Psychiatry for USMLE Step 2 CK: Exam Questions and Preparation
How Psychiatry is tested on Step 2 CK and Step 3, the high-yield topics, a preparation approach and original practice questions with explained answers.
Psychiatry on Step 2 CK combines diagnosis, safety and drug management. Questions often ask for the best next step with a patient at risk, or for the adverse effect of a psychiatric drug.
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 Psychiatry is tested
Vignettes ask you to identify a disorder from its criteria, choose the first-line treatment, or recognize an emergency such as suicidality, withdrawal or a drug reaction.
High-yield topics
- Depression, bipolar disorder and suicide risk assessment
- Psychotic disorders and the adverse effects of antipsychotic drugs
- Anxiety disorders, obsessive-compulsive disorder and trauma-related disorders
- Substance use disorders, intoxication and withdrawal
- Eating disorders, personality disorders and somatic symptom disorders
- Child and adolescent psychiatry: ADHD, autism and conduct problems
- Delirium and dementia, and psychopharmacology emergencies such as serotonin syndrome and lithium toxicity
Preparation approach
- Learn the diagnostic criteria well enough to separate similar disorders, using time course as the key.
- Make a table of psychiatric drugs: class, indication, major adverse effects and monitoring.
- Rehearse the management of safety emergencies, since the answer is usually to assess and ensure safety first.
- Know the timelines for alcohol and other withdrawal syndromes.
Practice questions
Question 1
A man taking haloperidol develops fever, severe muscle rigidity, confusion and a markedly elevated creatine kinase level. What is the most appropriate next step?
- A. Increase the haloperidol dose
- B. Stop the antipsychotic and begin supportive care
- C. Add benztropine only
- D. Start an SSRI
- E. Continue haloperidol and observe
Answer: B. This is neuroleptic malignant syndrome. The offending drug is stopped, and the patient receives supportive care with fluids and cooling, and sometimes dantrolene or bromocriptine.
Question 2
Two days after stopping heavy alcohol use, a man has tremor, tachycardia, sweating, agitation and visual hallucinations. Which medication is most appropriate?
- A. Haloperidol alone
- B. A benzodiazepine
- C. Naltrexone
- D. Disulfiram
- E. Buspirone
Answer: B. Benzodiazepines are first-line treatment for alcohol withdrawal and reduce the risk of seizures and delirium tremens.
Question 3
A woman with depression says she has been feeling that life is not worth living. What is the most appropriate next step?
- A. Reassure her that she will feel better
- B. Ask directly about suicidal thoughts, plan and intent
- C. Start an antidepressant and see her in 6 weeks
- D. Avoid the topic so as not to suggest the idea
- E. Refer her to a therapist without further questions
Answer: B. Asking directly about suicidal ideation, plan, intent and access to means does not increase risk. It is the necessary first step in assessing safety.
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.