Step 2 CK Question of the Week

How does the Step 2 CK question of the week work?

Every week we add one new Step 2 CK question here, with the newest at the top. Each comes from the TopQbank USMLE Step 2 CK question bank, reviewed by licensed doctors, with the answer and an explanation. Try it before you scroll to the answer.

Week of 5 October 2026 · Pediatrics

A previously healthy 5-year-old boy is brought to clinic with 1 week of progressive puffiness around the eyes, swelling of the legs, and decreased urine output. Two weeks earlier he had a mild viral upper respiratory infection. He was born at term after an uncomplicated pregnancy. Growth and development are normal. Immunizations are up to date. He takes no medications and has no allergies. Family history is negative for renal disease or autoimmune disorders. Examination shows BP 96/60 mmHg, periorbital edema, pitting edema to the ankles, ascites, and normal lung examination. Urinalysis shows 4+ protein without hematuria. Urine protein/creatinine ratio is markedly elevated. Serum albumin is 18 g/L, total cholesterol is 8.6 mmol/L, creatinine is normal, and C3/C4 levels are normal. What is the most likely diagnosis?

A) Acute poststreptococcal glomerulonephritis

B) Minimal change nephrotic syndrome

C) IgA nephropathy

D) Hemolytic uremic syndrome

E) Pyelonephritis

Correct answer: B) Minimal change nephrotic syndrome. Edema, heavy proteinuria, hypoalbuminemia, hyperlipidemia, and normal renal function in a young child are classic for minimal change disease.

Week of 28 September 2026 · Psychiatry

A 34-year-old man with a 4-year history of daily fentanyl use presents to the emergency department approximately 18 hours after his last use because he wants treatment. He reports severe anxiety, restlessness, diffuse muscle and bone aches, abdominal cramping, nausea, repeated diarrhea, and inability to sleep. Examination shows blood pressure 148/86 mm Hg, pulse 104/min, temperature 37.6°C, yawning, lacrimation, rhinorrhea, piloerection, diaphoresis, and markedly dilated pupils. He is alert and oriented, has no respiratory depression, and denies alcohol or benzodiazepine use. He asks for medication to control his symptoms and help him stop using opioids. If opioid agonist treatment is not immediately available or is declined, which medication can reduce autonomic withdrawal symptoms such as sweating, tachycardia, and restlessness?

A) Fluoxetine

B) Haloperidol

C) Clonidine

D) Bupropion

E) Lithium

Correct answer: C) Clonidine. Clonidine, an alpha-2 adrenergic agonist, reduces sympathetic symptoms of opioid withdrawal. It does not treat opioid use disorder itself or reduce mortality as effectively as maintenance treatment with buprenorphine or methadone.

Week of 21 September 2026 · Emergency medicine

A 24-year-old woman is brought to the emergency department 15 minutes after being stung multiple times by bees while hiking. She has a history of severe allergy to bee venom but did not carry her epinephrine autoinjector. Shortly after the stings she developed generalized itching, urticaria, facial swelling, hoarseness, wheezing, dizziness, and difficulty breathing. On arrival she appears anxious and is speaking in one-word sentences. Temperature is 36.9°C, blood pressure is 72/40 mmHg, heart rate is 136/min, respiratory rate is 34/min, and oxygen saturation is 88% on room air. Examination reveals diffuse urticaria, lip and tongue edema, inspiratory stridor, diffuse expiratory wheezing, and delayed capillary refill. ECG shows sinus tachycardia. Laboratory investigations are pending. What is the most appropriate immediate treatment?

A) Intravenous diphenhydramine only

B) Intramuscular epinephrine into the mid-anterolateral thigh

C) Nebulized salbutamol only

D) Intravenous hydrocortisone before epinephrine

E) Observation for spontaneous recovery

Correct answer: B) Intramuscular epinephrine into the mid-anterolateral thigh. Epinephrine is the first-line treatment for anaphylactic shock and should be administered immediately. Antihistamines, corticosteroids, oxygen, bronchodilators, and intravenous fluids are adjunctive therapies.

Week of 14 September 2026 · Dermatology

A 32-year-old nurse presents with a 6-month history of recurrent intensely pruritic erythematous patches involving both hands. Symptoms worsen after repeated handwashing, use of alcohol-based sanitizers, and wearing occlusive gloves during long shifts. She reports dryness, burning, fissuring, and occasional small vesicles along the lateral aspects of the fingers. During vacations, the eruption improves substantially. She has no fever, systemic symptoms, mucosal lesions, or similar rash among household contacts. Examination shows xerotic erythematous scaly plaques with superficial fissures over the dorsal hands and interdigital spaces. There are no burrows, honey-colored crusts, annular plaques with central clearing, or sharply demarcated plaques with silvery scale. What is the most likely diagnosis?

A) Tinea manuum

B) Irritant contact dermatitis (hand eczema)

C) Scabies

D) Psoriasis

E) Impetigo

Correct answer: B) Irritant contact dermatitis (hand eczema). Repeated exposure to water, detergents, sanitizers, and occlusion can disrupt the epidermal barrier and produce irritant contact dermatitis. Hand eczema commonly presents with pruritus, burning, xerosis, erythema, scaling, and fissuring.

Want more than one a week? Try 10 free Step 2 CK practice questions, the Step 2 CK sample question guide, or full timed blocks in the TopQbank Step 2 CK question bank.