11 USMLE Step 2 CK Clinical Review Questions with Answers (Set 7)

These 11 USMLE Step 2 CK clinical review questions are short clinical cases on diagnosis and next-step management, including Tubo-ovarian abscess, Oral vancomycin, CT angiography, β-Hexosaminidase A. Each question includes the correct answer and an explanation.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. A 52-year-old man with a mechanical aortic valve takes warfarin. He presents with a severe headache and vomiting. CT scan shows an intracranial hemorrhage. INR is 5.2. What is the best immediate reversal strategy?

A- Fresh frozen plasma only
B- Intravenous vitamin K only
C- Prothrombin complex concentrate plus intravenous vitamin K
D- Stop warfarin and observe

C-Prothrombin complex concentrate plus intravenous vitamin K- Life-threatening bleeding on warfarin requires rapid reversal with PCC (fast) plus IV vitamin K (sustained). FFP is slower and higher volume.
The correct answer is C

 

Question 2. A 31-year-old woman presents with 2 days of pelvic pain and fever. She has purulent cervical discharge and cervical motion tenderness. Pregnancy test is negative. She is diagnosed with pelvic inflammatory disease and started on antibiotics. Two days later, she returns with worsening pain and a palpable adnexal mass. What is the most likely diagnosis?

A- Appendicitis
B- Ectopic pregnancy
C- Ovarian torsion
D- Tubo-ovarian abscess

D-Tubo-ovarian abscess- PID complicated by persistent/worsening pain, fever, and adnexal mass suggests a tubo-ovarian abscess, which may require IV antibiotics and drainage.
The correct answer is D

 

Question 3. A 46-year-old man presents with progressive weakness and paresthesias. He recently had a diarrheal illness. On exam, he has symmetric ascending weakness and absent deep tendon reflexes. Vital capacity is decreasing. What is the most appropriate next step?

A- Administer corticosteroids
B- Begin intravenous immunoglobulin (IVIG)
C- Reassure and discharge home
D- Start oral antibiotics

B-Begin intravenous immunoglobulin (IVIG)- This is Guillain-Barré syndrome. With worsening weakness and declining vital capacity, treat with IVIG or plasmapheresis and monitor respiratory status closely. Steroids do not help.
The correct answer is B

 

Question 4. A 26-year-old woman at 34 weeks’ gestation presents with severe headache, visual disturbances, and right upper quadrant pain. Blood pressure is 170/110 mmHg. Labs show platelets 85,000/mm³ and elevated AST/ALT. Fetal monitoring is reassuring. What is the most appropriate next step in management?

A- Administer IV labetalol and observe
B- Administer magnesium sulfate and proceed to delivery
C- Begin oral methyldopa and outpatient follow-up
D- Delay delivery until 37 weeks

B- Administer magnesium sulfate and proceed to delivery- This is a case of severe preeclampsia with HELLP syndrome. At ≥34 weeks, the correct management is magnesium sulfate (seizure prophylaxis) and delivery, regardless of fetal status.
The correct answer is B

 

Question 5. A 68-year-old man with advanced COPD is hospitalized for pneumonia and develops respiratory failure. He previously completed an advance directive stating he does not want intubation. His family demands “everything be done.” What is the most appropriate next step?

A- Follow the family’s wishes
B- Intubate temporarily and reassess later
C- Honor the patient’s advance directive
D- Request a court order

C- Honor the patient’s advance directive- A competent patient’s prior expressed wishes take precedence over family requests. Physicians must respect advance directives.
The correct answer is C

 

Question 6. A 57-year-old man undergoes colon resection. On postoperative day 3, he develops fever, tachycardia, and abdominal pain. Abdomen is distended and tender. CT scan shows free air and fluid collection. What is the most appropriate next step?

A- Broad-spectrum antibiotics only
B- Percutaneous drainage
C- Return to the operating room
D- Supportive care and observation

C- Return to the operating room- This suggests anastomotic leak with peritonitis. Hemodynamic instability and free air require urgent surgical exploration, not conservative management.
The correct answer is C

 

Question 7. A 45-year-old woman presents with fever and a productive cough. She has been started on antibiotics for community-acquired pneumonia. Two days later, she develops profuse watery diarrhea. The stool test is positive for toxin. What is the most appropriate treatment?

A- Ciprofloxacin
B- Loperamide
C- Oral vancomycin
D- Stop antibiotics only

C-Oral vancomycin- This case is Clostridioides difficile infection. First-line treatment for initial severe infection is oral vancomycin.
The correct answer is C

 

Question 8. A 72-year-old woman presents with sudden, severe abdominal pain that is out of proportion to physical findings. She has atrial fibrillation. Lactate is elevated. What is the most appropriate next diagnostic step?

A- Abdominal ultrasound
B- Colonoscopy
C- CT angiography
D- Plain abdominal X-ray

C-CT angiography- This is classic acute mesenteric ischemia (pain out of proportion, AFib embolus). The best diagnostic test is CT angiography.
The correct answer is C

 

Question 9. A 58-year-old man presents with severe chest pain for 45 minutes. ECG shows ST elevations in leads II, III, and aVF. Blood pressure is 78/50 mmHg, and jugular venous distention is present. Lungs are clear on auscultation. What is the most appropriate next step in management?

A- Administer intravenous fluids
B- Give intravenous furosemide
C- Start nitroglycerin infusion
D- Start morphine for pain

A-Administer intravenous fluids- This is inferior MI with right ventricular infarction. Hypotension with clear lungs indicates decreased preload. IV fluids increase right ventricular preload and improve cardiac output. Nitrates and diuretics would worsen hypotension.
The correct answer is A

 

Question 10. A 6-month-old infant presents with developmental delay, hypotonia, and a cherry-red spot on retinal examination. There is no hepatosplenomegaly. Which enzyme deficiency is most likely responsible for this condition?

A- Arylsulfatase A
B- β-Hexosaminidase A
C- Glucocerebrosidase
D- Sphingomyelinase

B- β-Hexosaminidase A- Tay-Sachs disease results from deficiency of β-hexosaminidase A, causing the accumulation of GM2 ganglioside. It presents with neurodegeneration and cherry-red macula without hepatosplenomegaly.
The correct answer is B

 

Question 11. A patient with chronic kidney disease develops hypocalcemia. Which hormone normally increases renal calcium reabsorption in the distal tubule?

A- Aldosterone
B- Calcitonin
C- Parathyroid hormone
D- Vasopressin

C- Parathyroid hormone- PTH increases calcium reabsorption in the distal convoluted tubule, decreases phosphate reabsorption in the proximal tubule, and stimulates vitamin D activation.
The correct answer is C

 

High-yield points from this set

  • Life-threatening bleeding on warfarin requires rapid reversal with PCC (fast) plus IV vitamin K (sustained).
  • ovarian abscess- PID complicated by persistent/worsening pain, fever, and adnexal mass suggests a tubo-ovarian abscess, which may require IV antibiotics and drainage.
  • This is Guillain-Barré syndrome.
  • This is a case of severe preeclampsia with HELLP syndrome.
  • A competent patient’s prior expressed wishes take precedence over family requests.

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