Official Step 2 CK Practice Exam - Answers & Explanations

Updated: Aug 28, 2020

Practice exam:

Please note: The HY Medicine is in no way affiliated with the Federation of State

Medical Boards (FSMB) or the National Board of Medical Examiners® (NBME®)


1) Alcohol

• Alcohol → ↑ GGT

2) Herpes Zoster • Vesicular rash in a dermatomal distribution • Shingles can be triggered by severe physical stress (eg, chemotherapy) or immunosuppressed states

3) Haemophilus ducreyi • Multiple ulcers with gray/yellow exudate • Chancroid (H ducreyi) and HSV present with painful initial lesions; Granuloma inguinal (Klebsiella granulomatis), Syphilis (Treponemia pallidum), and Lymphogranuloma venereum (C trachomatis) do not have initial painful lesions

4) Excision of the lesion

• This lesion is concerning for cancer and should be completely excised

5) Adverse effects of medication • ACEi (eg, lisinopril) and potassium-sparing diuretics (eg, spironolactone) → hyperkalemia

6) Compression of the lateral femoral cutaneous nerve • Lateral femoral cutaneous nerve provides sensory innervation to the anterior and lateral thigh • Hematoma → compression of the lateral femoral cutaneous nerve → ↓ sensation (hematoma doesn’t directly cause ↓ sensation, but rather through nerve compression)

7) Reassurance • Moro reflex is normal until ~4 months

8) Ultrasonography of the upper abdomen • Intermittent, acute RUQ pain in an obese woman = biliary colic • RUQ ultrasound → visualization of biliary stones; HIDA scan is useful when U/S findings are equivocal • Tx: Elective cholecystectomy

9) Arteriovenous fistula

• Post-traumatic AV fistula → continuous bruit (→ buzzing sensation) + palpable thrill + no mass

• DDx: pseudoaneurysm → systolic bruit + pulsatile mass

10) Ultrasonography

• Ultrasound should be used to accurately assess this woman gestational age (LMP unknown)

• The most common cause of abnormal MSAFP is incorrect dating (ie, underestimation of gestational age)

11) Thrombotic thrombocytopenic purpura • Pentad: fever, microangiopathic hemolytic anemia (→ ↑ LDH & fragmented erythrocytes), thrombocytopenia (→ scattered petechiae), acute kidney injury (↑ BUN & creatinine), neurologic symptoms (confusion)

12) Systemic lupus erythematosus • ⊕ ANA (sensitive) and ⊕ anti-DNA (specific) = SLE

13) Measurement of serum insulin and C-peptide concentrations • Hypoglycemia in a nurse is suspicious for factitious disorder imposed on self (aka Munchausen syndrome)

• Exogenous insulin use: ↑ serum insulin, ↓ C-peptide

• C-peptide level helps distinguish exogenous insulin use from insulinoma (high C- peptide)

14) Exercise and weight reduction program

• In obese individuals, the most effective non-pharmacologic approach to reduce blood pressure is weight loss

• Urinalysis and renal U/S exclude renal HTN (eg, fibromuscular dysplasia, Conn syndrome)

15) Mastoiditis

• Complication of acute otitis media → otalgia, deviation of ear, inflammation of mastoid

• Tx: IV antibiotics

16) Vasculitis • Granulomatosis with polyangiitis (Wegener) → upper respiratory tract (eg, sinus congestion), lower respiratory tract (eg, cough + sputum), and renal (eg, hematuria, ↑ BUN & creatinine) involvement

• ⊕ c-ANCA • Tx: cyclophosphamide, corticosteroids

17) Decreased gluconeogenesis • Von Gierke disease: deficiency of glucose-6-phosphatase → inability of liver to regulate blood glucose → hepatomegaly + severe fasting hypoglycemia

18) Ventilation-perfusion mismatch • Pulmonary embolism → pleuritic chest pain, shortness of breath, tachypnea

19) Endometriosis

• Dysmenorrhea + Infertility

• Presence of secretory endometrium rules out anovulation; Progesterone (secreted by the corpus luteum during ovulatory cycles) → differentiation of proliferative endometrium into secretory endometrium

20) Decreasing myocardial contractility • β-bockers (and ynon-dihydropyradine CCBs) → ↓ contractility & heart rate → ↓ myocardial O2 demand

21) Alcohol withdrawal

• Agitation, tremulousness, uncooperative, and lack of orientation after an unexpected admission to the hospital (unanticipated detox) • DDx: fate embolism → respiratory distress, petechial rash, neurologic dysfunction

22) Dermatomysositis • Proximal muscle weakness + Gottron papules (flat-topped red papules over all knuckles) + heliotrope rash (purple-red discoloration over the