200+ Free USMLE Step 2 CK Practice Questions

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A 58-year-old man presents with crushing chest pain radiating to his left arm. The pain started 30 minutes ago while he was at rest. He is diaphoretic and short of breath. Vital signs: BP 100/60 mmHg, HR 110 bpm, RR 22/min, SpO2 92% on room air. ECG shows ST-segment elevation in leads II, III, and aVF. Which is the most appropriate next step in management?

Start aspirin and clopidogrel, then perform stress testing

Immediate percutaneous coronary intervention (PCI) within 90 minutes

Administer thrombolytics and transfer to a PCI-capable center

Start heparin drip and monitor serial cardiac enzymes

to track

2026 Statistics

Key Facts: USMLE Step 2 CK Exam

~95%

Est. Pass Rate

for first-time US/Canadian MD students

Pass/Fail (minimum ~214)

Passing Score

National Board of Medical Examiners (NBME)

318

Exam Questions

National Board of Medical Examiners (NBME)

9 hours

Exam Duration

National Board of Medical Examiners (NBME)

$710

Exam Fee

National Board of Medical Examiners (NBME)

The USMLE Step 2 Clinical Knowledge has 318 questions in 9 hours, requiring Pass/Fail (minimum ~214) to pass. The estimated pass rate is ~95%. USMLE Step 2 CK assesses clinical knowledge essential for patient care under supervision. It covers internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, and preventive medicine through clinical vignettes.

Sample USMLE Step 2 CK Practice Questions

Try these sample questions to test your USMLE Step 2 CK exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 58-year-old man presents with crushing chest pain radiating to his left arm. The pain started 30 minutes ago while he was at rest. He is diaphoretic and short of breath. Vital signs: BP 100/60 mmHg, HR 110 bpm, RR 22/min, SpO2 92% on room air. ECG shows ST-segment elevation in leads II, III, and aVF. Which is the most appropriate next step in management?

A.Start aspirin and clopidogrel, then perform stress testing

B.Immediate percutaneous coronary intervention (PCI) within 90 minutes

C.Administer thrombolytics and transfer to a PCI-capable center

D.Start heparin drip and monitor serial cardiac enzymes

Explanation: This patient has an ST-elevation myocardial infarction (STEMI) based on ST elevation in the inferior leads (II, III, aVF). The standard of care is primary PCI within 90 minutes of first medical contact (door-to-balloon time). This provides superior outcomes compared to thrombolysis when available. Aspirin and clopidogrel should be given, but PCI is the priority. Stress testing is contraindicated in acute STEMI.

2A 72-year-old woman with hypertension and diabetes presents with dyspnea on exertion and orthopnea. On examination, she has bibasilar crackles, an S3 gallop, and 2+ pitting edema in her lower extremities. Echocardiography shows a left ventricular ejection fraction of 35%. Which medication has been shown to reduce mortality in this patient?

A.Digoxin

B.Furosemide

C.Lisinopril

D.Amlodipine

Explanation: This patient has heart failure with reduced ejection fraction (HFrEF). ACE inhibitors (like lisinopril) have been proven to reduce mortality in HFrEF by reducing afterload, preventing ventricular remodeling, and decreasing neurohormonal activation. Beta-blockers and mineralocorticoid receptor antagonists also reduce mortality. Digoxin improves symptoms but not mortality. Diuretics improve symptoms but do not reduce mortality.

3A 45-year-old man is brought to the emergency department with palpitations and lightheadedness. His pulse is irregularly irregular at 140 bpm. ECG shows no P waves and irregularly irregular QRS complexes. His blood pressure is 110/70 mmHg. Which of the following is the most appropriate initial management?

A.Immediate electrical cardioversion

B.Intravenous beta-blocker for rate control

C.Intravenous heparin followed by warfarin

D.Amiodarone for rhythm control

Explanation: This patient has new-onset atrial fibrillation with rapid ventricular response. Since he is hemodynamically stable (BP 110/70), immediate cardioversion is not indicated. The first step is rate control with beta-blockers or calcium channel blockers. Anticoagulation should be considered based on CHA2DS2-VASc score, but rate control is the immediate priority. Rhythm control is not superior to rate control in most patients.

4A 65-year-old man with a history of atrial fibrillation presents with sudden-onset right-sided weakness and aphasia. CT scan of the head shows no hemorrhage. The patient is outside the window for thrombolysis. Which of the following is the most appropriate next step?

A.Immediate aspirin 325 mg

B.Warfarin initiation within 24 hours

C.Emergent endovascular thrombectomy if large vessel occlusion

D.Clopidogrel loading dose

Explanation: This patient has an acute ischemic stroke likely due to cardioembolism from atrial fibrillation. For patients with large vessel occlusion and disabling deficits presenting within 6-24 hours, emergent endovascular thrombectomy is indicated. Aspirin should be given within 24-48 hours, but immediate aspirin can increase hemorrhagic conversion risk. Anticoagulation is typically delayed 7-14 days after stroke in AF patients to prevent hemorrhagic conversion.

5A 28-year-old athlete collapses during a basketball game. He is found to be pulseless. AED analysis shows ventricular fibrillation. Which of the following is the most important factor in determining survival from sudden cardiac arrest?

A.Time to defibrillation

B.Quality of bystander CPR

C.Administration of epinephrine

D.Advanced airway placement

Explanation: In ventricular fibrillation, the single most important determinant of survival is time to defibrillation. Survival decreases by approximately 7-10% for every minute without defibrillation. While high-quality CPR is important, early defibrillation is the critical intervention that can convert VF to a perfusing rhythm. Epinephrine and advanced airways are secondary interventions.

6A 55-year-old woman presents with dyspnea and fatigue. She has a harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids. The murmur decreases with handgrip and increases with standing. What is the most likely diagnosis?

A.Aortic stenosis

B.Hypertrophic cardiomyopathy

C.Mitral regurgitation

D.Aortic regurgitation

Explanation: The harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids is classic for aortic stenosis. The decrease with handgrip (which increases afterload) helps differentiate it from hypertrophic cardiomyopathy and mitral regurgitation, which would increase with handgrip. Aortic regurgitation produces a diastolic murmur, not systolic.

7A 62-year-old man with known coronary artery disease presents with episodes of chest pain occurring with exertion that are relieved by rest. He is currently pain-free. ECG shows normal sinus rhythm with Q waves in leads V1-V3. Troponins are negative. Which medication should be added to his regimen to prevent future cardiac events?

A.Nifedipine

B.Ranolazine

C.Atorvastatin (high-intensity)

D.Nitroglycerin patch

Explanation: This patient has stable angina. High-intensity statin therapy (atorvastatin 40-80 mg) is indicated for secondary prevention in patients with known CAD to reduce cardiovascular events. While nifedipine, ranolazine, and nitrates can help with symptomatic control of angina, statins have the strongest evidence for event reduction. All patients with CAD should be on high-intensity statins unless contraindicated.

8A 68-year-old man with COPD presents with increased dyspnea and productive cough with purulent sputum. He has been using his albuterol inhaler more frequently. On examination, he is tachypneic with diffuse wheezing. Which of the following findings would indicate the need for hospitalization?

A.Oxygen saturation of 88% on room air

B.Respiratory rate of 22 breaths/min

C.Use of accessory muscles

D.All of the above

Explanation: All of these findings indicate severe COPD exacerbation requiring hospitalization. Severe COPD exacerbation is characterized by: severe dyspnea, use of accessory muscles, respiratory rate >20, oxygen saturation <90%, significant comorbidities, or lack of response to outpatient therapy. These patients require hospital admission for oxygen therapy, bronchodilators, corticosteroids, and possible antibiotics.

9A 45-year-old man presents with acute-onset pleuritic chest pain and dyspnea. He recently returned from a long flight. D-dimer is elevated. CT pulmonary angiography shows a pulmonary embolism in the left pulmonary artery. His blood pressure is 110/70 mmHg and he is not hypoxic. Which is the most appropriate treatment?

A.Intravenous heparin followed by warfarin

B.Systemic thrombolysis

C.Emergent embolectomy

D.Inferior vena cava filter

Explanation: This patient has acute pulmonary embolism without hemodynamic instability (systolic BP >90 mmHg, not in shock). Anticoagulation is the standard treatment, starting with parenteral heparin (UFH or LMWH) and transitioning to warfarin or a DOAC. Systemic thrombolysis is reserved for massive PE with hemodynamic instability. IVC filters are for patients with contraindications to anticoagulation.

10A 35-year-old woman with asthma presents with wheezing and shortness of breath. Peak expiratory flow is 40% of predicted. She has been using her albuterol inhaler every 2 hours without relief. Arterial blood gas shows pH 7.48, PCO2 32, PO2 70. Which of the following is the most appropriate next step?

A.Discharge with oral corticosteroids

B.Inhaled corticosteroids and follow-up in 24 hours

C.Hospital admission for systemic corticosteroids and monitoring

D.Intubation and mechanical ventilation

Explanation: This patient has severe asthma exacerbation (peak flow <50% predicted) not responding to home treatment. The normal or low PCO2 in severe asthma is a warning sign because asthmatics typically hyperventilate with low PCO2. A normal or elevated PCO2 indicates impending respiratory failure. This patient requires hospital admission for systemic steroids, frequent bronchodilators, and close monitoring.

About the USMLE Step 2 CK Exam

USMLE Step 2 CK assesses clinical knowledge essential for patient care under supervision. It covers internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, and preventive medicine through clinical vignettes.

Questions

318 scored questions

Time Limit

9 hours

Passing Score

Pass/Fail (minimum ~214)

Exam Fee

$710 (National Board of Medical Examiners (NBME) / FSMB)

USMLE Step 2 CK Exam Content Outline

25%

Clinical Knowledge & Assessment

Core knowledge, patient assessment, diagnostic interpretation, and clinical reasoning

25%

Patient Care & Procedures

Treatment protocols, procedural skills, pharmacology, and evidence-based interventions

20%

Safety & Compliance

Patient safety, infection control, regulatory standards, and quality assurance

15%

Professional Practice

Ethics, scope of practice, communication, and interdisciplinary collaboration

15%

Specialized Topics

Domain-specific advanced topics, emerging practices, and population-specific considerations

How to Pass the USMLE Step 2 CK Exam

What You Need to Know

Passing score: Pass/Fail (minimum ~214)
Exam length: 318 questions
Time limit: 9 hours
Exam fee: $710

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

USMLE Step 2 CK Study Tips from Top Performers

1Focus on the highest-weighted content areas first — they represent the most exam questions

2Complete at least 200 practice questions and review explanations for every missed item

3Study in focused 1-2 hour blocks with active recall and spaced repetition

4Review clinical guidelines and evidence-based practice standards relevant to this credential

5Take at least two full-length timed practice exams before your scheduled test date

Frequently Asked Questions

What is the USMLE Step 2 CK exam passing score?

The USMLE Step 2 Clinical Knowledge requires a score of Pass/Fail (minimum ~214) to pass. The exam has 318 questions in 9 hours. The estimated pass rate is ~95%.

How hard is the USMLE Step 2 CK exam?

The USMLE Step 2 Clinical Knowledge is considered moderately challenging with an estimated pass rate of ~95%. Candidates with clinical experience and structured study plans typically perform well. Plan for 60-120 hours of dedicated study.

How long should I study for the USMLE Step 2 CK?

Most candidates study for 6-12 weeks, investing 60-120 hours. Focus on content areas with the highest exam weight, complete practice questions, and review explanations for missed items.

What is the USMLE Step 2 CK exam fee?

The exam fee is $710. The exam is administered by National Board of Medical Examiners (NBME) / FSMB. Check the official website for the most current pricing and scheduling information.