USMLE Step 2 CK USMLE Step 2 CK Practice Test 2025
This is the official USMLE Step 2 CK USMLE Step 2 CK question paper for 2025, as set in the Model questions examination. It carries 318 full marks and a time allowance of 540 minutes, across 10 questions. On Kekkei you can attempt this USMLE Step 2 CK past paper online with a timer, get instant AI feedback and step-by-step solutions, and track the topics where you lose marks — completely free. Whether you are revising for your USMLE Step 2 CK USMLE Step 2 CK exam or solving previous years' question papers, this 2025 paper is a great way to practise under real exam conditions.
| Level | USMLE Step 2 CK |
|---|---|
| Subject | USMLE Step 2 CK |
| Year | 2025 BS |
| Exam session | Model questions |
| Full marks | 318 |
| Time allowed | 540 minutes |
| Questions | 10, all with step-by-step solutions |
Clinical Knowledge
Select the single best answer for each clinical vignette.
A 58-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the emergency department with crushing substernal chest pain radiating to his left arm for the past 45 minutes. He is diaphoretic and nauseated. ECG shows ST-segment elevation in leads II, III, and aVF. Troponin I is elevated. Blood pressure is 90/60 mmHg, heart rate is 110 bpm. Which of the following is the most appropriate next step in management?
Emergent percutaneous coronary intervention (PCI)
The patient presents with an acute inferior ST-elevation myocardial infarction (STEMI) complicated by hypotension. The most appropriate next step is emergent percutaneous coronary intervention (PCI). Primary PCI is the preferred reperfusion strategy when it can be performed within 90 minutes of first medical contact. Thrombolytics are second-line when PCI is not available. IV fluids may help with hypotension but do not address the underlying coronary occlusion.
A 35-year-old woman presents with a 24-hour history of progressively worsening right lower quadrant abdominal pain. She reports anorexia, nausea, and one episode of vomiting. Temperature is 38.5°C (101.3°F). Physical examination reveals rebound tenderness and guarding at McBurney’s point. WBC count is 14,500/µL with left shift. CT abdomen shows a dilated, fluid-filled appendix measuring 12 mm in diameter with periappendiceal fat stranding. What is the most appropriate management?
Laparoscopic appendectomy
This presentation is classic for acute appendicitis: periumbilical pain migrating to the right lower quadrant, fever, leukocytosis with left shift, and CT findings of an inflamed appendix. The standard of care is appendectomy (laparoscopic preferred). Antibiotics alone have a high failure and recurrence rate. Serial observation is not appropriate given the clear clinical and radiographic diagnosis.
A 4-year-old boy is brought to the pediatric clinic by his mother who reports that he has had a high fever (39.5°C) for the past 5 days, bilateral non-purulent conjunctivitis, cracked erythematous lips, a polymorphous rash over the trunk, and swollen hands and feet. On examination, he has a single palpable anterior cervical lymph node measuring 2 cm. Laboratory studies show elevated ESR and CRP. Which of the following is the most likely diagnosis?
Kawasaki disease
This child meets the classic criteria for Kawasaki disease: fever ≥5 days plus at least 4 of the 5 principal features (bilateral conjunctival injection, oral mucosal changes, extremity changes, polymorphous rash, and cervical lymphadenopathy ≥1.5 cm). Kawasaki disease is the leading cause of acquired heart disease in children in developed countries. Treatment with IV immunoglobulin and high-dose aspirin should be initiated promptly to prevent coronary artery aneurysms.
A 29-year-old primigravida at 34 weeks of gestation presents with sudden-onset painless vaginal bleeding. She reports soaking through two pads in the past hour. She denies abdominal pain, contractions, or trauma. Her vital signs are stable. Fetal heart tracing is category I (reassuring). Transabdominal ultrasound reveals an anteriorly located placenta completely covering the internal cervical os. Which of the following is the most appropriate initial management?
Admit, establish IV access, type and crossmatch, and monitor expectantly
This patient has classic placenta previa (painless vaginal bleeding, placenta covering the os). The initial management includes hospital admission, IV access, type and crossmatch, continuous fetal monitoring, and expectant management if the bleeding stops and mother and fetus are stable. Digital cervical examination is absolutely contraindicated as it can provoke catastrophic hemorrhage. Emergency cesarean section is reserved for uncontrolled hemorrhage or fetal distress.
A 22-year-old college student is brought to the emergency department by campus police after being found standing on the roof of a building shouting that he can fly. His roommate reports that the patient has not slept in 4 days, has been spending excessively on credit cards, talks rapidly, and has been engaging in risky sexual behavior. He has no prior psychiatric history and denies drug use. Urine toxicology screen is negative. On examination, he is grandiose, euphoric, and distractible with pressured speech. Which of the following is the most likely diagnosis?
Bipolar I disorder, manic episode
This patient demonstrates a classic manic episode: elevated/expansive mood, decreased need for sleep, grandiosity, pressured speech, excessive involvement in pleasurable activities with potential for painful consequences (spending sprees, sexual indiscretions), and impaired judgment. With negative toxicology and no prior history, this presentation is most consistent with bipolar I disorder, manic episode. Schizophrenia typically features negative symptoms and thought disorder without the classic manic cluster.
A 52-year-old woman with no significant past medical history presents for a routine health maintenance visit. She has never had a colonoscopy. Her mother was diagnosed with colon cancer at age 60. She is a non-smoker and drinks alcohol socially. BMI is 26 kg/m². She has no gastrointestinal symptoms. According to current USPSTF screening guidelines, which of the following is the most appropriate recommendation for colorectal cancer screening?
Colonoscopy now, repeat every 10 years if normal
The USPSTF recommends colorectal cancer screening for all adults aged 45–75 years at average risk. For patients with a first-degree relative diagnosed with colorectal cancer at age ≥60, guidelines recommend beginning screening at age 40 or 10 years before the age of the relative’s diagnosis, whichever comes first. This patient is 52, so she is already past the recommended start age. Colonoscopy every 10 years is one of the accepted screening strategies.
A 67-year-old man with a 40-pack-year smoking history presents with progressive dyspnea on exertion over the past 6 months. He now becomes short of breath walking one block. Physical examination reveals diminished breath sounds bilaterally, barrel chest, and prolonged expiratory phase. Pulmonary function testing shows FEV1/FVC ratio of 0.55 and FEV1 of 42% predicted, with minimal bronchodilator reversibility. Chest X-ray shows hyperinflated lungs with flattened diaphragms. Which of the following interventions has been shown to improve survival in this patient’s condition?
Smoking cessation
This patient has severe COPD (GOLD stage III, FEV1 30–49% predicted). Among the listed interventions, smoking cessation and supplemental oxygen (in patients with resting hypoxemia, PaO2 ≤55 mmHg) are the only two interventions proven to reduce mortality in COPD. Since smoking cessation is the single most important intervention that alters the natural history of COPD and improves survival at any stage, it is the best answer.
A 45-year-old woman presents with recurrent episodes of severe right upper quadrant pain lasting 2–4 hours, typically occurring after fatty meals. The most recent episode was associated with fever (38.8°C), persistent pain lasting 12 hours, and a positive Murphy’s sign on examination. Laboratory findings include WBC 16,000/µL, total bilirubin 1.0 mg/dL, alkaline phosphatase 90 U/L, and lipase within normal limits. Right upper quadrant ultrasound shows gallbladder wall thickening (5 mm), pericholecystic fluid, and multiple gallstones. The common bile duct measures 4 mm. What is the most appropriate management?
IV antibiotics and early laparoscopic cholecystectomy
This patient presents with acute cholecystitis (fever, persistent RUQ pain, positive Murphy’s sign, leukocytosis, and sonographic findings of gallbladder wall thickening with pericholecystic fluid). The standard treatment is IV antibiotics and early laparoscopic cholecystectomy (ideally within 24–72 hours of admission). The normal bilirubin, alkaline phosphatase, and common bile duct diameter make choledocholithiasis unlikely.
A 6-week-old male infant is brought to the emergency department with projectile, non-bilious vomiting after every feeding for the past week. The vomiting has become progressively worse, and the mother reports the infant appears hungry immediately after vomiting. On examination, the infant appears dehydrated with a sunken fontanelle. An olive-shaped mass is palpated in the right upper quadrant. Laboratory studies show Na 133 mEq/L, K 3.0 mEq/L, Cl 88 mEq/L, and HCO₃ 32 mEq/L. What is the most likely diagnosis?
Hypertrophic pyloric stenosis
This is a classic presentation of hypertrophic pyloric stenosis: a male infant aged 2–8 weeks with progressive, projectile, non-bilious vomiting, a palpable “olive” in the right upper quadrant (the hypertrophied pylorus), and hypochloremic, hypokalemic metabolic alkalosis from loss of gastric hydrochloric acid. The infant remains hungry after vomiting (“hungry vomiter”). Diagnosis is confirmed by ultrasound showing an elongated, thickened pylorus. Treatment is pyloromyotomy after fluid and electrolyte correction.
A 32-year-old woman at 28 weeks of gestation presents with a blood pressure of 162/108 mmHg on two separate measurements taken 4 hours apart. She reports a new-onset severe headache and visual disturbances. Urinalysis shows 3+ protein. Laboratory studies reveal platelet count of 90,000/µL, AST 180 U/L, ALT 165 U/L, and creatinine 1.4 mg/dL. Fetal heart tracing is category I. Which of the following is the most appropriate management?
IV magnesium sulfate, corticosteroids, antihypertensives, and plan for delivery
This patient has preeclampsia with severe features (BP ≥160/110, headache, visual disturbances, proteinuria, thrombocytopenia, elevated liver enzymes, and elevated creatinine). At 28 weeks, the management includes IV magnesium sulfate for seizure prophylaxis, antihypertensive therapy (IV labetalol or hydralazine), corticosteroids for fetal lung maturity, and planning for delivery. While the gestational age is early, delivery is indicated given the severity of the disease.
Frequently asked questions
- Where can I find the USMLE Step 2 CK USMLE Step 2 CK question paper 2025?
- The full USMLE Step 2 CK USMLE Step 2 CK 2025 (Model questions) question paper is available free on Kekkei. You can read every question online and attempt the paper under timed exam conditions.
- Does the USMLE Step 2 CK 2025 paper come with solutions?
- Yes. Every question on this USMLE Step 2 CK past paper includes a step-by-step solution, plus instant AI feedback when you attempt it on Kekkei.
- How many marks is the USMLE Step 2 CK USMLE Step 2 CK 2025 paper?
- The USMLE Step 2 CK USMLE Step 2 CK 2025 paper carries 318 full marks and is meant to be completed in 540 minutes, across 10 questions.
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- Yes — reading and attempting this USMLE Step 2 CK past paper on Kekkei is completely free.