USMLE® Step 2 CK Qbank – Highlights
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Free USMLE Step 2 CK Sample Questions
A 10-year-old boy is brought to a family physician by his mother with a history of recurrent headaches. The headaches are moderate-to-severe in intensity, unilateral, mostly affecting the left side, and pulsatile in nature. Past medical history is significant for mild mental retardation and complex partial seizures sometimes leading to secondary generalized seizures. He was adopted at the age of 7 days. His birth history and family history are not available. His developmental milestones were slightly delayed. There is no history of fever or head trauma. Physical examination reveals normal vital signs. His height and weight are at the 67th and 54th percentile for his age. An area of bluish discoloration is seen on his left eyelids and cheek. The rest of the examination is within normal limits. A computed tomography (CT) scan of his head is shown in the exhibit. Which of the following additional clinical findings would you expect to be present?
- Ash leaf spots
- Café-au-lait spots
- Charcot-Bouchard aneurysm
- Iris hamartoma
A 65-years-old man comes to the physician with a low-grade fever, fatigue, and anorexia for the past 10 days. The patient denies any chest pain, cough, or shortness of breath. He is a smoker for last 10 years and consumes alcohol occasionally. His past medical history is significant for colorectal carcinoma. His temperature is 38.3°C (101.0°F), blood pressure is 130/90 mm Hg and pulse is 100/min. Physical examination shows reddish-brown spots under his nail bed (as shown in the exhibit) and tender erythematous fingers tips. Cardiac auscultation reveals a new holosystolic murmur best heard at the apex with no radiation. Chest X-ray, electrocardiogram, and urinalysis are normal. Which one of the following is best next step in diagnosing this patient’s condition?
- Obtain anti-CCP antibody titers
- Obtain blood samples for blood culture
- Initiate empiric antibiotics
- Reassurance and symptomatic management
A 23-year-old man comes to the emergency department presenting with sudden-onset dyspnea and right-sided chest pain over the last hour. This event started when he was in class sitting for an exam. He reports that the pain is worse with inspiration and does not radiate. He says he has anxiety and takes alprazolam as needed. His paternal uncle died of an aortic dissection at age 42. He smokes half a pack of cigarettes a day and drinks alcohol socially. Temperature is 36.7°C (98.0°F), blood pressure is 130/80 mm Hg, pulse is 82/min, and respiration rate is 14/min. Pulse oximetry shows 97% on room air. The patient’s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m2. A chest X-ray is taken (see exhibit). After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication. Which of the following is the most appropriate further management of this patient?
- Needle thoracostomy
- Arterial blood gas
- IV antibiotics
- Supplemental oxygen
- CT angiogram of chest
- Lorazepam and follow-up with psychiatry
An otherwise healthy 37-year-old man has a routine full blood count done prior to donating blood for the first time. The results are:
|Mean corpuscular volume (MCV)||82 μm3|
|Mean corpuscular hemoglobin concentration (MCHC)||42%|
|White blood cell count||8,700/mm3|
A peripheral blood smear is shown in the picture below. On physical examination, his spleen is just palpable. Direct antiglobulin test (DAT) is negative. Which of the following best represents the etiology of this patient’s condition?
- Bone marrow hypocellularity
- Inherited membrane abnormality of red cells
- Microangiopathic process
- Immune-mediated hemolysis
- Oxidant hemolysis
A 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and ‘bruising on his feet’. The patient states that his symptoms started about a week ago and have steadily worsened. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the umbilical region. Past medical history is significant for 2 transient ischemic attacks 6 months prior, characterized by a sudden right-sided weakness and trouble speaking but recovered fully within 30 minutes. Current medications are sildenafil 100 mg orally as needed. Patient reports a 30-pack-year smoking history and heavy alcohol use on the weekends. Review of systems is significant for decreased appetite and feeling easily full. Vitals are temperature 37°C (98.6°F), blood pressure 155/89 mm Hg, pulse 89/min, respirations 16/min, and oxygen saturation 98% on room air. On physical examination, the patient is alert and cooperative. The cardiac exam is normal. Lungs are clear to auscultation. Carotid bruit present on the right. The abdomen is soft and non-tender. Bowel sounds present. A pulsatile abdominal mass is felt in the lower umbilical region. Patient’s feet have the following appearance seen in the picture. Abdominal ultrasound reveals the presence of an abdominal aortic aneurysm (AAA). Contrast CT reveals a small, unruptured AAA (diameter 4.1 cm). High flow supplemental oxygen and fluid resuscitation are initiated. Morphine sulfate and metoprolol are administered. Which of the following is the best course of treatment for this patient?
- Discharge with clinical surveillance and annual ultrasound
- Discharge with clinical surveillance and ultrasound every 6 months
- Elective endovascular repair
- Elective open surgical repair
- Emergency open surgical repair
A 32-year-old Caucasian female is referred to a gastroenterologist by her family physician for 8 months of abdominal pain, foul-smelling diarrhea with floating, bulky stools, weight loss, and macrocytic anemia. Her personal history is relevant for allergic rhinitis. Physical examination shows grouped, erythematous papulovesicular lesions on her arms, torso, and abdomen. Which of the following is the most appropriate approach to the management of this patient?
- Lactose-free diet
- Gluten-free diet
- Methysergide maleate
A 17-year-old male presents to his primary care physician with bilateral tremor of the hands. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months in that he has frequent episodes of depression, separated by episodes of bizarre behavior, including excessive alcohol drinking and shoplifting. His parents have begun to suspect him of using street drugs, which he denies. His handwriting has become very sloppy. His parents have noted slight slurring of his speech. Family history is irrelevant. Physical examination reveals upper extremity tremors, mild dystonia of the upper extremities and mild incoordination involving his hands. The patient eye is shown. Which of the following is the best initial management of this patient’s condition?
- Liver transplantation
- Oral zinc
- Oral deferasirox
- Watchful waiting
A 33-year-old man is brought to the emergency department by his partner for 24 hours of fever, severe headache, and neck stiffness. His companion also comments that he has been vomiting several times in the past 8 hours and looks confused. His personal medical history is unremarkable. Upon examination, he is found with fever but has stable vital signs; there is no rash or any other skin lesions, his lung sounds are clear and symmetrical. There is nuchal rigidity, jolt accentuation of a headache, and photophobia. A lumbar puncture is taken, and cerebrospinal fluid (CSF) is sent for analysis and a Gram stain (shown in the picture). The patient is put on empirical antimicrobial therapy with ceftriaxone and vancomycin. According to the clinical manifestations and Gram stain, which of the following should be considered in the management of this case?
- Addition of ampicillin
- Prophylaxis with rifampin for close contacts
- Switch to meropenem
- Initiation of amphotericin
- Initiation rifampin, isoniazid, pyrazinamide, and ethambutol
A 9-year-old girl is brought to her pediatrician by her mother for evaluation of seizures. She has had 2 episodes of generalized tonic-clonic seizures in the past 3 days. Each episode lasted for 1–2 minutes and aborted spontaneously. There is no history of fever, headache, altered behavior, diarrhea, vomiting, or previous seizures. Past medical history is unremarkable. Physical examination reveals a blood pressure of 102/64 mm Hg, a heart rate of 89/min, a respiratory rate of 16/min, and a temperature of 37.0°C (98.6°F). She looks anxious but oriented to time and space. Multiple flat hyperpigmented spots are present over her body, each more than 5 mm in diameter. Axillary freckling is present. Cranial nerves are intact. Muscle strength is normal in all 4 limbs with a normal sensory examination. Gait is normal. An eye examination is shown in the exhibit. What is the most likely diagnosis?
- Neurofibromatosis type 2
- Sturge-Weber disease
- Tuberous sclerosis
- Von Recklinghausen disease
- Wilson disease
A 32-year-old female presents with acute-onset abdominal pain accompanied by nausea, vomiting, and hematuria. She is currently taking glipizide for type 2 diabetes. Past medical history is also significant for lactose intolerance. She has just started marathon training this summer. She drinks a lot of Gatorade to replenish her electrolytes and eats a high protein diet to assist in muscle recovery. She admits to using laxatives sporadically to help her manage her weight. On physical exam the patient appears distressed and has difficulty getting comfortable. Vital signs are 36.8°C (98.2°F), heart rate 103/min, respiratory rate 15/min, blood pressure 105/85 mm Hg, breathing 100% oxygen on room air. CBC, CMP, and urinalysis are ordered. Renal ultrasound demonstrates an obstruction at the ureteropelvic junction (see image). Which of the following is also a likely component to the patient’s presentation?
- Edema and anuria—bilateral obstruction renal failure
- Flank pain that doesn’t radiate to the groin
- Colicky pain radiating to the groin-distal ureter
- Rebound tenderness, pain exacerbated by coughing – peritoneal signs
- Positional urinary retention-bladder stones