Pediatrics for USMLE Step 2 CK: Exam Questions and Preparation
How Pediatrics is tested on Step 2 CK and Step 3, the high-yield topics, a preparation approach and original practice questions with explained answers.
Pediatrics covers newborn care, growth and development, immunization, common childhood infections and congenital disease. Age is the most important clue in almost every pediatric vignette.
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 Pediatrics is tested
Questions use the age and the presentation to point to a diagnosis, then ask for the next step or treatment. Questions about development, vaccines, and child abuse are also common.
High-yield topics
- Newborn care, jaundice and the common congenital conditions
- Growth, developmental milestones and immunization schedules
- Congenital heart disease and genetic syndromes
- Respiratory illness: bronchiolitis, croup, epiglottitis and asthma
- Gastrointestinal disorders: pyloric stenosis, intussusception and celiac disease
- Fever in infants, and infections such as otitis media and meningitis
- Child abuse recognition, adolescent medicine and common poisonings
Preparation approach
- Build a table of milestones and vaccines by age and review it regularly.
- Pair each classic pediatric diagnosis with its age range and its signature finding.
- Learn the management of fever by age, since the threshold for work-up changes in young infants.
- Practice recognizing abuse and the legal duty to report it.
Practice questions
Question 1
A 3-week-old boy has projectile, nonbilious vomiting after every feeding. A small, firm mass is palpable in the epigastrium. Which laboratory finding is most likely?
- A. Hyperchloremic metabolic acidosis
- B. Hypochloremic, hypokalemic metabolic alkalosis
- C. Hyperkalemic metabolic acidosis
- D. Respiratory acidosis
- E. Hypernatremia with normal pH
Answer: B. This is hypertrophic pyloric stenosis. Loss of gastric acid causes hypochloremic, hypokalemic metabolic alkalosis.
Question 2
A 2-year-old has a barking cough, inspiratory stridor and a low-grade fever. A neck radiograph shows subglottic narrowing. What is the most appropriate treatment?
- A. Oral amoxicillin
- B. Dexamethasone
- C. Intubation
- D. Albuterol nebulization alone
- E. Chest physiotherapy
Answer: B. This is croup. A single dose of dexamethasone is the mainstay of treatment, with nebulized epinephrine for severe stridor.
Question 3
A full-term newborn becomes jaundiced at 18 hours of age. What is the most appropriate next step?
- A. Reassure the parents
- B. Measure total and direct bilirubin and evaluate for hemolysis
- C. Discharge with a follow-up in 1 week
- D. Stop breastfeeding
- E. Order an abdominal ultrasound
Answer: B. Jaundice in the first 24 hours is pathologic until proven otherwise, and hemolytic disease such as ABO or Rh incompatibility must be evaluated.
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.