9 USMLE Step 2 CK Clinical Review Questions with Answers (Set 9)

These 9 USMLE Step 2 CK clinical review questions are short clinical cases on diagnosis and next-step management, including Intravenous ceftriaxone, Galactose-1-phosphate uridyltransferase, Ischemic colitis. 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 59-year-old man presents with crushing chest pain for 1 hour. ECG shows ST elevation in the anterior leads. The hospital does not have a catheterization laboratory, and transfer would take 3 hours. What is the most appropriate next step?

A- Administer fibrinolytic therapy
B- Begin aspirin therapy only
C- Start intravenous heparin and observe
D- Wait for the transfer for PCI

A- Administer fibrinolytic therapy- If PCI cannot be performed within 120 minutes, fibrinolytic therapy should be given for STEMI to restore coronary perfusion.
The correct answer is A

 

Question 2. A 66-year-old man with cirrhosis presents with increasing abdominal distension and fever. Paracentesis reveals neutrophil count of 350 cells/mm³. What is the most appropriate treatment?

A- Intravenous ceftriaxone
B- Oral metronidazole
C- Paracentesis only
D- Prednisone

A- Intravenous ceftriaxone- Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic neutrophils are ≥250 cells/mm³. Immediate treatment with third-generation cephalosporins is required.
The correct answer is A

 

Question 3. A newborn develops jaundice and hepatomegaly within the first week of life. Laboratory studies show elevated galactose-1-phosphate levels. Which enzyme deficiency is most likely responsible?

A- Galactokinase
B- Galactose-1-phosphate uridyltransferase
C- Glucose-6-phosphate dehydrogenase
D- Pyruvate dehydrogenase

B- Galactose-1-phosphate uridyltransferase- Classic galactosemia results from deficiency of galactose-1-phosphate uridyltransferase, leading to accumulation of galactose-1-phosphate, liver damage, cataracts, and failure to thrive.
The correct answer is B

 

Question 4. A 68-year-old man presents with fever, productive cough, and confusion. Blood pressure is 82/50 mmHg despite receiving 2 liters of IV fluids. What is the next best step in management?

A- Administer intravenous norepinephrine
B- Begin oral antibiotics
C- Obtain chest CT scan
D- Start furosemide

A- Administer intravenous norepinephrine- This patient has septic shock with persistent hypotension despite fluid resuscitation. Norepinephrine is the first-line vasopressor.
The correct answer is A

 

Question 5. A 73-year-old man presents with urinary retention after undergoing surgery. Bladder scan shows 700 mL of urine. What is the most appropriate immediate management?

A- Foley catheter placement
B- Oral tamsulosin
C- Pelvic ultrasound
D- Suprapubic surgery

A- Foley catheter placement- Acute urinary retention requires immediate bladder decompression with a Foley catheter before further evaluation.
The correct answer is A

 

Question 6. A 24-year-old woman presents with acute unilateral lower abdominal pain and nausea. Ultrasound shows an enlarged ovary with decreased blood flow. What is the next best step in management?

A- Administer broad-spectrum antibiotics
B- Emergency laparoscopy
C- Observe and repeat ultrasound in 24 hours
D- Start oral contraceptives

B- Emergency laparoscopy- Ovarian torsion is a surgical emergency requiring immediate intervention to preserve ovarian viability.
The correct answer is B

 

Question 7. A 29-year-old man presents with sudden severe scrotal pain and nausea. Physical examination reveals a high-riding testis with absent cremasteric reflex. What is the best next step?

A- Oral antibiotics
B- Scrotal ultrasound before intervention
C- Supportive care and discharge
D- Surgical exploration immediately

D- Surgical exploration immediately- Testicular torsion is a surgical emergency. Do not delay surgery for imaging if suspicion is high. Torsion vs. epididymitis: Torsion starts suddenly, the testis rides high with a horizontal lie, the cremasteric reflex is absent, and lifting the scrotum does not relieve pain (negative Prehn sign). Epididymitis comes on gradually, often with fever or dysuria, the cremasteric reflex is present, and lifting the scrotum may ease the pain (positive Prehn sign). Surgery within 6 hours gives the best chance of saving the testis.
The correct answer is D

 

Question 8. A 62-year-old man presents with fever, dysuria, urinary frequency, and perineal pain. Digital rectal examination reveals a tender, boggy prostate. Which of the following is the most appropriate next step in management?

A- Begin empiric antibiotics
B- Perform prostate massage for culture
C- Schedule transurethral resection of the prostate
D- Treat with an alpha-blocker only

A- Begin empiric antibiotics- Acute bacterial prostatitis is diagnosed clinically. A tender, boggy prostate is classic. Prostate massage is contraindicated because it may precipitate bacteremia.
The correct answer is A

 

Question 9. A 76-year-old woman presents with abdominal pain and bright red blood per rectum. She recently underwent repair of an abdominal aortic aneurysm. Which of the following is the most likely diagnosis?

A- Diverticular bleeding
B- Infectious colitis
C- Ischemic colitis
D- Ulcerative colitis

C- Ischemic colitis- Recent vascular surgery and acute abdominal pain followed by hematochezia strongly suggest ischemic colitis, particularly in watershed areas of the colon.
The correct answer is C

 

High-yield points from this set

  • If PCI cannot be performed within 120 minutes, fibrinolytic therapy should be given for STEMI to restore coronary perfusion.
  • Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic neutrophils are ≥250 cells/mm³.
  • This patient has septic shock with persistent hypotension despite fluid resuscitation.
  • Acute urinary retention requires immediate bladder decompression with a Foley catheter before further evaluation.
  • Ovarian torsion is a surgical emergency requiring immediate intervention to preserve ovarian viability.

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