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Step 2 CK Practice Questions (Free, with Explanations)

Last reviewed September 5, 2026

What do Step 2 CK practice questions look like?

Step 2 CK practice questions are clinical vignettes: a patient's age, presentation, examination and results, followed by a single question — most often the next step in management or the most likely diagnosis — and four to ten answer choices. The 10 below are real StepGenie question-bank items with complete explanations, and none of them need an account.

10 free Step 2 CK practice questions

One question from each of 10 organ systems. Pick an answer, check it, then read the explanation: the stem decoded clue by clue, the reasoning chain with its infographic, why each wrong option is wrong, and the trap the question was built around.

Question 1 of 10Step 2 CK

A 23-year-old man with a history of chronic alcohol use presents to the emergency department with hematemesis. He reports multiple prior similar episodes. He is treated with ondansetron but continues to vomit. After another forceful episode of vomiting, he develops sudden-onset severe substernal chest pain and difficulty swallowing. Temperature is 37.2°C (99°F), blood pressure is 117/60 mm Hg, pulse is 122/min, respirations are 15/min, and oxygen saturation is 99% on room air. On examination, he appears uncomfortable, and there is palpable subcutaneous emphysema in the neck and supraclavicular regions. Which of the following is the most likely diagnosis?

Question 2 of 10Step 2 CKGenital tract tumors and tumor-like lesions

A 24-year-old woman presents for an annual routine examination. She has regular 28-day menstrual cycles that last 4 days with normal flow; her last menstrual period was 3 weeks ago. She is sexually active with one male partner and uses condoms consistently. She is 160 cm (5 ft 3 in) tall and weighs 72 kg (150 lb) (BMI 28.1 kg/m²). She reports feeling well. Pelvic examination reveals a smooth, mobile right adnexal mass. Pelvic ultrasound demonstrates a single, 2-cm, round, hypoechoic mass with a thin, smooth wall in the right ovary. The mass shows posterior acoustic enhancement without internal blood flow or septations. Which of the following is the most appropriate next step in management?

Question 3 of 10Step 2 CKDemyelinating diseases

A 35-year-old woman presents with 5 days of progressively worsening weakness and numbness in both upper extremities. Over the past 2 days, she has also developed new-onset urinary incontinence that is not associated with coughing, sneezing, or laughing. She reports a similar episode last summer involving weakness and numbness of the right lower extremity that was worse with heat exposure; those symptoms resolved over 3 weeks without treatment. She has no significant past medical history. She has had 10 male sexual partners and uses condoms inconsistently. Vital signs are within normal limits. Neurologic examination shows impaired tandem gait and mild spasticity with decreased muscle strength in both upper extremities. Deep tendon reflexes are 4+ bilaterally, and the abdominal reflex is absent. Muscle strength in the right lower extremity is mildly decreased. Sensation to vibration and fine touch is decreased in the upper extremities. Which of the following is the most appropriate next step in diagnosis?

Question 4 of 10Step 2 CK

A 64-year-old woman presents to the emergency department with severe, diffuse pruritus that began while she was taking a bath. She has never had similar symptoms before. Over the past several months, she has experienced episodes of painful swelling in the joints of her hands and intermittent redness, burning pain, and swelling of both hands and feet. Three months ago, she was diagnosed with a deep vein thrombosis of the left leg. Her medical history is also significant for type 2 diabetes mellitus, hypertension, and osteoporosis treated with metformin, enalapril, and alendronate. Vital signs are within normal limits. She appears uncomfortable and has excoriations on the skin of her forearms. Additional evaluation reveals the following laboratory results: Labs: - Serum sodium: 135 mEq/L - Serum chloride: 100 mEq/L - Serum potassium: 5.0 mEq/L - Serum bicarbonate (HCO3–): 22 mEq/L - Blood urea nitrogen (BUN): 19 mg/dL - Serum glucose: 130 mg/dL - Serum creatinine: 1.0 mg/dL - Hematocrit: 64% - Leukocyte count: 19,000 cells/mm^3 (normal differential) - Platelet count: 900,000/mm^3 What is the best next step in treatment of this patient’s underlying condition?

Question 5 of 10Step 2 CKObstructive and restrictive lung disease

A 2-year-old boy is brought to the emergency department with acute respiratory distress. About an hour after being put to bed, he developed a sudden onset of a harsh, “hacking” cough and a high-pitched noise with each breath. He has had only a runny nose over the past few days and has otherwise been healthy. He does not have toys or other small objects in his bed. On examination, he appears to be in respiratory distress. Which of the following is the most appropriate management for this patient?

Question 6 of 10Step 2 CKDisorders of the ear, nose, and throat

A 7-year-old boy is brought to the emergency department for worsening nasal symptoms. One week ago, he was evaluated by his pediatrician for acute sinusitis and was treated with decongestants. Since then, he has developed increasing nasal pain and a foul-smelling nasal discharge. His medical history is notable for well-controlled asthma managed with albuterol. Vital signs show temperature 99.5°F (37.5°C), blood pressure 90/48 mm Hg, pulse 124/min, respirations 17/min, and oxygen saturation 98% on room air. He appears well and in no acute distress. Cardiopulmonary examination is normal. Nasal examination reveals unilateral purulent discharge mixed with blood. The remainder of the physical examination is unremarkable. Which of the following is the most likely diagnosis?

Question 7 of 10Step 2 CKReproductive endocrinology

A 16-year-old girl is evaluated for primary amenorrhea. She has no history of serious illness and takes no medications. She is 162 cm (5 ft 3 in) tall and weighs 80 kg (176 lb), with a BMI of 31.2 kg/m². Breast and pubic hair development are Tanner stage 4. She has oily skin, acne, and hyperpigmented, velvety plaques in the intertriginous areas of the neck and axillae. The remainder of the physical examination, including pelvic examination, is unremarkable. Which of the following is the most likely explanation for this patient’s amenorrhea?

Question 8 of 10Step 2 CKHeart failure and shock

An 82-year-old woman is brought to the emergency department after a brief loss of consciousness at her nursing home. She had been sitting and watching television for several hours and became dizzy while standing to go to the bathroom, after which she fell and briefly lost consciousness. She denies headache or other pain. Medical history is significant for hypertension, intermittent atrial fibrillation, and stable angina pectoris. Her medications include warfarin, aspirin, hydrochlorothiazide, and nitroglycerin spray as needed. Her temperature is 36.7°C (98.1°F), pulse is 100/min and regular, and blood pressure is 102/56 mm Hg. Physical examination shows a dry tongue and decreased skin turgor, with a skin fold on the dorsum of the hand taking 2 seconds to return to normal. Cardiopulmonary examination is unremarkable. Further evaluation of this patient is most likely to show which of the following findings?

Question 9 of 10Step 2 CKAnaphylaxis and allergic reactions

A 23-year-old man presents to the emergency department with acute onset shortness of breath that began while playing football outside during a work lunch. He reports rapid worsening of dyspnea and lightheadedness. Medical history is significant for atopic dermatitis and asthma. On arrival, his temperature is 98.3°F (36.8°C), blood pressure is 87/58 mm Hg, pulse is 150/min, respirations are 22/min, and oxygen saturation is 85% on room air. Which of the following is the best next step in management?

Question 10 of 10Step 2 CKDisorders of the eye and associated structures

A 51-year-old man presents with a 1-day history of progressively worsening right eye pain, excessive tearing, and blurry vision. The symptoms began the previous evening while he was watching a movie in a theater. He wears contact lenses. Medical history is notable for atopic dermatitis treated with topical hydrocortisone. His temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 135/75 mm Hg. Visual acuity is 20/25 in the left eye and 20/40 in the right eye. Examination of the right eye reveals conjunctival injection and corneal edema with a whitish exudate layering in the anterior chamber. Fluorescein staining demonstrates a round corneal infiltrate. Which of the following is the most appropriate pharmacotherapy?

Source: StepGenie question bank. Questions are written by StepGenie, not taken from NBME or USMLE materials, and are chosen for this page by how students actually performed on them (first-attempt accuracy on StepGenie), one per organ system. Selection last refreshed September 5, 2026.

Want more questions?

The dashboard preview serves three more with the same explanations and no account needed. It picks them from the whole bank, so they may be Step 1 rather than Step 2 CK. A free account is where you choose what to practice and see your accuracy by system.

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How does the real Step 2 CK differ from practice questions?

The questions are the same kind of vignette; the exam adds a clock, a block structure, random ordering and silence.

Practising a question on its own, you can take as long as you like, change your mind, and read the explanation before moving on. On the real Step 2 CK you answer in timed blocks, the questions arrive in random order across every organ system, and you learn nothing about any answer until the score report. The USMLE's own sample booklet notes that most examinees perceive the time pressure to be greater during the actual examination — so once single questions feel comfortable, move to timed blocks.

Questions on this pageReal Step 2 CK from May 7, 2026Real Step 2 CK before May 7, 2026
Questions10, all on one pageUp to 20 per blockUp to 40 per block, up to 318 in total
BlocksOne, untimedSixteen 30-minute blocksEight 60-minute blocks
Testing sessionAs long as you wantOne 9-hour dayOne 9-hour day
Break timeUnlimitedAt least 55 minutes, more if you finish blocks earlyAt least 45 minutes
TutorialNone5-minute optional tutorial15-minute optional tutorial
Question orderGrouped so no two share an organ systemRandomRandom
FeedbackFull explanation after every questionNone during the exam; a score report afterwardsSame

Sources: USMLE, Step 2 CK exam content and format (accessed September 5, 2026); USMLE Step 2 CK Sample Test Questions booklet (updated March 2021) (question order and timing notes).

How should you use practice questions for Step 2 CK?

Practice questions work when every one of them changes what you do next.

Answer before you look, commit to a choice, and only then read the explanation. When you miss a question, write down the single fact or rule that would have got it right — the decoded clue, not the whole topic — and revisit it before your next block on that system. Questions you got right by elimination count as misses.

Work by organ system early and in mixed, timed blocks later, so the random ordering of the real exam is not itself a surprise. Every system below has its own hub of free questions, and practice questions by topic lists all of them, so you can spend the early weeks on the systems you are weakest in and save mixed blocks for the end.

At some point you need an estimate of where you stand rather than a count of questions completed. StepGenie's free self-assessment is a timed 120-question form in randomized blocks that returns a predicted three-digit score and a breakdown by subject — a better guide to the last weeks than volume is.

Which organ systems do these questions cover?

Each question above comes from a different organ system in the Step 2 CK content outline. Every system with a topic hub links to more free questions on that system.

Frequently Asked Questions

Are the Step 2 CK practice questions on this page free?

Yes. All 10 come from StepGenie's question bank and can be answered here without an account, with the full explanation shown after each one. The dashboard preview serves three more from across the bank without signing up, and a free account is where you choose what to practice and keep going.

How are these different from the official USMLE sample questions?

The official Step 2 CK sample booklet from usmle.org is the only public source of retired real exam items; it comes with an answer key but no explanations. StepGenie questions are written in the same vignette format and every one ends in a full explanation. Use both: the booklet to calibrate the exam's voice, a question bank for volume and feedback.

Is the real Step 2 CK harder than practice questions?

The content is comparable; the difficulty on the day comes from format. The real exam runs in one 9-hour session of timed blocks with no feedback, and the USMLE's own sample booklet warns that most examinees perceive the time pressure to be greater during the actual examination. Practice timed blocks before test day, not just single questions.

What does a Step 2 CK question usually ask?

Most stems end in a management question: the most appropriate next step, the best initial test, or the most likely diagnosis given the findings. Unlike Step 1, mechanism is rarely the question itself; it is what you use to get to the answer.

How many practice questions should I do before Step 2 CK?

Enough to have seen every organ system in vignette form and to have reviewed every question you missed at least once. The Step 2 CK study schedule page turns that into a daily count for your dates, and a question bank that tracks your accuracy by system tells you where to spend the last weeks.

Keep going

Free self-assessment

Estimate your score

Qbank comparisons

See how they differ

Practice questions by topic

Every organ system

Practice Step 2 CK the way you just did — by the block

Every StepGenie question ends in the explanation you saw above, with your accuracy tracked by organ system so the weeks before the exam go to the systems that need them.

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