First Aid for the USMLE Step 2 Ck, Eleventh Edition (2022)
First Aid for the USMLE Step 2 Ck, Eleventh Edition (2022) includes past certification exam papers, ensuring you practice effectively before the actual test.
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USMLE Step 2 CK
Eleventh Edition
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
MONA ASCHA, MD
Fellow, Department of Plastic Surgery
Johns Hopkins University
MARINA BOUSHRA, MD
Emergency Medicine and Critical Care Medicine
Cleveland Clinic Foundation, Cleveland, Ohio
CAROLINE COLEMAN, MD
Resident, Department of Medicine
Emory University School of Medicine
VIKAS BHUSHAN, MD
Founder, First Aid for the USMLE Step 1
Boracay, Philippines
ABHISHEK BHARDWAJ, MD
Pulmonologist and Intensivist
Coast Pulmonary Associates, Orange County, California
Assistant Clinical Professor, Health Sciences
University of California, Riverside
DANIEL GRIFFIN, DO
Intensivist, Saint Francis Medical Center
STEPHANIE JONES, PhD
Emory University Laney Graduate School
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
Eleventh Edition
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
MONA ASCHA, MD
Fellow, Department of Plastic Surgery
Johns Hopkins University
MARINA BOUSHRA, MD
Emergency Medicine and Critical Care Medicine
Cleveland Clinic Foundation, Cleveland, Ohio
CAROLINE COLEMAN, MD
Resident, Department of Medicine
Emory University School of Medicine
VIKAS BHUSHAN, MD
Founder, First Aid for the USMLE Step 1
Boracay, Philippines
ABHISHEK BHARDWAJ, MD
Pulmonologist and Intensivist
Coast Pulmonary Associates, Orange County, California
Assistant Clinical Professor, Health Sciences
University of California, Riverside
DANIEL GRIFFIN, DO
Intensivist, Saint Francis Medical Center
STEPHANIE JONES, PhD
Emory University Laney Graduate School
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
USMLE Step 2 CK
Eleventh Edition
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
MONA ASCHA, MD
Fellow, Department of Plastic Surgery
Johns Hopkins University
MARINA BOUSHRA, MD
Emergency Medicine and Critical Care Medicine
Cleveland Clinic Foundation, Cleveland, Ohio
CAROLINE COLEMAN, MD
Resident, Department of Medicine
Emory University School of Medicine
VIKAS BHUSHAN, MD
Founder, First Aid for the USMLE Step 1
Boracay, Philippines
ABHISHEK BHARDWAJ, MD
Pulmonologist and Intensivist
Coast Pulmonary Associates, Orange County, California
Assistant Clinical Professor, Health Sciences
University of California, Riverside
DANIEL GRIFFIN, DO
Intensivist, Saint Francis Medical Center
STEPHANIE JONES, PhD
Emory University Laney Graduate School
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
Eleventh Edition
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
MONA ASCHA, MD
Fellow, Department of Plastic Surgery
Johns Hopkins University
MARINA BOUSHRA, MD
Emergency Medicine and Critical Care Medicine
Cleveland Clinic Foundation, Cleveland, Ohio
CAROLINE COLEMAN, MD
Resident, Department of Medicine
Emory University School of Medicine
VIKAS BHUSHAN, MD
Founder, First Aid for the USMLE Step 1
Boracay, Philippines
ABHISHEK BHARDWAJ, MD
Pulmonologist and Intensivist
Coast Pulmonary Associates, Orange County, California
Assistant Clinical Professor, Health Sciences
University of California, Riverside
DANIEL GRIFFIN, DO
Intensivist, Saint Francis Medical Center
STEPHANIE JONES, PhD
Emory University Laney Graduate School
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
Copyright © 2023, 2019, 2016, 2012, 2010, 2007, by Tao Le. All rights reserved. Except as permitted under the United States Copyright Act of 1976,
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior
written permission of the publisher.
ISBN: 978-1-26-485651-0
MHID: 1-26-485651-2
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-485510-0,
MHID: 1-26-485510-9.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use
names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designa-
tions appear in this book, they have been printed with initial caps.
McGraw Hill eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To
contact a representative, please visit the Contact Us page at www.mhprofessional.com.
McGraw Hill, the McGraw Hill logo, Practice Makes Perfect, and related trade dress are trademarks or registered trademarks of McGraw Hill and/
or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their
respective owners. McGraw Hill is not associated with any product or vendor mentioned in this book.
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are
required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is com-
plete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in
medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other
sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to
administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the
contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms.
Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble,
reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any
part of it without McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the
work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES
AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUD-
ING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY
DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANT-
ABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions
contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its
licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting
therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall
McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from
the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior
written permission of the publisher.
ISBN: 978-1-26-485651-0
MHID: 1-26-485651-2
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-485510-0,
MHID: 1-26-485510-9.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use
names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designa-
tions appear in this book, they have been printed with initial caps.
McGraw Hill eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To
contact a representative, please visit the Contact Us page at www.mhprofessional.com.
McGraw Hill, the McGraw Hill logo, Practice Makes Perfect, and related trade dress are trademarks or registered trademarks of McGraw Hill and/
or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their
respective owners. McGraw Hill is not associated with any product or vendor mentioned in this book.
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are
required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is com-
plete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in
medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other
sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to
administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the
contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms.
Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble,
reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any
part of it without McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the
work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES
AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUD-
ING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY
DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANT-
ABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions
contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its
licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting
therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall
McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from
the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
iii
DEDICATION
To the contributors to this and past editions,
who took time to share their knowledge, insight, and
humor for the benefit of students and physicians everywhere.
DEDICATION
To the contributors to this and past editions,
who took time to share their knowledge, insight, and
humor for the benefit of students and physicians everywhere.
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v
Contents
Contributing Authors vi
Faculty Reviewers viii
Preface ix
Acknowledgments x
How to Contribute xi
How to Use This Book xii
SECTION 1: GUIDE TO EFFICIENT EXAM
PREPARATION 2
Introduction 2
USMLE Step 2 CK—Computer-Based Testing Basics 2
Defining Your Goal 10
Study Resources 12
Test-Day Checklist 13
Testing Agencies 14
SECTION 2: DATABASE OF HIGH-YIELD FACTS 15
How to Use the Database 16
Cardiovascular 17
Dermatology 87
Endocrinology 123
Epidemiology 157
Health Systems Science 177
Gastrointestinal 197
Hematology/Oncology 269
Musculoskeletal 313
Neurology 351
Obstetrics 427
Gynecology 467
Pediatrics 509
Psychiatry 585
Pulmonary 625
Renal/Genitourinary 675
Multisystem 717
Rapid Review 765
SECTION 3: TOP-RATED REVIEW RESOURCES 791
How to Use the Database 792
Comprehensive 794
Question Banks 794
Internal Medicine, Emergency Medicine,
Family Medicine 795
Neurology 795
OB/GYN 795
Pediatrics 796
Psychiatry 796
Surgery 796
Commercial Review Courses 797
Appendix I: Acronyms and Abbreviations 799
Appendix II: Common Laboratory Values 807
Index 809
About the Authors 842
Contents
Contributing Authors vi
Faculty Reviewers viii
Preface ix
Acknowledgments x
How to Contribute xi
How to Use This Book xii
SECTION 1: GUIDE TO EFFICIENT EXAM
PREPARATION 2
Introduction 2
USMLE Step 2 CK—Computer-Based Testing Basics 2
Defining Your Goal 10
Study Resources 12
Test-Day Checklist 13
Testing Agencies 14
SECTION 2: DATABASE OF HIGH-YIELD FACTS 15
How to Use the Database 16
Cardiovascular 17
Dermatology 87
Endocrinology 123
Epidemiology 157
Health Systems Science 177
Gastrointestinal 197
Hematology/Oncology 269
Musculoskeletal 313
Neurology 351
Obstetrics 427
Gynecology 467
Pediatrics 509
Psychiatry 585
Pulmonary 625
Renal/Genitourinary 675
Multisystem 717
Rapid Review 765
SECTION 3: TOP-RATED REVIEW RESOURCES 791
How to Use the Database 792
Comprehensive 794
Question Banks 794
Internal Medicine, Emergency Medicine,
Family Medicine 795
Neurology 795
OB/GYN 795
Pediatrics 796
Psychiatry 796
Surgery 796
Commercial Review Courses 797
Appendix I: Acronyms and Abbreviations 799
Appendix II: Common Laboratory Values 807
Index 809
About the Authors 842
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vi
CONTRIBUTING AUTHORS
Manik Aggarwal, MD, MBBS
Fellow, Gastroenterology and Hepatology
Mayo Clinic, Rochester, Minnesota
John Carl Barba II, MPH
MD Candidate
Ohio State University College of Medicine
Anup Chalise, MBBS, MS
Nepal
Paola Ghanem, MD
Physician, Department of Internal Medicine
Johns Hopkins University
Myles Mowery, DO, MBA
Resident, Diagnostic and Interventional Radiology
Spectrum Health/Michigan State University
Grand Rapids, Michigan
Waneeza Mughees, MD
Resident, Obstetrics and Gynecology
Drexel University College of Medicine, Philadelphia
Christian Cuvillier Padilla, MD
Chief Resident, Internal Medicine
Cleveland Clinic and Cleveland Veterans Affairs Medical Center,
Cleveland, Ohio
Vivek Podder, MBBS
Intern
BIRDEM General Hospital, Bangladesh
Vikram Shee, MBBS, MSc
Physician Case Manager
Teladoc Health, Inc.
Collin Andrew Weintraub, MD
Resident, General Surgery
State University of New York Upstate Medical University
IMAGE AND ILLUSTRATION TEAM
Yoree Grace Chung
MD/PhD Candidate
Emory University School of Medicine
Nikitha Crasta, MBBS
Mangalore, India
Sean Evans, MD
Resident, Internal Medicine
Emory University School of Medicine
Victor Jose Martinez Leon, MD
Resident, Internal Medicine
Einstein Medical Center, Philadelphia
Angel Xiao, MD, MSE
Resident, Orthopedic Surgery
University of California–San Francisco
CONTRIBUTING AUTHORS
Manik Aggarwal, MD, MBBS
Fellow, Gastroenterology and Hepatology
Mayo Clinic, Rochester, Minnesota
John Carl Barba II, MPH
MD Candidate
Ohio State University College of Medicine
Anup Chalise, MBBS, MS
Nepal
Paola Ghanem, MD
Physician, Department of Internal Medicine
Johns Hopkins University
Myles Mowery, DO, MBA
Resident, Diagnostic and Interventional Radiology
Spectrum Health/Michigan State University
Grand Rapids, Michigan
Waneeza Mughees, MD
Resident, Obstetrics and Gynecology
Drexel University College of Medicine, Philadelphia
Christian Cuvillier Padilla, MD
Chief Resident, Internal Medicine
Cleveland Clinic and Cleveland Veterans Affairs Medical Center,
Cleveland, Ohio
Vivek Podder, MBBS
Intern
BIRDEM General Hospital, Bangladesh
Vikram Shee, MBBS, MSc
Physician Case Manager
Teladoc Health, Inc.
Collin Andrew Weintraub, MD
Resident, General Surgery
State University of New York Upstate Medical University
IMAGE AND ILLUSTRATION TEAM
Yoree Grace Chung
MD/PhD Candidate
Emory University School of Medicine
Nikitha Crasta, MBBS
Mangalore, India
Sean Evans, MD
Resident, Internal Medicine
Emory University School of Medicine
Victor Jose Martinez Leon, MD
Resident, Internal Medicine
Einstein Medical Center, Philadelphia
Angel Xiao, MD, MSE
Resident, Orthopedic Surgery
University of California–San Francisco
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vii
ASSOCIATE AUTHORS
Aparna Savitri Bhat, MD
Fellow, Pulmonary and Critical Care Medicine
Cleveland Clinic, Cleveland, Ohio
Naveena Daram, MD
Resident, Obstetrics and Gynecology
Wright State University
Ifrah Fatima, MBBS
Resident, Internal Medicine
University of Missouri–Kansas City School of Medicine
Lindsay Friedman, MD, MS
Resident, General Surgery
Rush University Medical Center
Luise Josefine Froessl, MD
Resident
Université d’Aix-Marseille, Faculté de Medecine
Izhan Hamza, MBBS
Resident
University of Texas Medical Branch, Internal Medicine
Abdul Rehman Mustafa, MBBS
Alfaisal University College of Medicine, Saudi Arabia
Aaron Panicker, MD
Resident, Emergency Medicine
University of Florida College of Medicine
Austin Patrick, DO
Resident
Franciscan Health Olympia Fields
Faateh Ahmad Rauf, MBBS
CMH Lahore Medical College and Institute of Dentistry, Pakistan
Jaimie Rogner, MD, MPH
Resident, Internal Medicine/Pediatrics
University of Rochester Medical Center/Strong Memorial Hospital
Kyle Robert Wagner
MD Candidate
University of Illinois College of Medicine, Peoria
ASSOCIATE AUTHORS
Aparna Savitri Bhat, MD
Fellow, Pulmonary and Critical Care Medicine
Cleveland Clinic, Cleveland, Ohio
Naveena Daram, MD
Resident, Obstetrics and Gynecology
Wright State University
Ifrah Fatima, MBBS
Resident, Internal Medicine
University of Missouri–Kansas City School of Medicine
Lindsay Friedman, MD, MS
Resident, General Surgery
Rush University Medical Center
Luise Josefine Froessl, MD
Resident
Université d’Aix-Marseille, Faculté de Medecine
Izhan Hamza, MBBS
Resident
University of Texas Medical Branch, Internal Medicine
Abdul Rehman Mustafa, MBBS
Alfaisal University College of Medicine, Saudi Arabia
Aaron Panicker, MD
Resident, Emergency Medicine
University of Florida College of Medicine
Austin Patrick, DO
Resident
Franciscan Health Olympia Fields
Faateh Ahmad Rauf, MBBS
CMH Lahore Medical College and Institute of Dentistry, Pakistan
Jaimie Rogner, MD, MPH
Resident, Internal Medicine/Pediatrics
University of Rochester Medical Center/Strong Memorial Hospital
Kyle Robert Wagner
MD Candidate
University of Illinois College of Medicine, Peoria
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viii
FACULTY REVIEWERS
Brooks D Cash, MD
Professor, Department of Medicine
Chief, Gastroenterology, Hepatology, and Nutrition
University of Texas Health Science Center at Houston
Dimitri Cassimatis, MD
Associate Professor, Department of Medicine
Emory University School of Medicine
Bradley Cole, MD
Assistant Professor of Neurology
Loma Linda University School of Medicine
Meredith K Greer, MD
Assistant Professor, Department of Medicine
Emory University School of Medicine
Jennifer O Howell, MD
Associate Professor, Department of Obstetrics and Gynecology
Duke University Medical Center
Matthew Kraybill, PhD
Clinical Neuropsychologist
Cottage Health, Santa Barbara, California
Patrick M Lank, MD, MS
Assistant Professor, Department of Emergency Medicine
Northwestern University, Feinberg School of Medicine
Kachiu C Lee, MD, MPH
Assistant Professor (Adjunct), Department of Dermatology
Lewis Katz School of Medicine at Temple University
Carl Marfurt, PhD
Professor Emeritus, Department of Anatomy, Cell Biology and
Physiology
Indiana University School of Medicine–Northwest, Gary
Peter Marks, MD, PhD
Center for Biologics Evaluation and Research
US Food and Drug Administration
Kristen L Pagel, MD, MPH
Assistant Professor, Department of Psychiatry
University of Utah School of Medicine
Mahesh Patel, MD
Professor, Department of Medicine
University of Illinois at Chicago College of Medicine
Diane Payne, MD, MPT
Orthopedic, Hand and Microvascular Surgery
OrthoAtlanta Newnan, Georgia
Soroush Rais-Bahrami, MD
Professor of Urology and Radiology and Interim Chair, Department
of Urology
University of Alabama at Birmingham School of Medicine
Keisha Ray, PhD
Assistant Professor, McGovern Center for Humanities and Ethics
University of Texas Health Science Center at Houston
Rachel Marie E Salas, MD, MEd
Professor, Neurology and Nursing
Johns Hopkins Medicine
Sarah Schimansky, MB BCh BAO
Resident, Department of Ophthalmology
Bristol Eye Hospital
Shireen Madani Sims, MD
Associate Professor and Vice Chair for Education, Obstetrics and
Gynecology
University of Florida College of Medicine
Nathan Wm Skelley, MD
Associate Professor, Medical Director of Orthopaedic Surgery
Sanford Health–University of South Dakota School of Medicine
Matthew Sochat, MD
Physician, Hematology/Oncology
Southeastern Medical Oncology Center
Lorrel Toft, MD
Associate Professor of Cardiology, Department of Medicine
University of Nevada, Reno School of Medicine
Tisha Wang, MD
Professor of Clinical Medicine, Department of Medicine
David Geffen School of Medicine at UCLA
Sylvia Wassertheil-Smoller, PhD
Professor Emerita, Department of Epidemiology and Population
Health
Albert Einstein College of Medicine
Adam Weinstein, MD
Associate Professor of Medical Sciences and Pediatrics
Frank H. Netter MD School of Medicine at Quinnipiac University
James S Yeh, MD, MPH
Department of Medicine
Massachusetts General Hospital, Harvard Medical School
Kristal Young, MD
Clinical Instructor, Department of Cardiology
Huntington Hospital, Pasadena, California
FACULTY REVIEWERS
Brooks D Cash, MD
Professor, Department of Medicine
Chief, Gastroenterology, Hepatology, and Nutrition
University of Texas Health Science Center at Houston
Dimitri Cassimatis, MD
Associate Professor, Department of Medicine
Emory University School of Medicine
Bradley Cole, MD
Assistant Professor of Neurology
Loma Linda University School of Medicine
Meredith K Greer, MD
Assistant Professor, Department of Medicine
Emory University School of Medicine
Jennifer O Howell, MD
Associate Professor, Department of Obstetrics and Gynecology
Duke University Medical Center
Matthew Kraybill, PhD
Clinical Neuropsychologist
Cottage Health, Santa Barbara, California
Patrick M Lank, MD, MS
Assistant Professor, Department of Emergency Medicine
Northwestern University, Feinberg School of Medicine
Kachiu C Lee, MD, MPH
Assistant Professor (Adjunct), Department of Dermatology
Lewis Katz School of Medicine at Temple University
Carl Marfurt, PhD
Professor Emeritus, Department of Anatomy, Cell Biology and
Physiology
Indiana University School of Medicine–Northwest, Gary
Peter Marks, MD, PhD
Center for Biologics Evaluation and Research
US Food and Drug Administration
Kristen L Pagel, MD, MPH
Assistant Professor, Department of Psychiatry
University of Utah School of Medicine
Mahesh Patel, MD
Professor, Department of Medicine
University of Illinois at Chicago College of Medicine
Diane Payne, MD, MPT
Orthopedic, Hand and Microvascular Surgery
OrthoAtlanta Newnan, Georgia
Soroush Rais-Bahrami, MD
Professor of Urology and Radiology and Interim Chair, Department
of Urology
University of Alabama at Birmingham School of Medicine
Keisha Ray, PhD
Assistant Professor, McGovern Center for Humanities and Ethics
University of Texas Health Science Center at Houston
Rachel Marie E Salas, MD, MEd
Professor, Neurology and Nursing
Johns Hopkins Medicine
Sarah Schimansky, MB BCh BAO
Resident, Department of Ophthalmology
Bristol Eye Hospital
Shireen Madani Sims, MD
Associate Professor and Vice Chair for Education, Obstetrics and
Gynecology
University of Florida College of Medicine
Nathan Wm Skelley, MD
Associate Professor, Medical Director of Orthopaedic Surgery
Sanford Health–University of South Dakota School of Medicine
Matthew Sochat, MD
Physician, Hematology/Oncology
Southeastern Medical Oncology Center
Lorrel Toft, MD
Associate Professor of Cardiology, Department of Medicine
University of Nevada, Reno School of Medicine
Tisha Wang, MD
Professor of Clinical Medicine, Department of Medicine
David Geffen School of Medicine at UCLA
Sylvia Wassertheil-Smoller, PhD
Professor Emerita, Department of Epidemiology and Population
Health
Albert Einstein College of Medicine
Adam Weinstein, MD
Associate Professor of Medical Sciences and Pediatrics
Frank H. Netter MD School of Medicine at Quinnipiac University
James S Yeh, MD, MPH
Department of Medicine
Massachusetts General Hospital, Harvard Medical School
Kristal Young, MD
Clinical Instructor, Department of Cardiology
Huntington Hospital, Pasadena, California
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ix
Preface
With the 11th edition of First Aid for the USMLE Step 2 CK, we continue our commitment to pro-
viding students with the most high-yield and up-to-date preparation guide for the USMLE Step 2 CK
exam. Preparation for and performance on the Step 2 CK exam are more important than ever with the
transition of the Step 1 exam to a pass/fail scoring system in 2022. With this in mind, we have greatly
expanded the content and depth for the 11th edition. This revision includes:
■ Over 200 additional pages of content incorporating the most current evidence-based reviews and rec-
ommendations to help students on the Step 2 CK exam and in clinical practice.
■ 163 new and revised diagrams and illustrations, including more than 40 new diagnostic and manage-
ment algorithms, to further drive home the next best diagnostic and management options.
■ 140 new and revised photos/images to help visualize various disorders, descriptive findings, and clini-
cal content tie-ins.
■ Extensive text revisions, new mnemonics, and clarifications curated by a team of 26 medical student
and resident physician authors who excelled on their USMLE exams and verified by a team of expert
faculty advisors and nationally recognized USMLE instructors.
■ Continued focus on clinical presentation and the best initial step in diagnosis and management, mir-
roring the content outline and blueprint of Step 2 CK.
■ Vignette-style flash cards embedded in the margins to reinforce key concepts.
■ Heavily updated and revised Rapid Review section for last-minute preparation.
■ Revised rating of current high-yield review resources, with clear explanations of their relevance to
Step 2 CK exam review.
■ Improved organization and integrations of text, illustrations, clinical images, tables, and algorithms
throughout for focused review of high-yield topics.
The 11th edition of First Aid for the USMLE Step 2 CK truly is a completely revised, in-depth, student-
to-student guide for preparation for the Step 2 CK exam. The 11th edition would not have been pos-
sible without the help from hundreds of students and faculty members who contributed their feedback
and suggestions. We invite students and faculty to continue sharing their thoughts and ideas to help us
improve First Aid for the USMLE Step 2 CK (see How to Contribute, p. xi).
Tao Le
Louisville
Vikas Bhushan
Boracay
Mona Ascha
Baltimore
Abhishek Bhardwaj
Orange County
Marina Boushra
Cleveland
Daniel Griffin
Cape Girardeau, Missouri
Caroline Coleman
Atlanta
Stephanie Jones
Tumwater, Washington
Kimberly Kallianos
San Francisco
Preface
With the 11th edition of First Aid for the USMLE Step 2 CK, we continue our commitment to pro-
viding students with the most high-yield and up-to-date preparation guide for the USMLE Step 2 CK
exam. Preparation for and performance on the Step 2 CK exam are more important than ever with the
transition of the Step 1 exam to a pass/fail scoring system in 2022. With this in mind, we have greatly
expanded the content and depth for the 11th edition. This revision includes:
■ Over 200 additional pages of content incorporating the most current evidence-based reviews and rec-
ommendations to help students on the Step 2 CK exam and in clinical practice.
■ 163 new and revised diagrams and illustrations, including more than 40 new diagnostic and manage-
ment algorithms, to further drive home the next best diagnostic and management options.
■ 140 new and revised photos/images to help visualize various disorders, descriptive findings, and clini-
cal content tie-ins.
■ Extensive text revisions, new mnemonics, and clarifications curated by a team of 26 medical student
and resident physician authors who excelled on their USMLE exams and verified by a team of expert
faculty advisors and nationally recognized USMLE instructors.
■ Continued focus on clinical presentation and the best initial step in diagnosis and management, mir-
roring the content outline and blueprint of Step 2 CK.
■ Vignette-style flash cards embedded in the margins to reinforce key concepts.
■ Heavily updated and revised Rapid Review section for last-minute preparation.
■ Revised rating of current high-yield review resources, with clear explanations of their relevance to
Step 2 CK exam review.
■ Improved organization and integrations of text, illustrations, clinical images, tables, and algorithms
throughout for focused review of high-yield topics.
The 11th edition of First Aid for the USMLE Step 2 CK truly is a completely revised, in-depth, student-
to-student guide for preparation for the Step 2 CK exam. The 11th edition would not have been pos-
sible without the help from hundreds of students and faculty members who contributed their feedback
and suggestions. We invite students and faculty to continue sharing their thoughts and ideas to help us
improve First Aid for the USMLE Step 2 CK (see How to Contribute, p. xi).
Tao Le
Louisville
Vikas Bhushan
Boracay
Mona Ascha
Baltimore
Abhishek Bhardwaj
Orange County
Marina Boushra
Cleveland
Daniel Griffin
Cape Girardeau, Missouri
Caroline Coleman
Atlanta
Stephanie Jones
Tumwater, Washington
Kimberly Kallianos
San Francisco
Loading page 11...
x
Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thoughtful comments, correc-
tions, and advice of the many medical students, international medical graduates, and faculty who have supported
the authors in the continuing development of First Aid for the USMLE Step 2 CK.
Thanks to our publisher, McGraw Hill, for the valuable assistance of its staff, including Bob Boehringer, Christina
Thomas, and Jeffrey Herzich. For outstanding editorial work, we thank Megan Chandler and Lisa Nahach. We are
also grateful to our medical illustrator, Rachael Williams, and illustration manager, Susan Mazik. For administra-
tive support we thank Miranda Carter, Katherine Knight, and Louise Petersen. A special thanks to GW, Inc. for
remarkable production work.
For contributions and corrections, we thank Ataa Ahmed, Arjun Basnet, Jeffrey Beach, Monica I. Burgos Claudio,
Fiorella B. Castillo, Mallory Castillo, Christian Casteel, Anthony Chung, Jonathan Daou, Karanpal Dhaliwal, Fadi
Dib, Celia Escamilla, Arber Frakulli, Mohan Bharadwaj Gudivada, Jacqueline Hairston, Nathaniel Hayward, Lydia
Kaotzani, Panagiotis Kaparaliotis, Alex Lu, Juliana Maya, Austin McCullough, Nupur Mishra, Mounika Mukherjee
Peethala, Majd Oteibi, Shannon D. Powell, Aubtin Saedi, Tanjot Saini, Angelica Maria Sanchez Ruiz, Charles
Sanky, Maida Sarfraz Chaudhry, Neetu Scariya, Ryan Schusler, Tarif Shaaban, Tomonari Shimoda, Biraj Singh
Karki, Colton Southall, Charles Starling, Ari Stone, Erica Stratton, Jennifer Tram, Nicholas Ting, Vivekanand
Tiwari, Sheela Vaswani, and Earl Vialpando.
Tao Le
Louisville
Vikas Bhushan
Boracay
Mona Ascha
Baltimore
Abhishek Bhardwaj
Orange County
Marina Boushra
Cleveland
Daniel Griffin
Cape Girardeau, Missouri
Caroline Coleman
Atlanta
Stephanie Jones
Tumwater, Washington
Kimberly Kallianos
San Francisco
Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thoughtful comments, correc-
tions, and advice of the many medical students, international medical graduates, and faculty who have supported
the authors in the continuing development of First Aid for the USMLE Step 2 CK.
Thanks to our publisher, McGraw Hill, for the valuable assistance of its staff, including Bob Boehringer, Christina
Thomas, and Jeffrey Herzich. For outstanding editorial work, we thank Megan Chandler and Lisa Nahach. We are
also grateful to our medical illustrator, Rachael Williams, and illustration manager, Susan Mazik. For administra-
tive support we thank Miranda Carter, Katherine Knight, and Louise Petersen. A special thanks to GW, Inc. for
remarkable production work.
For contributions and corrections, we thank Ataa Ahmed, Arjun Basnet, Jeffrey Beach, Monica I. Burgos Claudio,
Fiorella B. Castillo, Mallory Castillo, Christian Casteel, Anthony Chung, Jonathan Daou, Karanpal Dhaliwal, Fadi
Dib, Celia Escamilla, Arber Frakulli, Mohan Bharadwaj Gudivada, Jacqueline Hairston, Nathaniel Hayward, Lydia
Kaotzani, Panagiotis Kaparaliotis, Alex Lu, Juliana Maya, Austin McCullough, Nupur Mishra, Mounika Mukherjee
Peethala, Majd Oteibi, Shannon D. Powell, Aubtin Saedi, Tanjot Saini, Angelica Maria Sanchez Ruiz, Charles
Sanky, Maida Sarfraz Chaudhry, Neetu Scariya, Ryan Schusler, Tarif Shaaban, Tomonari Shimoda, Biraj Singh
Karki, Colton Southall, Charles Starling, Ari Stone, Erica Stratton, Jennifer Tram, Nicholas Ting, Vivekanand
Tiwari, Sheela Vaswani, and Earl Vialpando.
Tao Le
Louisville
Vikas Bhushan
Boracay
Mona Ascha
Baltimore
Abhishek Bhardwaj
Orange County
Marina Boushra
Cleveland
Daniel Griffin
Cape Girardeau, Missouri
Caroline Coleman
Atlanta
Stephanie Jones
Tumwater, Washington
Kimberly Kallianos
San Francisco
Loading page 12...
xi
How to Contribute
In our effort to continue to produce a high-yield review source for the Step 2 CK exam, we invite you to submit any
suggestions or corrections. We also offer paid internships in medical education and publishing ranging from three
months to one year (see below for details). Please send us your suggestions for the following:
■ Study and test-taking strategies for the Step 2 CK exam
■ New high-yield facts, mnemonics, diagrams, and illustrations
■ Low-yield topics to remove
For each entry incorporated into the next edition, you will receive up to a $20 gift certificate to Amazon as well as
personal acknowledgment in the next edition. Diagrams, tables, partial entries, updates, corrections, and study hints
are also appreciated, and significant contributions will be compensated at the discretion of the authors. Also let us
know about material in this edition that you feel is low yield and should be deleted.
The preferred way to submit entries, suggestions, or corrections is via our blog:
www.firstaidteam.com
We are also reachable by e-mail at firstaid@scholarrx.com.
NOTE TO CONTRIBUTORS
All entries become property of the authors and are subject to editing and reviewing. Please verify all data and spell-
ings carefully. If similar or duplicate entries are received, only the first entry received will be used. Include a refer-
ence to a standard textbook to facilitate verification of the fact. Please follow the style, punctuation, and format of
this edition if possible.
INTERNSHIP OPPORTUNITIES
The author team is pleased to offer part-time and full-time paid internships in medical education and publishing to
motivated physicians. Internships may range from three months (eg, a summer) up to a full year. Participants will
have an opportunity to author, edit, and earn academic credit on a wide variety of projects, including the popular
First Aid series. Writing/editing experience, familiarity with Microsoft Word and Google Docs, and illustration skills
are highly desired. For more information, e-mail a résumé or a short description of your experience along with a
cover letter to firstaidteam@usmle-rx.com.
How to Contribute
In our effort to continue to produce a high-yield review source for the Step 2 CK exam, we invite you to submit any
suggestions or corrections. We also offer paid internships in medical education and publishing ranging from three
months to one year (see below for details). Please send us your suggestions for the following:
■ Study and test-taking strategies for the Step 2 CK exam
■ New high-yield facts, mnemonics, diagrams, and illustrations
■ Low-yield topics to remove
For each entry incorporated into the next edition, you will receive up to a $20 gift certificate to Amazon as well as
personal acknowledgment in the next edition. Diagrams, tables, partial entries, updates, corrections, and study hints
are also appreciated, and significant contributions will be compensated at the discretion of the authors. Also let us
know about material in this edition that you feel is low yield and should be deleted.
The preferred way to submit entries, suggestions, or corrections is via our blog:
www.firstaidteam.com
We are also reachable by e-mail at firstaid@scholarrx.com.
NOTE TO CONTRIBUTORS
All entries become property of the authors and are subject to editing and reviewing. Please verify all data and spell-
ings carefully. If similar or duplicate entries are received, only the first entry received will be used. Include a refer-
ence to a standard textbook to facilitate verification of the fact. Please follow the style, punctuation, and format of
this edition if possible.
INTERNSHIP OPPORTUNITIES
The author team is pleased to offer part-time and full-time paid internships in medical education and publishing to
motivated physicians. Internships may range from three months (eg, a summer) up to a full year. Participants will
have an opportunity to author, edit, and earn academic credit on a wide variety of projects, including the popular
First Aid series. Writing/editing experience, familiarity with Microsoft Word and Google Docs, and illustration skills
are highly desired. For more information, e-mail a résumé or a short description of your experience along with a
cover letter to firstaidteam@usmle-rx.com.
Loading page 13...
xii
How to Use This Book
We have made many improvements and added several new features to this edition of First Aid for the USMLE Step
2 CK. In particular, we have added more than two hundred pages of content and hundreds of new illustrations and
images throughout the text to facilitate studying. We encourage you to read all aspects of the text to learn the ma-
terial in context. We have also included comments in the margins and vignette questions to periodically test your
knowledge of key concepts. These questions are located in the lower corner of certain pages. To prevent peeking at
the answers, you’ll find the answer on the back of the same page in the lower corner. These questions are not always
representative of test questions.
To practice for the exam and simulate the actual test day, you can use the USMLE-Rx Step 2 CK Qmax question
test bank (www.usmle-rx.com). If you are constantly on the move, use the USMLE-Rx Step 2 CK app. The question
bank and this text are more than enough to allow many students to ace the exam.
Good luck!
How to Use This Book
We have made many improvements and added several new features to this edition of First Aid for the USMLE Step
2 CK. In particular, we have added more than two hundred pages of content and hundreds of new illustrations and
images throughout the text to facilitate studying. We encourage you to read all aspects of the text to learn the ma-
terial in context. We have also included comments in the margins and vignette questions to periodically test your
knowledge of key concepts. These questions are located in the lower corner of certain pages. To prevent peeking at
the answers, you’ll find the answer on the back of the same page in the lower corner. These questions are not always
representative of test questions.
To practice for the exam and simulate the actual test day, you can use the USMLE-Rx Step 2 CK Qmax question
test bank (www.usmle-rx.com). If you are constantly on the move, use the USMLE-Rx Step 2 CK app. The question
bank and this text are more than enough to allow many students to ace the exam.
Good luck!
Loading page 14...
Introduction 2
USMLE Step 2 CK—Computer-Based Testing Basics 2
Who Can RegisteR FoR the exam? 2
hoW Will the CBt Be stRuCtuRed? 2
testing Conditions: What Will the CBt Be like? 3
What does the CBt FoRmat mean FoR me? 3
hoW do i RegisteR to take the examination? 4
What iF i need to ResChedule the examination? 5
What aBout time? 6
seCuRity measuRes 6
iF i leave duRing the examination, What happens to my sCoRe? 6
What types oF Questions aRe asked? 6
hoW long Will i have to Wait BeFoRe i get my sCoRes? 8
hoW aRe the sCoRes RepoRted? 9
Defining Your Goal 10
W hen to take the exam 11
hoW Will the step 2 Ck sCoRe aFFeCt my matCh? 12
Study Resources 12
Quality ConsideRations 12
C liniCal RevieW Books 12
test Banks 12
texts and notes 13
CommeRCial CouRses 13
nBme/usmle puBliCations 13
Test-Day Checklist 13
things to BRing With you to the exam 13
Testing Agencies 14
1
S E C T I O N 1
GUIDE TO EFFICIENT EXAM PREPARATION
USMLE Step 2 CK—Computer-Based Testing Basics 2
Who Can RegisteR FoR the exam? 2
hoW Will the CBt Be stRuCtuRed? 2
testing Conditions: What Will the CBt Be like? 3
What does the CBt FoRmat mean FoR me? 3
hoW do i RegisteR to take the examination? 4
What iF i need to ResChedule the examination? 5
What aBout time? 6
seCuRity measuRes 6
iF i leave duRing the examination, What happens to my sCoRe? 6
What types oF Questions aRe asked? 6
hoW long Will i have to Wait BeFoRe i get my sCoRes? 8
hoW aRe the sCoRes RepoRted? 9
Defining Your Goal 10
W hen to take the exam 11
hoW Will the step 2 Ck sCoRe aFFeCt my matCh? 12
Study Resources 12
Quality ConsideRations 12
C liniCal RevieW Books 12
test Banks 12
texts and notes 13
CommeRCial CouRses 13
nBme/usmle puBliCations 13
Test-Day Checklist 13
things to BRing With you to the exam 13
Testing Agencies 14
1
S E C T I O N 1
GUIDE TO EFFICIENT EXAM PREPARATION
Loading page 15...
INTRODUCTION
The United States Medical Licensing Examination (USMLE) Step 2 allows
you to pull together your clinical experience on the wards with the numerous
“factoids” and classical disease presentations that you have memorized over
the years. Where Step 1 stresses basic disease mechanisms and principles,
Step 2 places more emphasis on clinical diagnosis and management, disease
pathogenesis, and preventive medicine. Previously, the Step 2 examination
consisted of the Step 2 Clinical Knowledge examination (Step 2 CK), and the
Step 2 Clinical Skills examination (Step 2 CS). However, recent changes
have removed the Step 2 CS exam as a requirement for ECFMG certification
after the onset of the pandemic, and this change has been recorded as perma-
nent by the ECFMG.
The USMLE Step 2 CK is the second of three examinations that you must
pass to become a licensed physician in the United States. The computerized
Step 2 CK is a 1-day (9-hour) multiple-choice examination.
USMLE STEP 2 CK—COMPUTER-BASED TESTING BASICS
WHO CAN REGISTER FOR THE EXAM?
The eligibility requirement for USMLE Step 2 CK exam is same as that of
USMLE Step 1 and can be taken either before or after the Step 1 exam. This
means that you should be:
■ Officially enrolled in, or be a graduate of, a US or Canadian medical
school leading to the MD degree (LCME accredited), or
■ Officially enrolled in, or be a graduate of, a US medical school leading to
the DO degree (COCA accredited), or
■ Officially enrolled in, or be a graduate of, a medical school outside the US
and Canada and listed in the World Directory of Medical Schools as meet-
ing ECFMG eligibility requirements and meet other ECFMG criteria.
These criteria should be met at the time of application and on the test day.
HOW WILL THE CBT BE STRUCTURED?
The Step 2 CK exam is a computer-based test (CBT) administered by Prometric,
Inc. It is a 1-day examination with a maximum of 318 items divided into eight
1-hour blocks that are administered during a single 9-hour testing session. The
number of items in a block are displayed at the beginning of each block. This
number may vary from block to block but will not exceed 40 items per block.
Two question styles predominate throughout. The most common format is
the single one-best-answer question. This is the traditional multiple-choice
format in which you are tasked with selecting the “most correct” answer.
Sequential item sets comprises the second question style. These are sets of
multiple-choice questions that are related and must all be answered in
sequence without skipping a question in the set. As you answer questions in a
set, the previous answers become locked and cannot be changed. These are
the only questions on the USMLE examination that are locked in such a way.
There are no more than five sequential item sets within each USMLE Step 2
CK exam.
During the time allotted for each block in the USMLE Step 2 CK exam,
you can answer test questions in any order and can also review responses and
change your answers (except for responses within the sequential item sets
KEY FACT
The goal of the Step 2 CK is to apply
your knowledge of medical facts
to clinical scenarios that you may
encounter as a resident.
KEY FACT
Sometimes the answer to the previous
question in a sequential question set
is provided to you once you lock your
answer. Do not be disheartened if
you got it wrong. Simply understand
that you now have an opportunity to
get at least one answer correct in the
sequence.
2 SECTION 1 GUIDE TO EFFICIENT EXAM PREPARATION
The United States Medical Licensing Examination (USMLE) Step 2 allows
you to pull together your clinical experience on the wards with the numerous
“factoids” and classical disease presentations that you have memorized over
the years. Where Step 1 stresses basic disease mechanisms and principles,
Step 2 places more emphasis on clinical diagnosis and management, disease
pathogenesis, and preventive medicine. Previously, the Step 2 examination
consisted of the Step 2 Clinical Knowledge examination (Step 2 CK), and the
Step 2 Clinical Skills examination (Step 2 CS). However, recent changes
have removed the Step 2 CS exam as a requirement for ECFMG certification
after the onset of the pandemic, and this change has been recorded as perma-
nent by the ECFMG.
The USMLE Step 2 CK is the second of three examinations that you must
pass to become a licensed physician in the United States. The computerized
Step 2 CK is a 1-day (9-hour) multiple-choice examination.
USMLE STEP 2 CK—COMPUTER-BASED TESTING BASICS
WHO CAN REGISTER FOR THE EXAM?
The eligibility requirement for USMLE Step 2 CK exam is same as that of
USMLE Step 1 and can be taken either before or after the Step 1 exam. This
means that you should be:
■ Officially enrolled in, or be a graduate of, a US or Canadian medical
school leading to the MD degree (LCME accredited), or
■ Officially enrolled in, or be a graduate of, a US medical school leading to
the DO degree (COCA accredited), or
■ Officially enrolled in, or be a graduate of, a medical school outside the US
and Canada and listed in the World Directory of Medical Schools as meet-
ing ECFMG eligibility requirements and meet other ECFMG criteria.
These criteria should be met at the time of application and on the test day.
HOW WILL THE CBT BE STRUCTURED?
The Step 2 CK exam is a computer-based test (CBT) administered by Prometric,
Inc. It is a 1-day examination with a maximum of 318 items divided into eight
1-hour blocks that are administered during a single 9-hour testing session. The
number of items in a block are displayed at the beginning of each block. This
number may vary from block to block but will not exceed 40 items per block.
Two question styles predominate throughout. The most common format is
the single one-best-answer question. This is the traditional multiple-choice
format in which you are tasked with selecting the “most correct” answer.
Sequential item sets comprises the second question style. These are sets of
multiple-choice questions that are related and must all be answered in
sequence without skipping a question in the set. As you answer questions in a
set, the previous answers become locked and cannot be changed. These are
the only questions on the USMLE examination that are locked in such a way.
There are no more than five sequential item sets within each USMLE Step 2
CK exam.
During the time allotted for each block in the USMLE Step 2 CK exam,
you can answer test questions in any order and can also review responses and
change your answers (except for responses within the sequential item sets
KEY FACT
The goal of the Step 2 CK is to apply
your knowledge of medical facts
to clinical scenarios that you may
encounter as a resident.
KEY FACT
Sometimes the answer to the previous
question in a sequential question set
is provided to you once you lock your
answer. Do not be disheartened if
you got it wrong. Simply understand
that you now have an opportunity to
get at least one answer correct in the
sequence.
2 SECTION 1 GUIDE TO EFFICIENT EXAM PREPARATION
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