have few false negatives and are used to rule ___ a
disease. Answer: Out
◉ PPD reactivity is used as a screening test because most people
with TB (except those who are anergic) will have a positive PPD.
Highly sensitivie or specific?. Answer: Sensitive. Screening tests with
high sensitivity are good for diseases with low prevalence
◉ Chronic diseases such as SLE - higher prevalence or incidence?.
Answer: Higher prevalence
◉ Epidemics such as influenza - higher prevalence or incidence?.
Answer: Higher incidence
, ◉ What is the difference between incidence and prevalence?.
Answer: Prevalence is the precentage of cases of disease in a
population at one snapshot in time. Incidence is the percentage of
new cases of disease that develop over a given time period among
the total population at risk
◉ Cross-sectional survey - incidence or prevalence?. Answer:
Prevalence
◉ Cohort study - incidence or prevalence?. Answer: Incidence and
prevalence
◉ Case-control study - incidence or prevalence?. Answer: Neither
◉ Describe a test that consistently gives identical results, but the
results are wrong. Answer: High reliability (precision), low validity
(accuracy)
◉ Difference between a cohort and a case-control study. Answer:
Cohort studies can be used to calculate RR< incidence and/or odds
ratio. Case-control studies can be used to calculate an OR< which is
an estimate of RR when the disease prevalence is low
◉ Attributable risk?. Answer: The difference in risk in the exposed
and unexposed groups (ie, the risk that is attributable to exposure)
