Internal Medicine for USMLE Step 2 CK: Exam Questions and Preparation
How Internal Medicine is tested on Step 2 CK and Step 3, the high-yield topics, a preparation approach and original practice questions with explained answers.
Internal medicine is the largest part of Step 2 CK and Step 3. It spans cardiology, pulmonary, gastroenterology, nephrology, endocrinology, hematology, infectious disease and rheumatology, so a steady plan and a lot of practice questions matter.
Step 2 CK and Step 3 test clinical judgment: given a patient, what is the most likely diagnosis, the best next step in management, or the most important thing to prevent or monitor. The practice questions here are original and written to show the style of reasoning the exam rewards; they are not real exam items. Management guidance changes, so confirm current guidelines and the official USMLE content outline.
How Internal Medicine is tested
Most questions ask for the most likely diagnosis, the next best step in management or the most appropriate treatment. Step 3 adds ongoing care, monitoring and the management of multiple chronic conditions.
High-yield topics
- Acute coronary syndromes, heart failure, arrhythmias and hypertension
- COPD, asthma, pneumonia and pulmonary embolism
- Liver disease, GI bleeding, inflammatory bowel disease and pancreatitis
- Acute kidney injury, electrolyte and acid-base disorders
- Diabetes and its emergencies, thyroid and adrenal disease
- Anemias, coagulation disorders and common cancers
- Infectious disease, rheumatology and outpatient care
Preparation approach
- Work through a good question bank by system, reading every explanation, then switch to mixed blocks.
- For each disease, know the first test, the best initial treatment and the complication to watch for.
- Memorize the key management algorithms, such as chest pain, DKA and COPD exacerbation, as short step lists.
- Review the preventive and chronic care guidelines that Step 3 emphasizes.
Practice questions
Question 1
A man has crushing chest pain and ST-segment elevation in leads II, III and aVF. Aspirin has been given. What is the most appropriate next step?
- A. Observation with serial troponins
- B. Outpatient stress test
- C. Primary percutaneous coronary intervention
- D. Oral beta-blocker and discharge
- E. CT angiography of the chest in the morning
Answer: C. ST-elevation myocardial infarction needs emergent reperfusion, preferably by primary PCI within 90 minutes of first medical contact.
Question 2
A man with type 1 diabetes has abdominal pain, a glucose of 520 mg/dL, pH 7.1 and a serum potassium of 3.0 mEq/L. What is the most appropriate next step?
- A. Start an insulin infusion immediately
- B. Give intravenous potassium before starting insulin
- C. Give sodium bicarbonate
- D. Give subcutaneous insulin and discharge
- E. Restrict fluids
Answer: B. Insulin drives potassium into cells and can cause dangerous hypokalemia. When potassium is below 3.3 mEq/L, replace it first.
Question 3
A woman taking oral contraceptives has sudden shortness of breath, pleuritic chest pain and a heart rate of 110/min. She is stable, and her chest radiograph is normal. What is the most appropriate next step?
- A. Discharge with an oral analgesic
- B. CT pulmonary angiography
- C. Lower extremity ultrasound only
- D. Repeat the chest radiograph in 24 hours
- E. Pulmonary function testing
Answer: B. This presentation suggests pulmonary embolism. In a stable patient with a high pretest probability, CT pulmonary angiography is the diagnostic test.
Make it a plan
Put this subject inside a dedicated study block with timed mixed question blocks and careful review. See our Step 2 CK preparation timeline for a schedule and weekly milestones. This article is general educational guidance and not an individualized study plan.
Educational content only. Confirm current exam requirements with USMLE.