Free USMLE Step 2 CK Practice Exams: What’s Official and Worth Using

What free Step 2 CK practice exams does USMLE offer?

USMLE publishes more than 100 Step 2 CK sample questions, both as a PDF and inside its interactive testing experience. If your exam is on or after May 7, 2026, use the new interactive version: it matches the current format of sixteen 30-minute blocks with up to 20 questions each, in one 9-hour session.

Best for: learning the exam software and question style before test day. USMLE also lets you register for a Practice Session at a Prometric test centre if you want to get used to the real testing environment.

NBME self-assessments for Step 2 CK

NBME’s Comprehensive Clinical Science Self-Assessment (CCSSA) is the self-assessment for Step 2 CK. NBME lists the price as starting at $62, and seven forms are available. Each form has four sections of 50 questions, with 1 hour 15 minutes per section at standard pace, or up to 5 hours per section if you choose the self-paced option.

Your score report gives an equated percent correct score and an estimated probability of passing Step 2 CK, with answer explanations and performance by content area. You can view the report for 2 years after you finish.

Best for: checking your readiness. Because each form gives an estimated probability of passing, the CCSSA is most useful once you have covered most of the content and want to measure where you stand.

How to use them together

Use the USMLE sample questions early to learn the format and software. Spread the CCSSA forms across your final weeks so you can see whether your scores are moving. In between, work through timed blocks of 20 questions in 30 minutes to build the pace of the new format. The content split is covered in the Step 2 CK content blueprint, and the score you need in the Step 2 CK passing score guide.

10 Step 2 CK practice questions with answers

These come from the TopQbank USMLE Step 2 CK question bank, reviewed by licensed doctors. They are not real USMLE questions, and they are different from the four in our Step 2 CK sample question guide. To mirror one block, give yourself 15 minutes for all 10.

Question 1 · Medicine

A 63-year-old woman with chronic SIADH has had serum sodium levels between 116 and 120 mEq/L for more than a week. She is admitted for worsening gait instability but has no seizure or coma. During treatment at an outside facility, her sodium rises from 117 to 132 mEq/L over approximately 10 hours. Two days later, she develops dysarthria, dysphagia, confusion, and progressive quadriparesis. Temperature is normal. Neurologic examination shows spastic weakness of all four extremities and impaired speech. MRI of the brain demonstrates symmetric abnormal signal in the central pons. Which complication most likely occurred?

A) Wernicke encephalopathy

B) Central pontine osmotic demyelination due to overly rapid correction of chronic hyponatremia

C) Acute bacterial meningitis

D) Posterior reversible encephalopathy syndrome

E) Myasthenic crisis

Correct answer: B) Central pontine osmotic demyelination due to overly rapid correction of chronic hyponatremia. Overly rapid correction of chronic hyponatremia can cause osmotic demyelination syndrome, classically affecting the central pons. Manifestations may be delayed and include dysarthria, dysphagia, altered mental status, and quadriparesis.

Question 2 · Medicine

A 64-year-old woman with type 2 diabetes mellitus, obesity, and heart failure with reduced ejection fraction presents for medication review. She currently takes metformin and a sulfonylurea. Her cardiologist recently documented an ejection fraction of 30%. She reports mild bilateral ankle swelling that worsens by evening but denies chest pain or syncope. Blood pressure is 122/70 mm Hg, pulse is 68/min, and BMI is 31 kg/m². Examination shows bibasilar crackles and 1+ pitting edema of both lower legs. BNP is elevated. Creatinine is 1.0 mg/dL and liver enzymes are normal. Which glucose-lowering medication should generally be avoided because it can worsen fluid retention and heart failure?

A) Pioglitazone

B) Metformin

C) Sitagliptin

D) Semaglutide

E) Empagliflozin

Correct answer: A) Pioglitazone. Thiazolidinediones such as pioglitazone activate PPAR-gamma and improve insulin sensitivity but can cause sodium and fluid retention, edema, weight gain, and worsening heart failure. They should be avoided in symptomatic heart failure.

Question 3 · Medicine

An 8-year-old boy is brought to clinic because of a 5-week history of scalp itching and progressive patchy hair loss. His mother reports that several classmates have recently had scalp fungal infections. Examination shows two circular areas of alopecia with scale, broken hairs, and multiple black dots where hairs have fractured near the scalp surface. There is mild posterior cervical lymphadenopathy. One area has recently become boggy, tender, and inflamed with scattered pustules, but the child is afebrile and otherwise well. He has no smooth completely nonscaly patches, exclamation-point hairs, or compulsive hair pulling. Which diagnostic test is most appropriate when confirmation is needed?

A) KOH examination and/or fungal culture of affected hairs and scalp scale

B) Patch testing

C) Tzanck smear

D) Serum ANA

E) Bacterial blood cultures in every patient

Correct answer: A) KOH examination and/or fungal culture of affected hairs and scalp scale. Microscopy with KOH can demonstrate fungal elements, while fungal culture can identify the dermatophyte species. Sampling affected hairs and scale is useful when the diagnosis is uncertain or species identification may affect management.

Question 4 · Surgery

A 7-year-old boy presents with recurrent episodes of colicky abdominal pain and vomiting over the past 24 hours. His parents report one prior episode of intussusception 6 months ago that was successfully reduced by air enema. Unlike typical infantile cases, he is older and has now had recurrent disease. He has also had intermittent painless maroon stools over the past month. Temperature is 36.9°C, blood pressure is 104/66 mm Hg, pulse is 94/min, and he is hemodynamically stable. The abdomen is mildly tender without peritonitis. Ultrasonography again confirms ileocolic intussusception. Pneumatic reduction is successful. Because of his age and recurrent episodes, the surgical team investigates for a pathologic lead point. Technetium-99m pertechnetate scintigraphy shows focal uptake in the right lower abdomen consistent with ectopic gastric mucosa. Which underlying lesion is most likely acting as the lead point?

A) Meckel diverticulum

B) Acute appendicitis

C) Hirschsprung disease

D) Pyloric stenosis

E) Duodenal atresia

Correct answer: A) Meckel diverticulum. Most ileocolic intussusception in infants is idiopathic, but older children and patients with recurrent intussusception are more likely to have a pathologic lead point. Meckel diverticulum is a classic lead point and may also cause painless lower gastrointestinal bleeding.

Question 5 · Surgery

A 59-year-old woman undergoes right hemicolectomy for a localized colon adenocarcinoma. Pathology shows tumor invasion through the muscularis propria into pericolonic tissue, with 3 of 24 regional lymph nodes positive for metastatic carcinoma. Surgical margins are negative and staging CT shows no distant metastases. She recovers well from surgery and asks whether additional therapy is needed. Which management strategy is most appropriate?

A) Observation only because the primary tumor was completely removed

B) Adjuvant systemic chemotherapy because regional lymph-node involvement indicates stage III disease

C) Routine pelvic radiation as the only adjuvant treatment

D) Lifelong antibiotics

E) Repeat colectomy despite negative margins

Correct answer: B) Adjuvant systemic chemotherapy because regional lymph-node involvement indicates stage III disease. Colon cancer with regional lymph-node involvement is stage III disease. After complete surgical resection, adjuvant systemic chemotherapy is generally recommended to reduce recurrence risk. Radiation is not routinely used for resected colon cancer but has an important role in selected rectal cancers.

Question 6 · Pediatrics

A previously healthy 3-week-old full-term male infant is brought to the emergency department because of sudden onset of bilious green vomiting that began 3 hours ago. He has vomited after every feed and is increasingly irritable. Pregnancy, birth, development, immunizations, medications, allergies, family, and social history are otherwise unremarkable. There is no diarrhea or fever. Examination shows HR 170/min, BP 74/42 mmHg, capillary refill 4 seconds, mild abdominal distension with diffuse tenderness but no palpable mass. CBC shows mild leukocytosis and lactate is elevated. Abdominal radiograph shows paucity of distal bowel gas. Upper GI contrast study demonstrates an abnormal position of the duodenojejunal junction with a corkscrew appearance of the proximal small bowel, concerning for midgut volvulus. What is the most likely diagnosis?

A) Hypertrophic pyloric stenosis

B) Necrotizing enterocolitis

C) Malrotation with midgut volvulus

D) Intussusception

E) Gastroesophageal reflux

Correct answer: C) Malrotation with midgut volvulus. Bilious vomiting in a neonate with corkscrew upper GI findings is a surgical emergency due to malrotation with volvulus.

Question 7 · Obstetrics and gynecology

A 22-year-old nulligravid woman presents 48 hours after unprotected vaginal intercourse when a condom broke. She has regular menstrual cycles every 29 days, her last menstrual period began 12 days ago, and she does not desire pregnancy. She has no history of thromboembolism, liver disease, or ectopic pregnancy. BMI is 33 kg/m². Pregnancy test is negative. She takes no regular medications and has no allergies. What is the most effective emergency contraceptive option for this patient within 5 days of unprotected intercourse?

A) Levonorgestrel pill

B) Copper intrauterine device

C) Combined oral contraceptives

D) Depot medroxyprogesterone

E) Rhythm method

Correct answer: B) Copper intrauterine device. A copper IUD is the most effective form of emergency contraception when inserted within 5 days of unprotected intercourse and provides ongoing contraception.

Question 8 · Psychiatry

A 30-year-old woman is brought to clinic for recurrent episodes of psychosis and mood disturbance over the past 3 years. She has had periods of severe depression with anhedonia, guilt, insomnia, poor concentration, and suicidal thoughts occurring together with auditory hallucinations and persecutory delusions. At other times she has experienced episodes of elevated mood, decreased need for sleep, pressured speech, grandiosity, and increased goal-directed activity. Her family reports that on several occasions the prominent mood symptoms completely resolved, yet she continued to hear voices and maintain bizarre delusions for approximately 3 to 4 weeks. She has had substantial occupational and social decline. Urine toxicology is negative, thyroid studies are normal, and no neurologic or medical cause is identified. Which historical feature is essential for distinguishing schizoaffective disorder from a mood disorder with psychotic features?

A) Presence of insomnia

B) At least 2 weeks of psychosis occurring without a major mood episode

C) Presence of depressive symptoms

D) Family history of psychiatric illness

E) Occupational impairment

Correct answer: B) At least 2 weeks of psychosis occurring without a major mood episode. In bipolar disorder or major depressive disorder with psychotic features, psychosis occurs exclusively during mood episodes. Independent psychosis for at least 2 weeks supports schizoaffective disorder.

Question 9 · Emergency medicine

A 34-year-old woman with type 1 diabetes mellitus is admitted for diabetic ketoacidosis precipitated by gastroenteritis. She has received intravenous saline potassium and a continuous regular insulin infusion. Four hours later she is alert and hemodynamically stable. Serum glucose has decreased from 520 mg/dL to 188 mg/dL. Laboratory studies show sodium 138 mEq/L potassium 4.1 mEq/L chloride 108 mEq/L bicarbonate 14 mEq/L and anion gap 16 mEq/L. Serum beta-hydroxybutyrate remains elevated. Which of the following is the most appropriate next step in management?

A) Stop the insulin infusion because the glucose is below 200 mg/dL

B) Add dextrose to the intravenous fluids and continue the insulin infusion

C) Switch immediately to metformin

D) Give intravenous sodium bicarbonate

E) Discontinue all intravenous fluids

Correct answer: B) Add dextrose to the intravenous fluids and continue the insulin infusion. The glucose has fallen but ketoacidosis has not resolved because the anion gap remains elevated and ketones remain present. Dextrose should be added to intravenous fluids to prevent hypoglycemia while insulin is continued until ketoacidosis resolves.

Question 10 · Biostatistics

A public health department evaluates a rapid screening test for a chronic infectious disease in 2,000 adults. The reference standard shows that 400 participants truly have the disease and 1,600 do not. Among those with disease, 360 have a positive screening test and 40 test negative. Among those without disease, 320 test positive and 1,280 test negative. Officials want to understand how the test performs before using it in populations with different disease prevalence. What is the specificity of this screening test?

A) 53%

B) 90%

C) 80%

D) 64%

E) 20%

Correct answer: C) 80%. Specificity is TN/(TN+FP). Here, specificity = 1,280/(1,280+320) = 1,280/1,600 = 80%. Specificity measures the probability of a negative test among people who do not have the disease.

Want one new question every week? Follow the Step 2 CK question of the week, or practise full timed blocks in the TopQbank Step 2 CK question bank.