USMLE Step 2 CK Practice Questions and a Full 316-Question Mock Exam
Answer clinical vignettes on diagnosis, next steps and management by current US guidelines, read why each option is right or wrong, then sit a full 316-question Step 2 CK mock in the 2026 format: sixteen 30-minute blocks. Every drill has a free try.
316 questions in 16 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drill- 389 original Step 2 CK questions, each with a note on every option and its source
- 316 questions in the full mock, in 16 timed 30-minute blocks
- 15 free drills: one per content-outline system plus a mixed drill
A 67-year-old man comes to the physician because of progressive dyspnea and a dry cough for 6 weeks. He has lost 5 kg (11 lb). He has no fever, and he has no history of heart, liver, or kidney disease. Breath sounds are absent and the chest is dull to percussion over the lower half of the left hemithorax. Chest x-ray shows a moderate left pleural effusion without mediastinal shift. Ultrasonography shows free-flowing fluid. Which of the following is the most appropriate next step in diagnosis?
USMLE Step 2 CK at a glance
Step 2 CK tests the clinical knowledge a resident needs for supervised patient care: diagnosis, choosing tests, management, pharmacotherapy, prevention and patient safety. It reports a three-digit score that residency programs read closely, and for international medical graduates it is the second exam toward ECFMG Certification.
- Owners
- The United States Medical Licensing Examination is sponsored by the Federation of State Medical Boards (FSMB) and NBME. Step 2 Clinical Knowledge is the second Step
- Format
- Single-best-answer multiple-choice questions on clinical vignettes. 316 questions in one 9-hour testing day
- Blocks
- Since May 7, 2026: sixteen 30-minute blocks of 18 to 20 questions (before that, eight 60-minute blocks of up to 40). You review only within the current block, and a closed block stays closed
- Breaks
- At least 55 minutes of break time for the day, taken between blocks
- Content
- Clinical knowledge for supervised patient care: medicine 55–65%, pediatrics 17–27%, obstetrics and gynecology 10–20%, psychiatry 10–15% and surgery 5–15%, organized by organ system and physician task
- Scoring
- A three-digit score. The minimum passing score is 218 for exams on or after July 1, 2025. USMLE says examinees typically need about 60% of questions correct to pass
- Fee
- $695 for 2026 and 2027. Students and graduates of medical schools outside the US apply through FSMB and pay a $235 region fee to test outside the US and Canada
- Attempts
- No more than three attempts at the same Step in 12 months. Four or more attempts at a Step without a pass make you ineligible for the USMLE
- Results
- Usually two to four weeks after the exam; allow up to eight weeks
USMLE Step 2 CK practice test: the full 316 questions
The mock follows the 2026 USMLE test software: 316 single-best-answer questions in 16 blocks of 19 or 20, each with its own 30-minute clock. Inside a block you can skip, go back and mark questions; once a block closes you cannot return to it. Each content area takes its share of the exam from the USMLE content outline, and your result shows your score in every one, with a worked review of all 316 questions.
The Step 2 CK content outline, and a free drill for each system
USMLE publishes the share of Step 2 CK that each system takes. Each drill is ten questions from one system with an explanation after every answer, and each system has its own guide page. The mock column shows how many questions each system has on our 316-question mock.
| System | Share of exam | On our mock | In the bank | Drill |
|---|---|---|---|---|
| Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient SafetyConsent, capacity and surrogates, confidentiality and its legal exceptions, minors, end-of-life care, error disclosure, handoffs, medication safety and quality improvement. | 10–15% | 39 | 46 | 10-question drill |
| Renal & Urinary System & Reproductive SystemsKidney injury and chronic kidney disease, electrolytes, urinary infections and stones, urologic cancer, and gynecology: bleeding, amenorrhea, contraception, infertility, menopause and breast disease. | 7–13% | 31 | 37 | 10-question drill |
| Cardiovascular SystemChest pain and acute coronary syndromes, heart failure, arrhythmias and resuscitation, hypertension, valvular and pericardial disease, endocarditis, and aortic and peripheral vascular disease. | 6–12% | 28 | 34 | 10-question drill |
| Musculoskeletal System/Skin & Subcutaneous TissueFractures and orthopedic emergencies, back pain, arthritis and rheumatologic disease, pediatric orthopedics, and dermatology from rashes to skin cancer and burns. | 6–12% | 28 | 34 | 10-question drill |
| Behavioral HealthDepression, bipolar and anxiety disorders, psychosis, personality and eating disorders, substance use and withdrawal, suicide risk and psychotropic adverse effects. | 5–10% | 24 | 30 | 10-question drill |
| Blood & Lymphoreticular/Immune SystemsAnemia, bleeding and clotting disorders, venous thromboembolism, transfusion reactions, hematologic cancer, neutropenic fever, HIV care, anaphylaxis and immunodeficiency. | 5–10% | 23 | 28 | 10-question drill |
| Gastrointestinal SystemGI bleeding, the acute abdomen, pancreatitis, biliary disease, liver disease and its complications, inflammatory bowel disease and colorectal cancer screening. | 5–10% | 23 | 28 | 10-question drill |
| Nervous System & Special SensesStroke and TIA, seizures, headache, head injury, CNS infection, neuromuscular and movement disorders, spinal cord emergencies, and eye and ENT emergencies. | 5–10% | 24 | 30 | 10-question drill |
| Respiratory SystemAsthma and COPD, pneumonia, pulmonary embolism, lung nodules and lung cancer screening, pleural effusion, interstitial lung disease, sleep apnea and ventilation. | 5–10% | 24 | 30 | 10-question drill |
| Multisystem Processes & DisordersSepsis and shock, trauma resuscitation, poisoning and overdose, environmental injury, infections across systems, nutrition and perioperative care. | 4–8% | 19 | 24 | 10-question drill |
| Endocrine SystemDiabetes and its emergencies, thyroid disease and nodules, adrenal and pituitary disease, calcium disorders and osteoporosis. | 3–7% | 16 | 20 | 10-question drill |
| Pregnancy, Childbirth & the PuerperiumPrenatal care and screening, hypertensive disorders of pregnancy, gestational diabetes, bleeding in pregnancy, labor and delivery, and postpartum complications. | 3–7% | 16 | 20 | 10-question drill |
| Biostatistics & Epidemiology/Population Health/Interpretation of Medical LiteratureTest characteristics, study design, bias and confounding, reading a study abstract, number needed to treat and screening. | 3–5% | 12 | 15 | 10-question drill |
| Human DevelopmentWell-child care, milestones and growth, adolescent health, adult preventive care and screening, and care of older adults. | 2–4% | 9 | 13 | 10-question drill |
Ready for the full exam day?
316 questions in 16 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drillUSMLE Step 2 CK pass rates
From USMLE performance data. First-time takers from medical schools outside the US pass at a lower rate than US MD students, and repeaters lower still, so a realistic full-length practice run matters.
| Examinees | Year | Tested | Passed |
|---|---|---|---|
| Non-US schools, first takers | 2024–2025 | 16,186 | 90% |
| Non-US schools, repeaters | 2024–2025 | 1,762 | 64% |
| Non-US schools, first takers | 2023–2024 | 15,064 | 89% |
| US MD schools, first takers | 2024–2025 | 22,249 | 98% |
How to use these Step 2 CK practice questions
- Take the free mixed drill to see where you stand across every system.
- Start with ethics and patient safety, the largest single category at 10–15%, then renal and reproductive, cardiovascular and musculoskeletal.
- Learn the guideline behind each answer. Every explanation names its source, such as USPSTF, ACC/AHA, the ADA Standards of Care or ACOG.
- Sit the 316-question mock in 30-minute blocks, then drill your two lowest systems and repeat the mixed drill a week before your exam.
Common questions
How many questions are on USMLE Step 2 CK?
316 questions in one 9-hour day. Since May 7, 2026 they come in sixteen 30-minute blocks of 18 to 20 questions, with at least 55 minutes of break time for the day.
What is the Step 2 CK passing score?
218, for exams on or after July 1, 2025. Step 2 CK reports a three-digit score, and USMLE says examinees typically need about 60% of questions correct to pass.
Can I practice Step 2 CK questions for free?
Yes. Each of the fifteen ten-question drills (one per content-outline system plus a mixed drill) has a free try, and every guide and mock page has free sample questions. The full 316-question mock in 16 timed blocks comes with a USMLE pass.
What does Step 2 CK test?
Clinical knowledge for supervised patient care: diagnosis, choosing tests, management, pharmacotherapy, prevention, prognosis, professionalism and patient safety. Medicine is 55–65% of the exam, pediatrics 17–27%, obstetrics and gynecology 10–20%, psychiatry 10–15% and surgery 5–15%.
Which guidelines do Step 2 CK questions follow?
Current US practice. Our explanations name the guideline or reference behind each answer, such as USPSTF screening recommendations, ACC/AHA guidelines, the ADA Standards of Care, GOLD, GINA, IDSA and ACOG guidance, and the CDC STI treatment guidelines.
How much does Step 2 CK cost for an IMG?
The application fee is $695 for 2026 and 2027. Applicants from medical schools outside the US apply through FSMB and pay a $235 region fee to test outside the US and Canada.
Ready for exam day?
316 questions in 16 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drillSources
- USMLE: Step 1 (blocks, items, testing day, break time)
- USMLE: Step 2 CK (blocks, items, testing day, break time)
- USMLE: Test delivery software updates for Step 2 CK and Step 1 (May 2026)
- USMLE: Step 1 content outline and specifications
- USMLE: Step 2 CK content outline and specifications
- USMLE: Examination results and scoring (minimum passing scores)
- USMLE Bulletin: Scoring and score reporting (about 60% correct to pass; result timing)
- USMLE Bulletin: Eligibility (attempt limits)
- USMLE: Apply for exams (2026 and 2027 fees, FSMB registration, region fees)
- USMLE: Performance data (pass rates)
- Intealth ECFMG: Fees overview (ECFMG Certification)
Original practice questions written to the USMLE content outlines and current standard references. USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and NBME. Independent practice, not affiliated with or endorsed by the FSMB, NBME or Intealth (ECFMG). The official USMLE sample questions are free on usmle.org. Follow current guidelines in clinical practice.