The Step 2 CK Clinical Knowledge exam is a multiple-choice exam designed to determine whether the examinee possesses an understanding of clinical science considered essential for the provision of patient care under supervision. These sample items are standard USMLE Step 2 CK type questions.
Question 1
A 42-year-old homeless man with no history of prior surgery presents with frequent vomiting and no passage of stool or flatus in the past 24 hours. His temperature is 100.8F. Physical exam reveals a tympanitic abdomen and a tender erythematous mass in the right groin. WBC count is 21,000, and an x-ray shows multiple air-fluid levels with no air visualized in the colon. Which of the following is the most appropriate next step in the management of this patient?
a) Colonoscopy to rule out obstructing carcinoma of ileocecal valve
b) Incision and drainage of the groin mass
b) Nasogastric suction and observation
c) Passage of a nasogastric tube and schedule for immediate surgery
d) Sedation and manual reduction of incarcerated hernia followed by observation
Answer
The correct answer is choice D.
Question 2
A 5-year-old boy presents with dysphagia. He began complaining of a sore throat 5 hours ago and was unable to swallow solid food. He had gone to bed but awoke 3 hours later frightened, hot, and having difficulty breathing. On physical exam, his temperature is 103.2F, heart rate is 100, and respiratory rate is 42. The boy is frightened, sitting forward in his father's lap with his neck extended, and drooling with his tongue protruding from his mouth. Both inspiratory and expiratory stridor are prominent. Which of the following is the most appropriate next step in the management of this patient?
a) Arterial blood gas analysis to assess degree of respiratory compromise
b) Complete physical examination to identify other signs of illness
c) Focused exam of oropharynx to identify the cause of his respiratory distress
d) Immediate monitored transfer to the operating room for the placement of an artificial airway
e) Immediate administration of aerosolized racemic epinephrine to reduce airway obstruction
Answer
The correct answer is choice D.
Extended Matching Questions
(A) Amytal interview
(B) Buspirone
(C) Diazepam
(D) Electronconvulsive therapy
(E) Fluoxetine
(F) Haloperidol
(G) Lithium carbonate
(H) Nortriptyline
(I) Phenelzine
(J) Propranolol
(K) Trazodone
(L) Yohimbine
For each patient below, select the therapy most likely responsible for the observed side effect.
1) A 70-year-old man being treated in an inpatient psychiatric unit develops short-term amnesia for the past 3 weeks. He has an impaired ability in simple arithmetic and cannot execute three-step commands.
Answer
The correct answer is choice D.
2) A 20-year-old patient in the psychiatric emergency room becomes violent. After treatment, he develops a sustained, powerful contraction of the right sternocleidomastoid muscle.
Answer
The correct answer is choice F.