USMLE EXAM zm
Exam Solution zm
USMLE Step 2 CK 2026 A+ GRADE ASSURED COMPLETE zm zm zm zm zm zm zm zm z
SOLUTIONS AND VERIFIED ANSWERS (A3B79)
m zm zm zm zm
QUESTION 1 zm
Slipped Capital Femoral Epiphysis Ice Cream falling Frog-Leg Lateral X-
zm zm zm zm zm zm zm zm zm
Ray shows Epiphyseal displacement Requires immediate surgical screw fixation to red
zm zm zm zm zm zm zm zm zm zm
uce risk of AVN SCFE
zm zm zm zm
ANSWER
Obese Teen Child with dull hip PAIN or referred knee pain and a painful limp with restricted ROM
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
and inability to bear weight on exam has limited rotation and abduction of the hip Diagnosis & Tx?
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 2 zm
Legg-Calve-
Perthes Disease or Idiopathic Osteonecrosis (avascular necrosis) of the femoral epiphy
zm zm zm zm zm zm zm zm zm zm
sis. - zm
Flattened and fragmented femoral head on radiograph Tx: Mild: Observation Moderate
zm zm zm zm zm zm zm zm zm zm
: bracing, hip abduction with a petrie cast Extensive: osteotomy
zm zm zm zm zm zm zm zm zm
ANSWER
Chronic, progressive leg pain and limp in a 3-
zm zm zm zm zm zm zm zm
12 yo Boy Limited abduction and internal rotation. Atrophy of proximal thigh muscles. Diagnosis &
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
Tx?
QUESTION 3 zm
Aortic Stenosis Most common causes: 1. senile calcific aortic stenosis (Elderly) 2. bicus
zm zm zm zm zm zm zm zm zm zm zm zm
pid aortic valve (<70 yo) 3. rheumatic heart disease high resistance generated by sten
zm zm zm zm zm zm zm zm zm zm zm zm zm
osed aortic valve causes concentric hypertrophy and stiffening of the left ventricle (S4
zm zm zm zm zm zm zm zm zm zm zm zm
) leading to CHF.
zm zm zm
ANSWER
,Pulsus Parvus (decreased pulse amplitude) and Pulsus Tardus (delayed pulse upstroke) (weak, delay
zm zm zm zm zm zm zm zm zm zm zm zm
ed carotid upstroke) and a single or paradoxically split S2 sound; systolic murmur radiating to the c
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
arotids. associated with what cardiac defect?
zm zm zm zm zm
QUESTION 4 zm
Aortic Regurgitation Congenital Bicuspid Aortic Valve Rheumatic Heart Disease Endoca
zm zm zm zm zm zm zm zm zm
rditis Aortic Root Dilation (Marfan & Syphilis) -
zm zm zm zm zm zm zm
Tx: Vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation u
zm zm zm zm zm zm zm zm zm zm
ntil symptoms become severe enough to warrant valve replacement
zm zm zm zm zm zm zm zm
ANSWER
Bounding or "water hammer" pulses with widened pulse pressure and head bob with heartbeat are
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
associated with what cardiac defect? Common etiologies? Treatment?
zm zm zm zm zm zm zm
QUESTION 5 zm
Meniscal tear -MRI for diagnosis -Mild, older patient: REST, NSAID -
zm zm zm zm zm zm zm zm zm zm
Impaired activity, young: SURGERYzm zm zm
ANSWER
Acute popping sensation in knee with catching, and locking and slow onset joint effusion Patient co
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
mplains of sensation of instability with joint line tenderness on exam. What is the Problem, Diagnosi
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
s, and Management?
zm zm
QUESTION 6 zm
Pyloric stricture - zm zm
Upper Endoscopy required to confirm diagnosis and treatment is surgical. -
zm zm zm zm zm zm zm zm zm zm
Common causes of GASTRIC OUTLET OBSTRUCTION: Gastric malignancy, PUD, Crohns,
zm zm zm zm zm zm zm zm zm zm
Strictures from caustic ingestion, gastric bezoars.
zm zm zm zm zm
ANSWER
postprandial pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested acid 3
zm zm zm zm zm zm zm zm zm zm zm zm zm
months ago. diagnosis? common causes?
zm zm zm zm
QUESTION 7 zm
Diabetic gastroparesis -Treat w/pro-
zm zm zm
motility agent such as metoclopramide, exercise, & low fat diet -
zm zm zm zm zm zm zm zm zm zm
Gastric Emptying study would be helpful in evaluating
zm zm zm zm zm zm zm
ANSWER
,Chronic nausea, vomiting and early satiety in a chronic diabetic. What is the diagnosis? How is it tre
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
ated?
QUESTION 8 zm
Friedreich's ataxia AR (loss of function trinucleotide repeat (GAA) in Frataxin gene Mo
zm zm zm zm zm zm zm zm zm zm zm zm
rtality due to cardiac dysfunction (hypertrophic cardiomyopathy) Genetic testing requi
zm zm zm zm zm zm zm zm zm
red to confirm diagnosis. Management is supportive as no disease modifying therapies
zm zm zm zm zm zm zm zm zm zm zm
are available.
zm zm
ANSWER
Adolescent with progressive gait instability, dysarthria, wide based gait, marked atrophy of medulla
zm zm zm zm zm zm zm zm zm zm zm zm zm
and dorsal columns of the spinal cord (loss of vibration and position sense), and scoliosis. What is t
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
he diagnosis? Risk of mortality?
zm zm zm zm
QUESTION 9 zm
TRACHOMA (due to Chlamydia trachomatis) Treat with Oral Azithromycin
zm zm zm zm zm zm zm zm
ANSWER
Child with conjunctival injection, watery discharge, tarsal inflammation, and pale follicles. As well as
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
rhinorrhea, Pharyngitis. Diagnosis? Cause? Treatment?
zm zm zm zm
QUESTION 10 zm
Gonococcal conjunctivitis zm
ANSWER
Conjunctival injection, eye discharge and swollen eyelids 2-5 days after birth?
zm zm zm zm zm zm zm zm zm zm
QUESTION 11 zm
Chlamydial conjunctivitis zm
ANSWER
Conjunctival injection, eye discharge and swollen eyelids 5-14 days after birth?
zm zm zm zm zm zm zm zm zm zm
QUESTION 12 zm
Orbital cellulitis (Infection posterior to orbital septum) Most common risk factor = SI
zm zm zm zm zm zm zm zm zm zm zm zm
NUSITIS (ethmoid or maxillary) NEED CT SCAN OF ORBITS AND SINUSES IV ABX mains
zm zm zm zm zm zm zm zm zm zm zm zm zm
tay of tx and drainage
zm zm zm zm
ANSWER
, Abrupt onset of fever, proptosis, restriction of extra ocular movements, swollen, red eyelids. Unilater
zm zm zm zm zm zm zm zm zm zm zm zm zm
al. Paranasal sinus infection. Diagnosis?
zm zm zm zm
QUESTION 13 zm
Tardive Dyskinesia Dopamine receptor upregulation and supersensitivity, from chroni
zm zm zm zm zm zm zm zm
c blockade of dopamine receptors. From first generation antipsychotics (potent D2 blo
zm zm zm zm zm zm zm zm zm zm zm
ckers). Tx: Discontinue med, Switch to second gen antipsychotic (Clozapine), treat wit
zm zm zm zm zm zm zm zm zm zm zm
h Valbenazine (Vesicular Monoamine Transporter 2 Inhibitor)
zm zm zm zm zm zm
ANSWER
Patient with hx of Schizoaffective disorder on treatment. Presenting with orofacial dyskinesia (rhyth
zm zm zm zm zm zm zm zm zm zm zm zm
mic movements of face, smacking lips, sticking out tongue) and choreoathetoid movement of trunk a
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
nd extremities Underlying cause? How to treat it?
zm zm zm zm zm zm zm
QUESTION 14 zm
Huntington's disease ATROPHY of the CAUDATE AD 30-50yozm zm zm zm zm zm zm
ANSWER
Choreiform movements (facial grimacing, ataxia, dystonia, tongue protrusion, writhing movements), P
zm zm zm zm zm zm zm zm zm zm
sychiatric symptoms, dementia. Caudate nucleus atrophy on MRI. Diagnosis?
zm zm zm zm zm zm zm zm
QUESTION 15 zm
imperforate hymen Hymenal incision and drainage zm zm zm zm zm
ANSWER
Cyclic lower abdominal pain Bulk symptoms (defecatory and urinary dysfunction) Primary amenorrh
zm zm zm zm zm zm zm zm zm zm zm
ea Suprapubic mass Blue tinged vaginal mass (Hematocolpos). Diagnosis and treatment?
zm zm zm zm zm zm zm zm zm zm
QUESTION 16 zm
missed abortion zm
ANSWER
No vaginal bleeding Closed Cervical Os No fetal cardiac activity or empty sac Type of Miscarriage?
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 17 zm
threatened abortion zm
ANSWER
Exam Solution zm
USMLE Step 2 CK 2026 A+ GRADE ASSURED COMPLETE zm zm zm zm zm zm zm zm z
SOLUTIONS AND VERIFIED ANSWERS (A3B79)
m zm zm zm zm
QUESTION 1 zm
Slipped Capital Femoral Epiphysis Ice Cream falling Frog-Leg Lateral X-
zm zm zm zm zm zm zm zm zm
Ray shows Epiphyseal displacement Requires immediate surgical screw fixation to red
zm zm zm zm zm zm zm zm zm zm
uce risk of AVN SCFE
zm zm zm zm
ANSWER
Obese Teen Child with dull hip PAIN or referred knee pain and a painful limp with restricted ROM
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
and inability to bear weight on exam has limited rotation and abduction of the hip Diagnosis & Tx?
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 2 zm
Legg-Calve-
Perthes Disease or Idiopathic Osteonecrosis (avascular necrosis) of the femoral epiphy
zm zm zm zm zm zm zm zm zm zm
sis. - zm
Flattened and fragmented femoral head on radiograph Tx: Mild: Observation Moderate
zm zm zm zm zm zm zm zm zm zm
: bracing, hip abduction with a petrie cast Extensive: osteotomy
zm zm zm zm zm zm zm zm zm
ANSWER
Chronic, progressive leg pain and limp in a 3-
zm zm zm zm zm zm zm zm
12 yo Boy Limited abduction and internal rotation. Atrophy of proximal thigh muscles. Diagnosis &
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
Tx?
QUESTION 3 zm
Aortic Stenosis Most common causes: 1. senile calcific aortic stenosis (Elderly) 2. bicus
zm zm zm zm zm zm zm zm zm zm zm zm
pid aortic valve (<70 yo) 3. rheumatic heart disease high resistance generated by sten
zm zm zm zm zm zm zm zm zm zm zm zm zm
osed aortic valve causes concentric hypertrophy and stiffening of the left ventricle (S4
zm zm zm zm zm zm zm zm zm zm zm zm
) leading to CHF.
zm zm zm
ANSWER
,Pulsus Parvus (decreased pulse amplitude) and Pulsus Tardus (delayed pulse upstroke) (weak, delay
zm zm zm zm zm zm zm zm zm zm zm zm
ed carotid upstroke) and a single or paradoxically split S2 sound; systolic murmur radiating to the c
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
arotids. associated with what cardiac defect?
zm zm zm zm zm
QUESTION 4 zm
Aortic Regurgitation Congenital Bicuspid Aortic Valve Rheumatic Heart Disease Endoca
zm zm zm zm zm zm zm zm zm
rditis Aortic Root Dilation (Marfan & Syphilis) -
zm zm zm zm zm zm zm
Tx: Vasodilator therapy (dihydropyridines or ACEIs) for isolated aortic regurgitation u
zm zm zm zm zm zm zm zm zm zm
ntil symptoms become severe enough to warrant valve replacement
zm zm zm zm zm zm zm zm
ANSWER
Bounding or "water hammer" pulses with widened pulse pressure and head bob with heartbeat are
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
associated with what cardiac defect? Common etiologies? Treatment?
zm zm zm zm zm zm zm
QUESTION 5 zm
Meniscal tear -MRI for diagnosis -Mild, older patient: REST, NSAID -
zm zm zm zm zm zm zm zm zm zm
Impaired activity, young: SURGERYzm zm zm
ANSWER
Acute popping sensation in knee with catching, and locking and slow onset joint effusion Patient co
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
mplains of sensation of instability with joint line tenderness on exam. What is the Problem, Diagnosi
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
s, and Management?
zm zm
QUESTION 6 zm
Pyloric stricture - zm zm
Upper Endoscopy required to confirm diagnosis and treatment is surgical. -
zm zm zm zm zm zm zm zm zm zm
Common causes of GASTRIC OUTLET OBSTRUCTION: Gastric malignancy, PUD, Crohns,
zm zm zm zm zm zm zm zm zm zm
Strictures from caustic ingestion, gastric bezoars.
zm zm zm zm zm
ANSWER
postprandial pain, vomiting with early satiety. Abdominal succussion splash. Patient ingested acid 3
zm zm zm zm zm zm zm zm zm zm zm zm zm
months ago. diagnosis? common causes?
zm zm zm zm
QUESTION 7 zm
Diabetic gastroparesis -Treat w/pro-
zm zm zm
motility agent such as metoclopramide, exercise, & low fat diet -
zm zm zm zm zm zm zm zm zm zm
Gastric Emptying study would be helpful in evaluating
zm zm zm zm zm zm zm
ANSWER
,Chronic nausea, vomiting and early satiety in a chronic diabetic. What is the diagnosis? How is it tre
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
ated?
QUESTION 8 zm
Friedreich's ataxia AR (loss of function trinucleotide repeat (GAA) in Frataxin gene Mo
zm zm zm zm zm zm zm zm zm zm zm zm
rtality due to cardiac dysfunction (hypertrophic cardiomyopathy) Genetic testing requi
zm zm zm zm zm zm zm zm zm
red to confirm diagnosis. Management is supportive as no disease modifying therapies
zm zm zm zm zm zm zm zm zm zm zm
are available.
zm zm
ANSWER
Adolescent with progressive gait instability, dysarthria, wide based gait, marked atrophy of medulla
zm zm zm zm zm zm zm zm zm zm zm zm zm
and dorsal columns of the spinal cord (loss of vibration and position sense), and scoliosis. What is t
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
he diagnosis? Risk of mortality?
zm zm zm zm
QUESTION 9 zm
TRACHOMA (due to Chlamydia trachomatis) Treat with Oral Azithromycin
zm zm zm zm zm zm zm zm
ANSWER
Child with conjunctival injection, watery discharge, tarsal inflammation, and pale follicles. As well as
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
rhinorrhea, Pharyngitis. Diagnosis? Cause? Treatment?
zm zm zm zm
QUESTION 10 zm
Gonococcal conjunctivitis zm
ANSWER
Conjunctival injection, eye discharge and swollen eyelids 2-5 days after birth?
zm zm zm zm zm zm zm zm zm zm
QUESTION 11 zm
Chlamydial conjunctivitis zm
ANSWER
Conjunctival injection, eye discharge and swollen eyelids 5-14 days after birth?
zm zm zm zm zm zm zm zm zm zm
QUESTION 12 zm
Orbital cellulitis (Infection posterior to orbital septum) Most common risk factor = SI
zm zm zm zm zm zm zm zm zm zm zm zm
NUSITIS (ethmoid or maxillary) NEED CT SCAN OF ORBITS AND SINUSES IV ABX mains
zm zm zm zm zm zm zm zm zm zm zm zm zm
tay of tx and drainage
zm zm zm zm
ANSWER
, Abrupt onset of fever, proptosis, restriction of extra ocular movements, swollen, red eyelids. Unilater
zm zm zm zm zm zm zm zm zm zm zm zm zm
al. Paranasal sinus infection. Diagnosis?
zm zm zm zm
QUESTION 13 zm
Tardive Dyskinesia Dopamine receptor upregulation and supersensitivity, from chroni
zm zm zm zm zm zm zm zm
c blockade of dopamine receptors. From first generation antipsychotics (potent D2 blo
zm zm zm zm zm zm zm zm zm zm zm
ckers). Tx: Discontinue med, Switch to second gen antipsychotic (Clozapine), treat wit
zm zm zm zm zm zm zm zm zm zm zm
h Valbenazine (Vesicular Monoamine Transporter 2 Inhibitor)
zm zm zm zm zm zm
ANSWER
Patient with hx of Schizoaffective disorder on treatment. Presenting with orofacial dyskinesia (rhyth
zm zm zm zm zm zm zm zm zm zm zm zm
mic movements of face, smacking lips, sticking out tongue) and choreoathetoid movement of trunk a
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
nd extremities Underlying cause? How to treat it?
zm zm zm zm zm zm zm
QUESTION 14 zm
Huntington's disease ATROPHY of the CAUDATE AD 30-50yozm zm zm zm zm zm zm
ANSWER
Choreiform movements (facial grimacing, ataxia, dystonia, tongue protrusion, writhing movements), P
zm zm zm zm zm zm zm zm zm zm
sychiatric symptoms, dementia. Caudate nucleus atrophy on MRI. Diagnosis?
zm zm zm zm zm zm zm zm
QUESTION 15 zm
imperforate hymen Hymenal incision and drainage zm zm zm zm zm
ANSWER
Cyclic lower abdominal pain Bulk symptoms (defecatory and urinary dysfunction) Primary amenorrh
zm zm zm zm zm zm zm zm zm zm zm
ea Suprapubic mass Blue tinged vaginal mass (Hematocolpos). Diagnosis and treatment?
zm zm zm zm zm zm zm zm zm zm
QUESTION 16 zm
missed abortion zm
ANSWER
No vaginal bleeding Closed Cervical Os No fetal cardiac activity or empty sac Type of Miscarriage?
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 17 zm
threatened abortion zm
ANSWER
