Explanations to Released Items
Every fall, the NBME ( National Board of Medical Examiners) releases 150 sample questions for candidates to see what USMLE Step 2 CK questions look like. They publish the items on CD-ROM; they also can be downloaded from the USMLE web site. It is important for you to review these items, as they are similar in both format and content to those on the real exam.
What the NBME doesn't provide are the explanations. That's where we offer you our USMLE preparation courses! We have written comprehensive explanations to all 150 items, including discussions of why the right answers are right and why all the distracters are wrong. Please note that the questions themselves are copyrighted by the NBME and can not be reproduced. If you don't already have the USMLE's CD-ROM, visit www.usmle.org.
Step 2CK Sample Questions
Question 1
1. A 42-year-old homeless man with no history of prior surgery presents with frequent vomiting and no passage of stool or flatus in the past 24 hours. His temperature is 100.8F. Physical exam reveals a tympanitic abdomen and a tender erythematous mass in the right groin. WBC count is 21,000, and an x-ray shows multiple air-fluid levels with no air visualized in the colon. Which of the following is the most appropriate next step in the management of this patient?
| (A) | Colonoscopy to rule out obstructing carcinoma of ileocecal valve |
| (B) | Incision and drainage of the groin mass |
| (C) | Nasogastric suction and observation |
| (D) | Passage of a nasogastric tube and schedule for immediate surgery |
| (E) | Sedation and manual reduction of incarcerated hernia followed by observation |
2.A 5-year-old boy presents with dysphagia. He began complaining of a sore throat 5 hours ago and was unable to swallow solid food. He had gone to bed but awoke 3 hours later frightened, hot, and having difficulty breathing. On physical exam, his temperature is 103.2F, heart rate is 100, and respiratory rate is 42. The boy is frightened, sitting forward in his father's lap with his neck extended, and drooling with his tongue protruding from his mouth. Both inspiratory and expiratory stridor are prominent. Which of the following is the most appropriate next step in the management of this patient?
| (A) | Arterial blood gas analysis to assess degree of respiratory compromise |
| (B) | Complete physical examination to identify other signs of illness |
| (C) | Focused exam of oropharynx to identify the cause of his respiratory distress |
| (D) | Immediate monitored transfer to the operating room for the placement of an artificial airway |
| (E) | Immediate administration of aerosolized racemic epinephrine to reduce airway obstruction |
USMLE Step 2 CK
Question 2
A 5-year-old boy presents with dysphagia. He began complaining of a sore throat 5 hours ago and was unable to swallow solid food. He had gone to bed but awoke 3 hours later frightened, hot, and having difficulty breathing. On physical exam, his temperature is 103.2F, heart rate is 100, and respiratory rate is 42. The boy is frightened, sitting forward in his father's lap with his neck extended, and drooling with his tongue protruding from his mouth. Both inspiratory and expiratory stridor are prominent. Which of the following is the most appropriate next step in the management of this patient?
| (A) | Arterial blood gas analysis to assess degree of respiratory compromise |
| (B) | Complete physical examination to identify other signs of illness |
| (C) | Focused exam of oropharynx to identify the cause of his respiratory distress |
| (D) | Immediate monitored transfer to the operating room for the placement of an artificial airway |
| (E) | Immediate administration of aerosolized racemic epinephrine to reduce airway obstruction |
The correct answer is choice D.