Free USMLE Step 2 CK: Clinical Knowledge Exam Questions and Answers

A 58-year-old man has 40 minutes of crushing chest pain. ECG shows ST elevation in leads II, III and aVF. Which artery is most likely occluded?

• AA. Left circumflex artery
• BB. Left main coronary artery
• CC. Right coronary artery
• DD. First diagonal branch
• EE. Left anterior descending artery

A 24-year-old tall, thin man develops sudden dyspnea after a motor vehicle collision. He is hypotensive, tachycardic, has absent breath sounds on the right, distended neck veins and tracheal deviation to the left. What is the next step?

• AA. Observation with supplemental oxygen
• BB. Immediate needle decompression of the right chest
• CC. CT angiography of the chest
• DD. Chest radiograph
• EE. Intubation without further intervention

A 62-year-old woman has fever, jaundice, right upper quadrant pain, confusion and blood pressure of 85/50 mm Hg. Ultrasound shows a dilated common bile duct. Which is the most appropriate management?

• AA. Liver biopsy
• BB. IV fluids and antibiotics, then urgent biliary decompression by ERCP
• CC. Oral ursodeoxycholic acid
• DD. Elective cholecystectomy next month
• EE. Observation with analgesia

A 7-year-old boy has cola-colored urine, periorbital edema and hypertension 2 weeks after a sore throat. C3 is low. Which finding is expected on immunofluorescence of a renal biopsy?

• AA. Spike and dome appearance with silver stain only
• BB. Mesangial IgA deposits only
• CC. Linear IgG deposits along the basement membrane
• DD. Granular IgG and C3 deposits
• EE. No immune deposits

A 19-year-old with type 1 diabetes presents with glucose 520 mg/dL, pH 7.10, positive serum ketones and potassium 2.9 mEq/L. Fluids have started. What is the next best step?

• AA. Start insulin infusion immediately
• BB. Give IV potassium and delay insulin until potassium is above 3.3 mEq/L
• CC. Give sodium bicarbonate
• DD. Give subcutaneous insulin only
• EE. Stop fluids

A 70-year-old man has sudden aphasia and right arm weakness that began 2 hours ago. BP is 170/95 mm Hg, glucose is normal, and noncontrast head CT shows no hemorrhage. What is the most appropriate treatment?

• AA. Aspirin only
• BB. IV alteplase
• CC. IV heparin
• DD. Labetalol to reduce BP below 120/80 mm Hg
• EE. Wait for MRI before any treatment

A 4-year-old has petechiae and bruises 2 weeks after a viral illness. He is otherwise well, with platelets 15,000/uL, normal hemoglobin and white count, and no mucosal bleeding. What is the most appropriate management?

• AA. Observation with activity restriction and follow-up
• BB. Bone marrow transplant
• CC. Emergency splenectomy
• DD. Long-term high-dose prednisone
• EE. Platelet transfusion

A 28-year-old woman at 35 weeks has a severe headache, BP 168/112 mm Hg, 3+ proteinuria and brisk reflexes. What is the most appropriate management?

• AA. Bed rest until 40 weeks
• BB. IV magnesium sulfate, antihypertensive therapy and plan delivery
• CC. Diazepam only
• DD. Furosemide only
• EE. Oral acetaminophen and discharge

A 26-year-old Rh(D)-negative woman at 28 weeks has a negative antibody screen. The father is Rh-positive. What is indicated?

• AA. No intervention until delivery
• BB. Induction of labor
• CC. Rh immune globulin now
• DD. Weekly amniocentesis
• EE. Intrauterine transfusion

A 40-year-old man stable on lithium for bipolar disorder develops tremor, ataxia and vomiting after a new drug was added for hypertension. Which drug most likely caused this?

• AA. Atorvastatin
• BB. Levothyroxine
• CC. Omeprazole
• DD. Hydrochlorothiazide
• EE. Amlodipine