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Step 2 CK Free 120 Answers

Block/Question (1.0 difficulty score)
A 16-year-old girl is brought to the ...
Systemic lupus erythematosusπŸ”

Block/Question (0.6 difficulty score)
A 67-year-old woman comes to the physician ...
Compression of the lateral femoral cutaneous nerveπŸ”

Block/Question (0.5 difficulty score)
A 5-year-old boy is brought to the physician ...
Impaired phagocytic oxidative metabolismπŸ”

Block/Question (0.6 difficulty score)
A 42-year-old woman is brought to the ...
LaparotomyπŸ”

Block/Question (0.7 difficulty score)
A 42-year-old woman comes to the physician ...
AlcoholπŸ”

Block/Question (0.5 difficulty score)
A 37-year-old woman comes to the emergency ...
Nasogastric intubationπŸ”

Block/Question (0.4 difficulty score)
A 9-year-old boy is brought to the physician ...
DermatomyositisπŸ”

Block/Question (0.4 difficulty score)
A 56-year-old man has had the painful weeping ...
Herpes ZosterπŸ”

Block/Question (0.3 difficulty score)
A sexually active 20-year-old woman has had ...
Haemophilus ducreyiπŸ”

Block/Question (0.3 difficulty score)
A 67-year-old woman comes to thy physician 1 ...
Excision of the lesionπŸ”

Block/Question (0.3 difficulty score)
A 67-year-old man is brought to the emergency ...
Adverse effect of medicationsπŸ”

Block/Question (0.3 difficulty score)
A 2-week-old newborn is brought to the ...
ReassuranceπŸ”

Block/Question (0.2 difficulty score)
An obese 33-year-old woman has had four ...
Ultrasonography of the upper abdomenπŸ”

Block/Question (0.2 difficulty score)
Five years after being shot in the right ...
Arteriovenous fistulaπŸ”

Block/Question (0.2 difficulty score)
An 18-year-old primigravid woman comes for ...
UltrasonographyπŸ”

Block/Question (0.2 difficulty score)
A previously healthy 34-year-old woman is ...
Thrombotic thrombocytopenic purpuraπŸ”

Block/Question (0.2 difficulty score)
A 16-year-old girl is brought to the ...
Systemic lupus erythematosusπŸ”

Block/Question (0.2 difficulty score)
A 27-year-old nurse comes to the emergency ...
Measurement of serum insulin and C-peptide concentrationsπŸ”

Block/Question (0.2 difficulty score)
A 15-year-old girl is brought to the ...
Exercise and weight reduction programπŸ”

Block/Question (0.2 difficulty score)
A 3-year-old girl is brought to the physician ...
MastoiditisπŸ”

Block/Question (0.2 difficulty score)
A 62-year-old man comes to the physician ...
VasculitisπŸ”

Block/Question (0.3 difficulty score)
A 2-month-old boy is brought to the physician ...
Decreased gluconeogenesisπŸ”

Block/Question (0.2 difficulty score)
A previously healthy 42-year-old man is ...
Ventilation-perfusion mismatchπŸ”

Block/Question (0.2 difficulty score)
A 36-year-old nulligravid woman with primary ...
EndometriosisπŸ”

Block/Question (0.2 difficulty score)
A 55-year-old man has had crushing substernal ...
Decreasing myocardial contractilityπŸ”

Block/Question (0.2 difficulty score)
Four days after undergoing open reduction and ...
Alcohol withdrawalπŸ”

Block/Question (0.2 difficulty score)
A 67-year-old woman has had fatigue, dry ...
Chronic lymphocytic thyroiditis (Hashimoto disease)πŸ”

Block/Question (0.2 difficulty score)
A 67-year-old woman comes to the physician ...
Bone marrow aspirationπŸ”

Block/Question (0.2 difficulty score)
A 4-year-old boy with asthma becomes limp ...
Decrease in cardiac outputπŸ”

Block/Question (0.3 difficulty score)
A 67-year-old woman comes to the physician ...
Adjusting her medication regimenπŸ”

Block/Question (0.2 difficulty score)
A 77-year-old man is brought to the physician ...
CT scan of the headπŸ”

Block/Question (0.2 difficulty score)
A 14-year-old boy is brought to the office ...
Approve basketball participationπŸ”

Block/Question (0.2 difficulty score)
A 32-year-old man who is a jackhammer ...
Axillary-subclavian venous thrombosisπŸ”

Block/Question (0.2 difficulty score)
A 6-year-old girl is brought to the physician ...
Topical corticosteroid therapyπŸ”

Block/Question (0.2 difficulty score)
A 27-year-old woman comes to the office because of
Pulmonary embolismπŸ”

Block/Question (0.2 difficulty score)
An 82-year-old woman with a 20-year history ...
Detrusor instabilityπŸ”

Block/Question (0.3 difficulty score)
A 70-year-old man comes to the physician ...
Multiple myelomaπŸ”

Block/Question (0.3 difficulty score)
Three days after hospitalization for diabetic ...
Offer insulin but allow the patient to refuse itπŸ”

Block/Question (0.2 difficulty score)
A 27-year-old woman comes to the physician because
NortriptylineπŸ”

Block/Question (0.2 difficulty score)
A 68-year-old man is brought to the emergency ...
Oral lactulose therapyπŸ”

Block/Question (0.3 difficulty score)
A 45-year-old woman comes to the emergency ...
Serum antineutrophil cytoplasmic autoantibody assayπŸ”

Block/Question (0.2 difficulty score)
An 87-year-old woman, gravida 6, para 6, is ...
Urinary retentionπŸ”

Block/Question (0.1 difficulty score)
A 25-year-old woman is admitted to the ...
MethimazoleπŸ”

Block/Question (0.2 difficulty score)
A 16-year-old boy is brought to the emergency ...
Antibiotic therapyπŸ”

Block/Question (0.2 difficulty score)
A previously healthy 29-year-old woman is ...
Adherence to immunization guidelinesπŸ”

Block/Question (0.2 difficulty score)
A 27-year-old primigravid woman comes to the ...
HIVπŸ”

Block/Question (0.2 difficulty score)
An investigator would like to decrease the ...
Withdraw from the study nowπŸ”

Block/Question (0.2 difficulty score)
A 70-year-old man comes to the clinic because ...
Measurement of postvoid residual volumeπŸ”

Block/Question (0.2 difficulty score)
A 52-year-old woman comes to the physician ...
VancomycinπŸ”

Block/Question (0.2 difficulty score)
A 52-year-old man with hepatic cirrhosis ...
5 (five)πŸ”

Block/Question (0.2 difficulty score)
Which of the following most strongly limits ...
EPCS is available only at specialty centersπŸ”


Block/Question (0.2 difficulty score)
A 42-year-old man comes to the office as a ...
Cardiovascular diseaseπŸ”

Block/Question (0.2 difficulty score)
A 40-year-old divorced woman comes to the ...
Education on sleep hygieneπŸ”

Block/Question (0.1 difficulty score)
A 58-year-old woman is brought to the office ...
Measurement of cerebrospinal fluid 14-3-3 protein concentrationπŸ”

Block/Question (0.0 difficulty score)
A 38-year-old woman is brought to the ...
Submerge the feet in a moderately warm whirlpoolπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old woman comes to the emergency ...
Prednisone therapyπŸ”

Block/Question (0.0 difficulty score)
A 13-year-old boy is brought to the emergency ...
MyocarditisπŸ”

Block/Question (0.0 difficulty score)
A 10-day-old female newborn is brought to the ...
VolvulusπŸ”

Block/Question (0.0 difficulty score)
An 85-year-old man with severe dementia, ...
Absence of resource stewardshipπŸ”

Block/Question (0.1 difficulty score)
A 62-year-old woman with myasthenia gravis ...
Assessment of medical decision-making capacityπŸ”

Block/Question (0.0 difficulty score)
A 55-year-old man is brought to the emergency ...
Vitamin B1 (thiamine)πŸ”

Block/Question (0.0 difficulty score)
A 16-year-old boy is brought to the emergency ...
Testicular torsionπŸ”

Block/Question (0.0 difficulty score)
A 5-year-old boy is brought to the emergency ...
Discuss the family’s goals for the patientπŸ”

Block/Question (0.0 difficulty score)
A 50-year-old woman comes to the office ...
SarcoidosisπŸ”

Block/Question (0.0 difficulty score)
A 64-year-old man comes to the clinic because ...
Serum creatine kinase activityπŸ”

Block/Question (0.1 difficulty score)
A 23-year-old man who is on active duty in ...
Cleanse the site and apply iceπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old man is brought to the emergency ...
Electroconvulsive therapyπŸ”

Block/Question (0.0 difficulty score)
A 60-year-old woman comes to the office as a ...
Hepatitis CπŸ”

Block/Question (0.0 difficulty score)
A 12-year-old girl is brought to the ...
Use of a nonpenicillin antibiotic to treat the pharyngitisπŸ”

Block/Question (0.0 difficulty score)
A 45-year-old woman is hospitalized for ...
Encourage questions from all team membersπŸ”

Block/Question (0.0 difficulty score)
An 82-year-old man comes to the physician 1 ...
KeratoacanthomaπŸ”

Block/Question (0.0 difficulty score)
A 37-year-old man comes to the physician for ...
Serum lipid studiesπŸ”

Block/Question (0.0 difficulty score)
A 35-year-old woman is evaluated for a ...
CT scan of the abdomenπŸ”

Block/Question (0.0 difficulty score)
A 23-year-old man is being evaluated in the ...
Begin a continuous infusion of norepinephrineπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old nulligravid woman comes to the ...
Gestational diabetesπŸ”

Block/Question (0.0 difficulty score)
A 17-year-old girl is brought to the ...
Inform the parents that the physician cannot deceive the patientπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old woman with type 2 diabetes ...
Acute kidney injuryπŸ”

Block/Question (0.0 difficulty score)
A 15-year-old girl is brought to the ...
Osteogenesis imperfectaπŸ”

Block/Question (0.0 difficulty score)
A 22-year-old primigravid woman at 10 weeks’ ...
β€œHow do you think he will react?β€πŸ”

Block/Question (0.0 difficulty score)
Five days after admission to the hospital for ...
Aortic embolismπŸ”

Block/Question (0.0 difficulty score)
A 75-year-old man comes to the clinic because ...
High-resolution CT scan of the chestπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 20-year-old woman, who ...
K+: decreased; Cl-: decreased; HCO3-: increasedπŸ”

Block/Question (0.0 difficulty score)
A 58-year-old man comes to the clinic for a ...
CystoscopyπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old woman is brought to the ...
Operative reduction and internal fixationπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old man comes to the physician 1 ...
Antihypertensive therapyπŸ”

Block/Question (0.0 difficulty score)
A 27-year-old primigravid woman at 21 weeks’ ...
Influenza A virusπŸ”

Block/Question (0.0 difficulty score)
A 7-year-old boy is brought to the physician ...
Learning disorderπŸ”

Block/Question (0.0 difficulty score)
A 23-year-old woman who is an active-duty ...
Otitis externaπŸ”

Block/Question (0.0 difficulty score)
A 16-year-old boy with VATER syndrome is ...
Tracheal collapseπŸ”

Block/Question (0.0 difficulty score)
A 34-year-old woman who is on active duty in ...
Ibuprofen and decongestant therapyπŸ”

Block/Question (0.0 difficulty score)
A 68-year-old woman comes to the office ...
No additional diagnostic studies are indicatedπŸ”

Block/Question (0.0 difficulty score)
A 33-year-old woman is admitted to the ...
MRI of the brainπŸ”

Block/Question (0.0 difficulty score)
A chief medical officer at a hospital has ...
Instruct the surgeon to take a temporary leave of absence and undergo a medical evaluationπŸ”

Block/Question (0.0 difficulty score)
Echocardiography shows a small pericardial ...
Ibuprofen and colchicine therapyπŸ”

Block/Question (0.0 difficulty score)
A 44-year-old man comes to the emergency ...
EchocardiographyπŸ”

Block/Question (0.0 difficulty score)
A 55-year-old man with major depressive ...
Discontinue paroxetine and duloxetineπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old man comes to the office for a ...
Determine whether the patient has had thoughts of harming othersπŸ”

Block/Question (0.0 difficulty score)
A 40-year-old woman is admitted to the ...
Acyclovir therapyπŸ”

Block/Question (0.0 difficulty score)
An 87-year-old woman, gravida 2, para 2, is ...
Vulvar carcinomaπŸ”

Block/Question (0.0 difficulty score)
A 47-year-old woman comes to the office for a ...
Ultrasonography of the thyroid glandπŸ”

Block/Question (0.0 difficulty score)
A 1-hour-old male newborn is examined in the ...
Zidovudine (AZT)πŸ”

Block/Question (0.0 difficulty score)
A 25-year-old woman comes to the office ...
Cabergoline therapyπŸ”

Block/Question (0.0 difficulty score)
A 2-week-old boy is evaluated in the neonatal ...
X-ray of the abdomenπŸ”

Block/Question (0.0 difficulty score)
A 13-month-old boy is brought to a small ...
The suburban hospital violated the Emergency Medical Treatment and Active Labor Act (EMTALA)πŸ”

Block/Question (0.0 difficulty score)
A 25-year-old woman is brought to the ...
Video EEG monitoringπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old woman comes to the emergency ...
Ibuprofen therapyπŸ”

Block/Question (0.0 difficulty score)
A 30-year-old nulligravid woman, who is a ...
Hypothalamic hypogonadismπŸ”

Block/Question (0.0 difficulty score)
A 45-year-old woman comes to the office ...
Follicle-stimulating hormoneπŸ”

Block/Question (0.0 difficulty score)
A 2-month-old girl is brought to the office ...
Oral prophylactic penicillin therapyπŸ”

Block/Question (0.0 difficulty score)
A 3-week-old boy is brought to the physician ...
Ultrasonography of the abdomenπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old woman comes to the physician ...
Discontinuation of lisinoprilπŸ”

Block/Question (0.0 difficulty score)
A 27-year-old primigravid woman at 41 weeks' ...
Neonatal respiratory depressionπŸ”

Block/Question (0.0 difficulty score)
A 7-year-old girl is brought to the clinic by ...
PolysomnographyπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old man comes to the emergency ...
Immobilization of the right foot in a posterior splintπŸ”

Block/Question (0.0 difficulty score)
An 8-year-old boy is brought to the emergency ...
Proceed with the blood transfusion while obtaining an emergency telephone court orderπŸ”

Block/Question (0.0 difficulty score)
A female newborn has the onset of tachypnea 4 ...
Intravenous alprostadil (prostaglandin E1)πŸ”

Block/Question (0.0 difficulty score)
A 43-year-old woman comes to the office for a ...
DiltiazemπŸ”

Block/Question (0.0 difficulty score)
A 67-year-old man is brought to the emergency ...
Mobitz type II (second-degree) atrioventricular blockπŸ”

Block/Question (0.0 difficulty score)
A 35-year-old woman is brought to the ...
Alcohol use disorderπŸ”

Block/Question (0.0 difficulty score)
A 76-year-old woman, who is receiving home ...
Administer intravenous morphineπŸ”

Block/Question (0.0 difficulty score)
A 42-year-old woman comes to the physician ...
Medullary thyroid carcinomaπŸ”

Block/Question (0.0 difficulty score)
A 26-year-old woman with common variable ...
Lymph node biopsyπŸ”

Block/Question (0.0 difficulty score)
A 9-month-old boy is brought to the office by ...
Skeletal surveyπŸ”

Block/Question (0.0 difficulty score)
A 62-year-old woman is admitted to the ...
Ultrasonography of the right upper abdominal quadrantπŸ”

Block/Question (0.0 difficulty score)
A 28-year-old woman, gravida 2, para 1, at 39 ...
Umbilical cord prolapseπŸ”

Block/Question (0.0 difficulty score)
A 63-year-old man with chronic obstructive ...
Titrated oxygen therapyπŸ”

Block/Question (0.0 difficulty score)
A 49-year-old man returns to the office for ...
Adenocarcinoma of the colonπŸ”

Block/Question (0.0 difficulty score)
A 27-year-old man is examined in the ...
Decreased uptake of glucose by insulin-sensitive tissuesπŸ”

Block/Question (0.0 difficulty score)
A 72-year-old woman is evaluated in the acute ...
Discharge the patient with a plan for home health care and physical therapyπŸ”

Block/Question (0.0 difficulty score)
A 46-year-old woman comes to the office for ...
HyperaldosteronismπŸ”

Block/Question (0.0 difficulty score)
A 50-year-old woman is brought to the ...
Necrotizing fasciitisπŸ”

Block/Question (0.0 difficulty score)
A 37-year-old woman comes to the office for a ...
Using a respirator at workπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old man with alcohol use disorder ...
SpironolactoneπŸ”

Block/Question (0.0 difficulty score)
A 48-year-old man is admitted to the hospital ...
Gemfibrozil therapyπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old man is admitted to the hospital ...
Vitamin B1 (thiamine)πŸ”

Block/Question (0.0 difficulty score)
Three days after an operation for uterine ...
Develop an institutional policy with standardized orders for DVT prophylaxisπŸ”

Block/Question (0.0 difficulty score)
A clinical trial is performed to assess the ...
Absolute risk reduction is 1%πŸ”

Block/Question (0.0 difficulty score)
An 18-year-old man is being prepared to ...
Ask the surgeon to continue the operation only after the discrepancy is resolvedπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old man is brought to the emergency ...
Application of positive end-expiratory pressureπŸ”

Block/Question (0.0 difficulty score)
A 14-year-old boy is brought to the emergency ...
Cardiac monitoringπŸ”

Block/Question (0.0 difficulty score)
A 65-year-old man with mild hypertension ...
Duplex ultrasonography of the abdomenπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old man comes to the physician ...
Serum protein electrophoresisπŸ”

Block/Question (0.0 difficulty score)
A 38-year-old woman, gravida 1, para 1, comes ...
OsteoporosisπŸ”

Block/Question (0.0 difficulty score)
A 27-year-old man comes to the physician ...
von Willebrand diseaseπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 57-year-old woman comes ...
Right hemicolectomyπŸ”

Block/Question (0.0 difficulty score)
A 37-year-old woman comes to the office for a ...
Generalized anxiety disorderπŸ”

Block/Question (0.0 difficulty score)
A 55-year-old man comes to the emergency ...
CefotaximeπŸ”

Block/Question (0.0 difficulty score)
A 45-year-old man is brought to the emergency ...
Vitamin DπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old man comes to the office because ...
Ketorolac 0.5% solution, 1 drop in right eye, four times dailyπŸ”

Block/Question (0.0 difficulty score)
A 14-year-old girl is brought to the ...
Pubic hair development: normal; Breast development: normalπŸ”

Block/Question (0.0 difficulty score)
A healthy 19-year-old woman comes to the ...
Subdermal contraceptive implantπŸ”

Block/Question (0.0 difficulty score)
A 56-year-old man with adenocarcinoma of the ...
Increased total protein concentrationπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 17-year-old girl comes ...
Tubo-ovarian abscessπŸ”

Block/Question (0.0 difficulty score)
A 15-year-old girl is brought to the office ...
GonadectomyπŸ”

Block/Question (0.0 difficulty score)
A 50-year-old man returns to the office for a ...
HydrochlorothiazideπŸ”

Block/Question (0.0 difficulty score)
A 23-year-old woman is brought to the ...
Reaction to food additiveπŸ”


Block/Question (0.0 difficulty score)
A 47-year-old woman comes to the office ...
S1 radiculopathyπŸ”

Block/Question (0.0 difficulty score)
A 37-year-old man with type 1 diabetes ...
Adhere to the patient's wishes and discuss home-care optionsπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 22-year-old college ...
Herpes simplex encephalitisπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old woman comes to the physician ...
Iron deficiencyπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 37-year-old woman comes ...
ParoxetineπŸ”

Block/Question (0.0 difficulty score)
A 19-year-old college student comes to the ...
Combination oral contraceptiveπŸ”

Block/Question (0.0 difficulty score)
A 72-year-old woman with unresectable small ...
Nonphysiologic ADH (vasopressin) secretionπŸ”

Block/Question (0.0 difficulty score)
During the past month, a 37-year-old woman ...
Na+: 130; K+: 2.8; Cl-: 88; HCO3-: 32πŸ”

Block/Question (0.0 difficulty score)
A 37-year-old woman comes to the physician ...
Streptococcus pneumoniaeπŸ”

Block/Question (0.1 difficulty score)
An 18-year-old man with a 12-year history of ...
Diabetic nephropathyπŸ”

Block/Question (0.0 difficulty score)
A cohort study is conducted to compare the ...
Selection biasπŸ”

Block/Question (0.0 difficulty score)
A 17-year-old girl comes to the physician for ...
Potassium: decreased; Bicarbonate: increasedπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 27-year-old nulligravid ...
Incision and drainageπŸ”

Block/Question (0.0 difficulty score)
A 30-year-old woman comes to the physician ...
Adrenal medullaπŸ”

Block/Question (0.0 difficulty score)
A 4-year-old boy is brought to the physician ...
Intravenous immune globulinπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old woman is brought to the ...
History of gastrectomyπŸ”

Block/Question (0.0 difficulty score)
Six hours after delivery, a 1200-g (2-lb ...
Pulmonary surfactant deficiencyπŸ”

Block/Question (0.0 difficulty score)
A 47-year-old man is brought to the emergency ...
Aortic dissectionπŸ”

Block/Question (0.0 difficulty score)
A 67-year-old woman comes to the physician ...
Inquiry about an egg allergyπŸ”

Block/Question (0.0 difficulty score)
A 57-year-old woman comes to the physician ...
Paroxetine therapyπŸ”

Block/Question (0.0 difficulty score)
Two days after admission to the hospital for ...
WBC: 20,000; Crystals: needle-shaped; Gram stain: no organismsπŸ”

Block/Question (0.0 difficulty score)
A 52-year-old woman comes to the emergency ...
CT scan of the abdomen with contrastπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old man comes to the physician ...
Bipolar disorderπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old woman, gravida 3, para 2, at 41 ...
Amniotic fluid embolismπŸ”

Block/Question (0.0 difficulty score)
A 60-year-old man has had painful skin with ...
Toxic epidermal necrolysisπŸ”

Block/Question (0.0 difficulty score)
A hospitalized 57-year-old man has had severe ...
PseudogoutπŸ”

Block/Question (0.0 difficulty score)
A 47-year-old woman with end-stage renal ...
Metabolic acidosis, respiratory compensationπŸ”

Block/Question (0.0 difficulty score)
A 37-year-old woman with AIDS comes to the ...
Cryptosporidium parvumπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 19-year-old college ...
CeftriaxoneπŸ”

Block/Question (0.0 difficulty score)
A 64-year-old woman comes to the physician ...
Non-small cell lung carcinomaπŸ”

Block/Question (0.0 difficulty score)
A healthy 4-year-old girl is brought for a ...
Atrial septal defectπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 47-year-old man comes to ...
ColonoscopyπŸ”

Block/Question (0.0 difficulty score)
A 22-year-old man comes to the physician for ...
Persistence of a patent processus vaginalisπŸ”

Block/Question (0.0 difficulty score)
A 38-year-old woman comes to the physician ...
Interstitial nephropathyπŸ”

Block/Question (0.0 difficulty score)
A 25-year-old man is brought to the emergency ...
HeroinπŸ”

Block/Question (0.0 difficulty score)
A 5-year-old boy is brought to the physician ...
The findings are clinically insignificant but statistically significantπŸ”

Block/Question (0.0 difficulty score)
A 22-year-old man is brought to the emergency ...
Left tube thoracostomyπŸ”

Block/Question (0.0 difficulty score)
A 19-year-old man comes to the physician ...
Intravenous methylprednisoloneπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 17-year-old girl comes ...
AsthmaπŸ”

Block/Question (0.0 difficulty score)
A 62-year-old white man comes to the ...
PhlebotomyπŸ”

Block/Question (0.0 difficulty score)
A 32-year-old man who is a jackhammer ...
Axillary-subclavian venous thrombosisπŸ”

Block/Question (0.0 difficulty score)
A 62-year-old woman comes to the physician ...
HypothyroidismπŸ”


Block/Question (0.0 difficulty score)
A 6-year-old boy is brought to the emergency ...
Attention-deficit/hyperactivity disorderπŸ”

Block/Question (0.0 difficulty score)
A previously healthy 18-year-old man is ...
Diabetic ketoacidosisπŸ”

Block/Question (0.0 difficulty score)
A 42-year-old woman comes to the physician ...
Endometrial biopsyπŸ”

Block/Question (0.0 difficulty score)
A 15-year-old boy is brought to the physician ...
Exercise programπŸ”

Block/Question (0.0 difficulty score)
A 5-year-old girl is brought to the physician ...
EchocardiographyπŸ”

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Recent comments ...

... carolebaskin made a comment on step2ck_free120/block1/q#2 (A 56-year-old man has had the painful weeping rash...)
 +1 
submitted by carolebaskin(35)

Dewdrop on a rose petal appearance in a CN V1 dermatomal distribution. Rash is painful and weeping. Immunocompromised host (s/p chemo)


Wrong answers

Impetigo: honey colored crusting lesion related to group A strep infection

Pyoderma gangrenosum: think green cheese; usually a single large round ulcer. Rapidly progresses from small papule or pustule to large painful ulcer with purulent, violaceous border. Associated with IBD (crohn disease, UC, RA, trauma). Most commonly lower limbs.

Syphilis: Causes a few types of skin lesions: chancre, gummas, etc. Chancre: most common, painless, genital. Doesn't really fit the story here anyway.

SLE: doesn't fit

... carolebaskin made a comment on step2ck_free120/block1/q#11 (A previously healthy 34-year-old woman is brought to...)
 +1 
submitted by carolebaskin(35)

Meets the 5 FAT RN criteria:

  • fever
  • anemia
  • thrombocytopenia
  • renal symptoms
  • neuro symptoms

Also, Indirect hyperbilirubinemia and increased LDH should tip you off to MAHA

... carolebaskin made a comment on step2ck_free120/block3/q#20 (Three days after hospitalization for diabetic...)
 +1 
submitted by carolebaskin(35)

Eeaaasy there, partner. They said they don't want insulin and you're gonna kick them to the curb?

One step at a time, bud.

Offer the insulin, let them refuse (they seem to have capacity), but who ever said anything about discharging them.

Where would they go!?

Haven't they been through enough?

... benwhite_dotcom made a comment on step2ck_free120/block1/q#1 (A 16-year-old girl is brought to the physician...)
 +0 
submitted by benwhite_dotcom(466)

Intermittent polyarthritis with positive ANA (sensitive but not specific) and anti-DNA (very specific) means lupus. You don’t even need the non-painful mouth ulcers.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#2 (A 67-year-old woman comes to the physician for a...)
 +0 
submitted by benwhite_dotcom(466)

Anesthesia to the anterolateral thigh is the distribution of the lateral femoral cutaneous nerve. LFC neuropathy can be caused by compression near the inguinal ligament (say, from a hematoma). Note that it’s the compression of the nerve that causes decreased sensation, not the hematoma itself.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#3 (A 5-year-old boy is brought to the physician because...)
 +0 
submitted by benwhite_dotcom(466)

Recurrent infections with abscesses should raise the suspicion of chronic granulomatous disease. Suppurative arthritis does even more, if you’re likely to remember that. The real diagnosis is made from the Step 1 style question. Nitroblue tetrazolium is the test used to diagnose CGD, which is a defect in NADPH oxidase (the oxidative burst that kills Staph aureus).

... benwhite_dotcom made a comment on step2ck_free120/block1/q#4 (A 42-year-old woman is brought to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

Unstable and hypotensive patients after blunt trauma get laparotomies (don’t put an unstable patient in the CT scanner). In addition to saline and blood products, definitive surgery is how you address the C in ABC.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#5 (A 42-year-old woman comes to the physician for an...)
 +0 
submitted by benwhite_dotcom(466)

Alcohol raises GGT. The other liver enzyme lab to remember is the 2:1 or greater AST/ALT ratio associated with alcoholic liver disease.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#6 (A 37-year-old woman comes to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

The patient has a small bowel obstruction, likely due to adhesions from prior surgery, evident clinically and confirmed by radiograph (grossly dilated small bowel without distal colonic dilation to suggest paralytic ileus). Conservative treatment in a stable patient involves NG tube decompression and NPO. A CT can be obtained for further characterization and to look signs of bowel compromise (and would be in real life), but there is no reason to delay appropriate care to get it.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#7 (A 9-year-old boy is brought to the physician because...)
 +0 
submitted by benwhite_dotcom(466)

Proximal muscle weakness + skin findings = dermatomyositis. Yes, kids can get this. In this case, they’ve gone to the trouble of describing Gottron’s papules (β€œflat-topped red papules over all knuckles”) and the heliotrope rash (purple-red discoloration over the eyelids). Please note the USMLE will never actually say things β€œheliotrope” on the actual exam. They always describe.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#2 (A 56-year-old man has had the painful weeping rash...)
 +0 
submitted by benwhite_dotcom(466)

Dermatomal rash means zoster (a chickenpox/varicella reactivation disease). Immune insults, like chemotherapy, predispose to zoster flares.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#3 (A sexually active 20-year-old woman has had fever,...)
 +0 
submitted by benwhite_dotcom(466)

The STD that forms a painful ulcer aka chancroid = H ducreyi (ducreyi makes you cry, as they say).

... carolebaskin made a comment on step2ck_free120/block1/q#4 (A 67-year-old woman comes to thy physician 1 month...)
 +0 
submitted by carolebaskin(35)

This is a keratoacanthoma.

It's a cup shaped squamous cell carcinoma that's filled with keratin debris. It rapidly grows then usually spontaneously regresses. But, it's still an SCC, so we should excise.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#4 (A 67-year-old woman comes to thy physician 1 month...)
 +0 
submitted by benwhite_dotcom(466)

The thing you do with things that look like skin cancer is excise them completely.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#5 (A 67-year-old man is brought to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

Lisinopril and especially spironolactone (a K-sparing diuretic) can both cause hyperkalemia. Renal failure (severe AKI or ESRD) is also a major cause of hyperkalemia, but not in this case with the only mildly elevated Cr and BUN levels.

... carolebaskin made a comment on step2ck_free120/block1/q#7 (A 2-week-old newborn is brought to the physician for...)
 +0 
submitted by carolebaskin(35)

The video shows a normal Moro reflex. This is a primitive "hang on for your life!" reflex.

Asymmetric Moro is associated with clavicle fracture or brachial trauma 2/2 shoulder dystocia.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#8 (An obese 33-year-old woman has had four 12-hour...)
 +0 
submitted by benwhite_dotcom(466)

Again, acute RUQ pain (especially in an obese woman) should set off the gallstone alarms. Fever and other systemic signs, white count, etc lead you down the acute cholecystitis. Simple pain leads you to symptomatic cholelithiasis. Either way the first step is to get a RUQ sono to see those stones! HIDA is used as an adjunctive study in cases of cholelithiasis to assess for cystic duct obstruction (and thus likely acute cholecystitis) in equivocal cases.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#9 (Five years after being shot in the right thigh, a...)
 +0 
submitted by benwhite_dotcom(466)

Post-traumatic AV fistula! Just like dialysis AV fistulae have bruits and thrills, so do non-purposefully created ones. These can take a long time to form but can be associated with steal syndromes due to decreased perfusion to the distal extremity, venous incompetence, varicosities, and eventually stenoses due to unreasonably high flow, and even high-output heart failure.

... carolebaskin made a comment on step2ck_free120/block1/q#10 (An 18-year-old primigravid woman comes for her initial)
 +0 
submitted by carolebaskin(35)

Increased AFP can be due to

1) neural tube defects

2) abdominal wall defects

3) multiple gestations

Do an ultrasound to r/o (3)

... benwhite_dotcom made a comment on step2ck_free120/block1/q#10 (An 18-year-old primigravid woman comes for her initial)
 +0 
submitted by benwhite_dotcom(466)

We can only put the laboratory tests into context if we have an accurate gestational age. Since her LMP is unreliable (totally unknown), we need an ultrasound to date her pregnancy. The most common cause of an abnormal MSAFP is wrong dates.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#11 (A previously healthy 34-year-old woman is brought to...)
 +0 
submitted by benwhite_dotcom(466)

TTP always seems like too many disparate symptoms but just remember the pentad: thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal failure, and fever. If the symptoms list seems super long, keep TTP in mind.

... carolebaskin made a comment on step2ck_free120/block1/q#13 (A 27-year-old nurse comes to the emergency...)
 +0 
submitted by carolebaskin(35)

Classic factitious disorder Q

Health care worker (nurse) with dramatic hypoglycemia and some signs of mental illness (+ risky drinking, + stress, + young woman)

To check for exogenous insulin, look for C-peptide.

C-peptide is a cleavage byproduct of endogenous insulin production. If high insulin and normal or low C-peptide --> exogenous insulin = factitious disorder

Kind of a Step 1 question

... benwhite_dotcom made a comment on step2ck_free120/block1/q#13 (A 27-year-old nurse comes to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

Working up serious hypoglycemia involves measurement of both insulin and C-peptide (the cleaved by-product of endogenous proinsulin) to assess for hyperinsulinemia and distinguish endogenous (e.g. insulinoma) from exogenous (e.g. Munchausen’s) causes. β€œNurse” is a common Munchausen tip-off (someone with the know-how and skills to pull it off well).

... benwhite_dotcom made a comment on step2ck_free120/block1/q#14 (A 15-year-old girl is brought to the physician 3 months)
 +0 
submitted by benwhite_dotcom(466)

Via urinalysis and renal ultrasound, we’ve excluded serious/treatable causes of renal hypertension including Conn’s disease (hyperaldosteronism) and renal artery stenosis such as due to fibromuscular dysplasia. That leaves her obesity.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#15 (A 3-year-old girl is brought to the physician...)
 +0 
submitted by benwhite_dotcom(466)

Fever, pain, and swelling behind the ear mean mastoiditis (remember the mastoid air cells?). The cause is nearly universally direct spread from otitis media.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#16 (A 62-year-old man comes to the physician because of...)
 +0 
submitted by benwhite_dotcom(466)

Vasculitides like Wegener’s granulomatosis, microscopic polyangiitis, and others can cause poly-symptom disease and glomerulonephritis (hence the hematuria and proteinuria). Positive ANCA, (either P-ANCA or C-ANCA depending on the variant) is the key laboratory finding.

... carolebaskin made a comment on step2ck_free120/block1/q#17 (A 2-month-old boy is brought to the physician...)
 +0 
submitted by carolebaskin(35)

Infant with persistent diarrhea, vomiting after feeds, weight loss, hepatosplenomegaly, jaundice and +reducing substances

Classic Galactosemia

From step 1: Galactokinase deficiency, phosphate trapping

... benwhite_dotcom made a comment on step2ck_free120/block1/q#17 (A 2-month-old boy is brought to the physician...)
 +0 
submitted by benwhite_dotcom(466)

These questions can be a true pain of biochemistry on the Step 1 or relatively straightforward depending on how well you know it. This patient has classical Galactosemia, caused by a deficiency in galactose-1-P uridyl transferase deficiency, the enzyme that converts galactose and lactose to glucose. Intolerance to dairy, hepatomegaly/liver disease/jaundice with hypoglycemia due to decreased gluconeogenesis, and reducing substances in urine are classic. Listlessness and lethargy ensue with mental retardation and eventually death if untreated. Cataracts are also common. If you didn’t get to galactosemia (or thought it was Von Gierke’s disease, which isn’t all that unreasonable), the answer is still A. By process of elimination, given the serum hypoglycemia but no urine glucose, the issue is the inability to make glucose from stores (not to absorb it).

... benwhite_dotcom made a comment on step2ck_free120/block1/q#18 (A previously healthy 42-year-old man is brought to...)
 +0 
submitted by benwhite_dotcom(466)

Pleuritic chest pain and hypoxia with a normal chest x-ray should lead you to pulmonary embolism. There’s usually enough total lung and blood flow, but it’s the VQ mismatch that’s the issue.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#19 (A 36-year-old nulligravid woman with primary...)
 +0 
submitted by benwhite_dotcom(466)

Endometriosis is a common cause of infertility and is associated with chronic pelvic/abdominal pain and excruciating periods. Gold standard for diagnosis is laparoscopy (visualization of β€œchocolate cysts”).

... benwhite_dotcom made a comment on step2ck_free120/block1/q#20 (A 55-year-old man has had crushing substernal chest pain)
 +0 
submitted by benwhite_dotcom(466)

The primary mechanism by which beta-blockers reduce angina is via decreased contractility, which reduces the oxygen demand of the myocardium (which has a constrained supply due to coronary artery disease). Lowering heart rate also helps, but that isn’t one of your choices.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#21 (Four days after undergoing open reduction and...)
 +0 
submitted by benwhite_dotcom(466)

Confusion and tremulousness a few days after an unexpected hospital admission on the USMLE means alcohol withdrawal (unanticipated detox).

... carolebaskin made a comment on step2ck_free120/block1/q#30 (A 67-year-old woman has had fatigue, dry skin,...)
 +0 
submitted by carolebaskin(35)

Hashimoto thyroiditis

  • early stage transient hyperthyroidism
  • progresses to subclinical hypothyroidism
  • then finally overt hypothyroidism

This patient has clear signs of hypothyroidism (dry skin, brittle hair, periph edema, temp intolerance, weight gain, bradycardia, lethargy, etc)

Most common cause of noniatrogenic hypothyroidism

... benwhite_dotcom made a comment on step2ck_free120/block1/q#30 (A 67-year-old woman has had fatigue, dry skin,...)
 +0 
submitted by benwhite_dotcom(466)

The most common cause of hypothyroidism in developed countries is Hashimoto’s thyroiditis. In developing countries, it’s iodine deficiency.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#33 (A 67-year-old woman comes to the physician because...)
 +0 
submitted by benwhite_dotcom(466)

Thrombocytopenia without antiplatelet antibodies or splenomegaly implies a platelet production problem (e.g. myelofibrosis). History of radiation therapy is a risk factor. The only way to know what’s happening at the factory is a bone marrow biopsy.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#37 (A 4-year-old boy with asthma becomes limp during...)
 +0 
submitted by benwhite_dotcom(466)

The radiograph is showing complete collapse of the left lung (2/2 mucous plugging) with resultant severe ipsilateral mediastinal shift. An acute shift can have the same effect as any other β€œtension”-type process, causing impaired venous return to the heart and decreased cardiac output via the Starling mechanism.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#1 (A 67-year-old woman comes to the physician because...)
 +0 
submitted by benwhite_dotcom(466)

This patient has chronic (6 weeks) symptomatic hypotension while not coincidentally on three BP meds: a diuretic, a beta blocker, and an ACE inhibitor. The most likely explanation and easiest/fastest intervention is to reduce her polypharmacy.

... carolebaskin made a comment on step2ck_free120/block2/q#15 (A 77-year-old man is brought to the physician...)
 +0 
submitted by carolebaskin(35)

He's probably having an ischemic stroke

But you can't be sure!

First step is non-con CT


Other wrong answers:

  • Don't do an LP until you know there is no bleed; they could herniate!

  • EEG has no place in acute stroke w/u

  • Carotid duplex US helps find source of stroke, but doesn't help in acute w/u

  • angiography maybe later

... benwhite_dotcom made a comment on step2ck_free120/block2/q#15 (A 77-year-old man is brought to the physician...)
 +0 
submitted by benwhite_dotcom(466)

The first imaging test in acute stroke is a noncontrast CT scan of the head. At 12 hours out, it may show ischemic strokes, but more importantly, it will diagnose hemorrhagic strokes, for which reperfusion and antiplatelet therapies are contraindicated.

... carolebaskin made a comment on step2ck_free120/block2/q#18 (A 14-year-old boy is brought to the office for an...)
 +0 
submitted by carolebaskin(35)

A P T M

There's a physiologic splitting on inspiration in the pulmonic area

It's not pulmonic stenosis because there's no associated murmur. You would expect crescendo-decrescendo murmur, increase on inspiration, systolic ejection click, widened split of S2. All we hear is split S2.

Let the poor kid BALL

... carolebaskin made a comment on step2ck_free120/block2/q#24 (A 32-year-old man who is a jackhammer operator comes...)
 +0 
submitted by carolebaskin(35)

This is Paget-Schroetter disease

An upper extremity thrombosis triggered by extreme activity.

He's a fit young jackhammerer just trying to do his jackhammer thing

... benwhite_dotcom made a comment on step2ck_free120/block2/q#28 (A 6-year-old girl is brought to the physician because)
 +0 
submitted by benwhite_dotcom(466)

Atopic dermatitis (eczema) is the β€œitch that rashes.” It’s one leg of the allergic triad: asthma, allergic rhinitis, and atopic dermatitis. Treatment is with topical steroids and rigorous emollient therapy.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#35 (An 82-year-old woman with a 20-year history of urinary)
 +0 
submitted by benwhite_dotcom(466)

This patient has urge incontinence, which is commonly caused by detrusor instability (and can be treated with anticholinergics like oxybutynin). This is opposed to stress incontinence, the other most common type, which is worsened by abdominal pressure/coughing/laughing/etc and can be caused by pelvic floor prolapse secondary to multiple childbirths etc. Neurogenic bladder can cause overflow incontinence.

... carolebaskin made a comment on step2ck_free120/block2/q#37 (A 70-year-old man comes to the physician because of...)
 +0 
submitted by carolebaskin(35)

Hypercalcemia + lytic spinal lesions = multiple myeloma

What about the fever, leukocytosis, and consolidation?

MM predisposes to infection! It's PNA.

... benwhite_dotcom made a comment on step2ck_free120/block2/q#37 (A 70-year-old man comes to the physician because of...)
 +0 
submitted by benwhite_dotcom(466)

Multiple lytic bone lesions equals multiple myeloma. Blastic/sclerotic lesions should make you think of metastatic prostate cancer (in men) and breast cancer (in women).

... benwhite_dotcom made a comment on step2ck_free120/block3/q#20 (Three days after hospitalization for diabetic...)
 +0 
submitted by benwhite_dotcom(466)

Patients who have the capacity to make medical decisions are allowed to refuse life-saving medical treatment. You should offer it but accept her refusal.

... carolebaskin made a comment on step2ck_free120/block3/q#40 (A 27-year-old woman comes to the physician because)
 +0 
submitted by carolebaskin(35)

Young woman with long history of crampy abd pain, diarrhea, + relieved by defection, without red flag symptoms.

It's IBS

Tricyclics can be used for IBS; they help with pain and can help with diarrhea


Could also have used antispasmodics like dicyclomine and hyoscyamine for the pain

For diarrhea, can also use loperamide or other antidiarrheals

For constipation type IBS try fiber, osmotic laxatives, lubiprostone

... benwhite_dotcom made a comment on step2ck_free120/block3/q#40 (A 27-year-old woman comes to the physician because)
 +0 
submitted by benwhite_dotcom(466)

IBS is a β€œfunctional” G.I. problem, which means that it is a diagnosis of exclusion (must rule out IBD, Celiac, etc). You may have enjoyed its recent popular appearance on television as a disturbing anthropomorphized walking bowel. Common symptoms include diarrhea, constipation, pain relieved by defecation, and flatulence, often subject to a degree of emotional valence. As such, like headaches, IBS symptoms can be improved by TCA therapy, such as nortriptyline.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#1 (A 68-year-old man is brought to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

While you may have initially been thinking of alcohol withdrawal, the case presents you with signs/symptoms of decompensated cirrhosis including hepatic encephalopathy from hyperammonemia (AMS, asterixis). Treatment is oral lactulose, which helps clear ammonia via the power of horrible diarrhea.

... benwhite_dotcom made a comment on step2ck_free120/block1/q#2 (A 45-year-old woman comes to the emergency...)
 +0 
submitted by benwhite_dotcom(466)

You know that granulomatosis with polyangiitis (nΓ©e Wegener’s) causes lung disease, but did you know it also causes peripheral neuropathy? Keep in mind that β€œnot all that wheezes is asthma.” Wheezing is a sign of obstructive lung disease, not a diagnostic feature, so consider asthma alternatives in adults. Hemoptysis and fever change the game.