USMLE Step 2 CK Exam Practice
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 65-year-old man with hypertension presents with sudden onset
chest pain radiating to the back. Blood pressure is 180/100 in the right
arm and 150/90 in the left arm. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. GERD
Answer: C. Aortic dissection
Rationale: Sudden tearing chest pain with unequal blood pressures
between arms strongly suggests aortic dissection.
2. A 23-year-old woman presents with fatigue, pallor, and spoon-shaped
nails. Labs show microcytic hypochromic anemia. Most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Sickle cell disease
D. Aplastic anemia
E. Thalassemia major
,Answer: B. Iron deficiency anemia
Rationale: Koilonychia (spoon nails) and microcytic anemia are classic for
iron deficiency.
3. A patient presents with fever, flank pain, and dysuria. Urinalysis shows
WBC casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Kidney stones
E. Prostatitis
Answer: B. Pyelonephritis
Rationale: WBC casts indicate upper urinary tract infection involving the
kidney.
4. A 55-year-old smoker has chronic cough and barrel chest. What is the
most likely diagnosis?
A. Chronic bronchitis
B. Emphysema
C. Asthma
D. Bronchiectasis
E. Pulmonary fibrosis
Answer: B. Emphysema
Rationale: Barrel chest and smoking history suggest alveolar destruction in
emphysema.
5. A newborn has failure to pass meconium within 48 hours. Diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Meckel diverticulum
D. Intussusception
E. Volvulus
,Answer: B. Hirschsprung disease
Rationale: Absence of ganglion cells leads to failure of bowel motility and
delayed meconium.
6. A 30-year-old woman has tremor, weight loss, and exophthalmos.
Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
E. Toxic multinodular goiter
Answer: B. Graves disease
Rationale: Autoimmune stimulation of TSH receptors causes
hyperthyroidism and eye signs.
7. A patient has severe headache, neck stiffness, and photophobia. Most
appropriate initial test?
A. CT head without contrast
B. MRI brain
C. Lumbar puncture
D. EEG
E. Carotid ultrasound
Answer: A. CT head without contrast
Rationale: CT is done first to rule out increased intracranial pressure before
lumbar puncture.
8. A diabetic patient has fruity breath and Kussmaul breathing.
Diagnosis?
A. Hypoglycemia
B. DKA
C. HHS
, D. Lactic acidosis
E. Uremia
Answer: B. DKA
Rationale: Ketoacidosis causes acetone breath and compensatory
hyperventilation.
9. A child presents with slapped cheek rash. Cause?
A. Measles virus
B. Parvovirus B19
C. Rubella virus
D. Varicella zoster
E. Coxsackievirus
Answer: B. Parvovirus B19
Rationale: Erythema infectiosum causes “slapped cheek” appearance.
10. A patient develops chest pain relieved by leaning forward.
Diagnosis?
A. MI
B. Pericarditis
C. Angina
D. Pneumothorax
E. GERD
Answer: B. Pericarditis
Rationale: Pain relief when leaning forward is classic for pericardial
inflammation.
11. A 70-year-old man has resting tremor and bradykinesia.
Diagnosis?
A. Huntington disease
B. Parkinson disease
C. ALS
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 65-year-old man with hypertension presents with sudden onset
chest pain radiating to the back. Blood pressure is 180/100 in the right
arm and 150/90 in the left arm. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. GERD
Answer: C. Aortic dissection
Rationale: Sudden tearing chest pain with unequal blood pressures
between arms strongly suggests aortic dissection.
2. A 23-year-old woman presents with fatigue, pallor, and spoon-shaped
nails. Labs show microcytic hypochromic anemia. Most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Sickle cell disease
D. Aplastic anemia
E. Thalassemia major
,Answer: B. Iron deficiency anemia
Rationale: Koilonychia (spoon nails) and microcytic anemia are classic for
iron deficiency.
3. A patient presents with fever, flank pain, and dysuria. Urinalysis shows
WBC casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Kidney stones
E. Prostatitis
Answer: B. Pyelonephritis
Rationale: WBC casts indicate upper urinary tract infection involving the
kidney.
4. A 55-year-old smoker has chronic cough and barrel chest. What is the
most likely diagnosis?
A. Chronic bronchitis
B. Emphysema
C. Asthma
D. Bronchiectasis
E. Pulmonary fibrosis
Answer: B. Emphysema
Rationale: Barrel chest and smoking history suggest alveolar destruction in
emphysema.
5. A newborn has failure to pass meconium within 48 hours. Diagnosis?
A. Pyloric stenosis
B. Hirschsprung disease
C. Meckel diverticulum
D. Intussusception
E. Volvulus
,Answer: B. Hirschsprung disease
Rationale: Absence of ganglion cells leads to failure of bowel motility and
delayed meconium.
6. A 30-year-old woman has tremor, weight loss, and exophthalmos.
Diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
E. Toxic multinodular goiter
Answer: B. Graves disease
Rationale: Autoimmune stimulation of TSH receptors causes
hyperthyroidism and eye signs.
7. A patient has severe headache, neck stiffness, and photophobia. Most
appropriate initial test?
A. CT head without contrast
B. MRI brain
C. Lumbar puncture
D. EEG
E. Carotid ultrasound
Answer: A. CT head without contrast
Rationale: CT is done first to rule out increased intracranial pressure before
lumbar puncture.
8. A diabetic patient has fruity breath and Kussmaul breathing.
Diagnosis?
A. Hypoglycemia
B. DKA
C. HHS
, D. Lactic acidosis
E. Uremia
Answer: B. DKA
Rationale: Ketoacidosis causes acetone breath and compensatory
hyperventilation.
9. A child presents with slapped cheek rash. Cause?
A. Measles virus
B. Parvovirus B19
C. Rubella virus
D. Varicella zoster
E. Coxsackievirus
Answer: B. Parvovirus B19
Rationale: Erythema infectiosum causes “slapped cheek” appearance.
10. A patient develops chest pain relieved by leaning forward.
Diagnosis?
A. MI
B. Pericarditis
C. Angina
D. Pneumothorax
E. GERD
Answer: B. Pericarditis
Rationale: Pain relief when leaning forward is classic for pericardial
inflammation.
11. A 70-year-old man has resting tremor and bradykinesia.
Diagnosis?
A. Huntington disease
B. Parkinson disease
C. ALS
