Hi, Im a final-year medical/research student at the University of Queensland, Australia.

I sat
the USMLE Step 2CK on December 29th, 2014, and I would like to share my experience for those
who may find it helpful.
Just for the sake of clarity, the Australian academic year is the same as the calendar year, so I
sat the 2CK at the end of my third year of medicine. The pediatric, OBGYN and critical care
rotations are fourth year in my program, so I didnt have these under my belt going into the
exam. I haphazardly prepped for these externally.
The preparation for this exam is much different compared to that for Step 1. Theres no single
textbook that is a real trustworthy compendium. And unlike Step 1, where disease
pathophysiology or the LM/EM appearance of a microorganism isnt going to change year after
year, management and screening guidelines often do change. In turn, books like First Aid (FA
2CK) and Master the Boards (MTBs 2 and 3) are not very reliable for 2CK. Theyre good for
merely getting you to be aware of certain things (e.g., coloboma of the eye = CHARGE
syndrome), but do not memorize these texts as though their management (Mx) algorithms/Tx
delineations are what you should answer on the real deal.
The real 2CK questions are patient-specific stories where you have to look at the whole
picture/Hx and then choose the most appropriate next step in management. This can be really
annoying because whereas on the Step 1 you might look at an image and say I objectively
know thats a picture of Aspergillus because of the 45-degree septate hyphae, on the 2CK, the
correct answer often tends to be a judgement call that is subjective. Sometimes you will need
to elevate the bed, place a NG tube and give fluids (all of which may be answer choices), but
which one first? Oh, hes unstable? Fluids. Oh no, wait, looks like hes stable. Elevate the bed
first then give the fluids. Although obviously there can only be one answer, a lot of 2CK feels
subjective, rather than objective, when arriving at a conclusion.
This is why its a common phenomenon for people to walk out of this exam feeling pretty
terrible compared to Step 1. We feel good when we have conviction in the actual answers.
Many of the questions on the 2CK, however, you wont necessarily feel as though youre
choosing the answer as much as merely eliminating unreasonable answers. We would want
the MRI, but thats too expensive and long whereas the CT is quicker. Oh but hold on, the CT is
a lot of radiation for this young kid and an ultrasound is simple to dobut CT is better than
ultrasound for visualizing kidney trauma, RIGHT?
The heart of 2CK prep is practice questions, UpToDate, the Clinical Mastery Series questions
(these are on the NBME website and are 50-question subject-specific exams; there are two per
subject; the subjects are IM, surg, obgyn, peds, psych and neuro = 12 exams = 12 x 50 = 600

questions total), the NBMEs and free-131 (not 150 like for Step 1; you can find this on the
official USMLE website).
UpToDate is really really important for 2CK preparation.
And chances are, if youre still enrolled in med school, youve probably got a free subscription,
so definitely utilize it. If ever youre uncertain about the way something is managed, UpToDate
gives you the most recent guidelines and recommendations. And it does so with definitiveness.
This will save you a lot of time in the long run.
Youll also find that despite practice questions being crucial to prep, sometimes their
explanations are vague or conflict with other explanations. And often times theyre not
updated for several months (Kaplan is even worse; sometimes its years). This was even the
case with UWorld. So any time something seemed equivocal, Id just check UpToDate.
Preparation for 2CK
What I can say outright is this:
The best preparation for Step 2CK is solid preparation for Step 1.
I had heard that MTB2 was pretty good so I started with that. I went through this book and
pretty much memorized it. I wrote out flashcards for each chapter and rubberbanded them
into separate stacks. Once I finished the book, I typed all of the flashcards into Powerpoints.
Therefore, writing the flashcards was one layer of reinforcement. Then the PPTs were the
second layer. I do not recommend doing this.
MTB has some sort of obsession with the best initial test versus the most diagnostic test. But
the real exam doesnt ask questions like that. The USMLE wants to know the next best step in
management, and sometimes the most accurate test is the best initial test. As Ive said above,
the MTBs are outdated. Dont memorize these books. Use them to gain a rough
skeleton/initial idea of what topics might show up on the exam, but dont trust any screening
guidelines. In fact, had I adhered to MTB instead of UpToDate on my real exam, I would have
gotten at least a couple additional question wrong. It frustrated me because I didnt like
answering questions knowing these resources conflicted, but I stayed consistent and answered
everything according to UpToDate (which paid off).
After I finished making the flashcards for MTB2, I went on to FA 2CK. This book unfortunately
did not pack the punch and isnt very good. I know, how can that be, right? FA was/is the
current Bible/Torah/Quran for Step 1. But believe it: it isnt good for 2CK. Its basically just an
ongoing agglomeration of circumlocutory paragraphs that never cut to the chase. And even
worse, nothing is emphasized, so theres no way to pick out whats HY versus what isnt. Like

with MTB2, I made flashcards from FA 2CK, thinking that FA 2CK must be the Torah once again.
But this proved to be a waste of time as well. Dont memorize or overly adhere to anything
from this book. Gain a mere idea/sense of what topics might show up, but dont memorize it.
After I finished FA 2CK, I went on to read MTB3 (thats right, for Step 3). I had heard on SDN
that this book was good for covering certain things so I decided to just go through the whole
thing. And once I started reading it, I realized the material was pretty much exactly the same as
that in MTB2, but with slight differences here and there. In turn, I viewed MTB2 and 3 as one
collective resource. After I went through it, I was glad I had reinforced some topics, but once
again, dont memorize any algorithms, screening guidelines, or specific Tx sequences. Merely
get yourself accustomed to what tests/drugs could be involved in the Mx of certain conditions,
but leave it at that.
Furthermore, I do not recommend MTB2, MTB3 and FA 2CK for USMLE Step 2CK preparation
apart from cursory overview / fast reading.
I had also used SECRETS for 2CK, but I found the text overly vague/basic and I do not
recommend this whatsoever. I know people who have aced the exam who had used this
book/recommended it, but theres no real substance to it and at no point during my exam did I
feel this book helped me in any way. I read ~3/4 of it before tossing it aside out of sheer
boredom/impatience.
Designated prep (6 weeks)
I spent the first week of my designated prep time in the Maldives, so technically I spent ~5
weeks prepping toward the end. I had haphazardly completed Rx throughout the year
(random, tutor-mode, ~81% correct overall), so I started Kaplan QBank in mid-late-November.
However unlike Step 1, where I had finished Kaplan QBank in its entirety, for 2CK, I did about 2300 questions before realizing that all of the questions I was getting wrong were lame tricks or
minutiae, so I didnt bother with the rest. I definitely learned a lot using Kaplan QBank for Step
1, but after I had sat the actual Step 1, it was very clear that the real USMLE questions were
nothing remotely like Kaplans. So for 2CK, I took this as an indicator to not waste my time.
Saying goodbye to Kaplan was like finally blocking the psycho ex and not looking back.
The reason this proved to be extremely ironic, however, is that during my 2CK, there were two
questions I got right specifically because of those 2-300 Kaplan questions I had done. I really
was shocked. In other words, as much as I hated Kaplan, they got me two questions on my real
deal (this was notable such that mid-exam I was like wow, this was in Kaplan QBank; in
retrospect, I believe I may have been able to reason through one of them, but the second I
know I would have gotten wrong had it not been for Kaplan). So (un)fortunately Im going to
have to say that I do recommend Kaplan QBank for 2CK.

Overall, in terms of question quality, Id say UWorld > Rx Kaplan. Rx was definitely higher
quality for Step 1 than it was for Step 2, which is why Id say either Kaplan or Rx could be done
prior to UWorld. That being said, its important to save UWorld for reinforcement after youve
done a different QBank first (whether you choose Rx or Kaplan [or both], it doesnt matter).
So after jettisoning Kaplan, I went on to UWorld and completed it in random tutor-mode,
usually completing two blocks of 44 questions/day. I completed the QBank at ~83% correct
overall, with occasional blocks in the high-60s and others that were hundreds. I made sure I
critically read HY topics such as screening guidelines and Tx algorithms (e.g., Strep pharyngitis,
blunt abdominal trauma), looked at exhibits for topics I wasnt excellent at (e.g.,
ophthalmology), and kept UpToDate open as a separate tab so I could frequently jump to if I
needed elaboration.
During the time I was going through UWorld, I would occasionally allocate a day to doing the
Clinical Mastery Series exams on the NBME website (to break the monotony). I did both 50question forms for IM, surg, peds and obgyn. I didnt do the ones for psych because that was
my best subject going in, and I didnt do the ones for neuro because its not even a HY topic of
2CK (and I felt fine with neuro anyway). I PrntScrned all incorrect questions from extended
feedback into a PPT, with alternating slides presenting the correct answers after having
researched the questions (I also did this for all NBME, clinical mastery series and free-131 Qs).
After I finished UWorld I sat the UWSA (~11 days out). I completed each of the four blocks with
about 10 minutes left and scored 260. Then I spent the next day reviewing the explanations for
about 2 hours.
I then spent the next day doing NBME 4 (~9 days out) and scored 248. When I got this result
back I was half freaked out and half apathetic. I spent the next day reviewing my incorrect
questions.
I then did NBME 6 (~7 days out) and scored 250. Once again, half freaked out and half
apathetic.
I spent the 5th day out doing Free-131 and scored 93%.
I had kept a small notebook of HY bottom-line statements from UW. This amounted to
probably 8 pages total of my tiny handwriting. Three days before my exam, I spent ~10 hours
memorizing these by converting them into Anki cards. I never actually reviewed them. But the
transcription served as a single layer of reinforcement. I also reviewed UpToDate for all
important things like screening guidelines, endocarditis prophylaxis, etc. In retrospect, that day
having made the Anki cards and reviewing UpToDate was probably the most substantial day of
my entire 2CK preparation. The next day I woke up and felt decently prepared.

I exhort spending one of the days during the final week reading the HY topics in UpToDate. This
saved me on the real deal. There were some borderline questions that I didnt have to secondguess on.
I then sat NBME 7 (2 days out) and scored 260. Because this exam was fairly new, it was hard
finding the answers online, but UpToDate was ultra-clutch here.
The day before my exam I flew from Brisbane to Melbourne. I spent a total of probably 15
minutes on the plane reviewing my notebook of UW bottom line statements (the ones I had
converted to Anki cards), then just ended my prep there. I checked in at my hotel, had an
extra-cold ginger ale, watched half of Escape from Alcatraz on my laptop, went to sleep, and
then sat the USMLE 2CK on the 29th of December, 2014.
Exam experience
I got about 7 hours of sleep the night before. My breakfast consisted of a protein drink I picked
up at the 7/11 while walking to the testing centre. Because it was the 29th of December, there
were only three other test-takers present that day. I was the first to arrive and they let me get
started right away.
My initial plan was to do the first two blocks back to back with no break (as I had done for Step
1), but I made a really stupid error early in the first block on a 3-question sequence where I
couldnt change my answer, which prompted a mandatory diet Red Bull before starting the
second block.
I ended up taking ~5 minutes as break time after each block. My overall consumption consisted
of three diet Red Bulls, two protein bars and one high-carb protein shake, in addition to the one
I had walking to the testing centre. The diet Red Bulls were spaced after blocks 1, 4 and 7.
There were 350 total questions (blocks 1-6 and 8 were 44 questions; block 7 was 42 questions).
I marked an average of 2-3 questions per block and finished with ~10-12 minutes left for blocks
1-4 and 8. Blocks 5-7, in contrast, were brutally tight on time because the question stems were
essentially all massive paragraphs ending in which of the following is the most appropriate
next step in management? Im an extremely fast test-taker but these blocks literally came
down to the wire with me sitting erect in my chair. The 7th block was notably difficult because
it had a drug ad, a complex insulin regimen question requiring analysis and several biostats Qs
that required time aside to write out the math (and especially in the 7th block, triple-checking to
make sure I didnt flake out with any calculation errors).
Ill give general breakdowns for each subject as far as what showed up on my exam. But be
aware that everyones form is different. The following isnt what would necessarily appear on

your exam. Its just an example of what is possible. In terms of difficulties that I cite (i.e., easy,
medium, hard, etc.), they are my objective assessment of what the questions would be for most
test-takers based on what I think the % answering correctly would be.
Immunology: The congenital immunodeficiency syndromes are exceedingly HY on Step 2. You
will get asked at least a couple. Its true, this is Step 1 material, but its still assessed. Had an
easy question on X-linked agammaglobulinemia, a medium-difficulty question on NADPH
oxidase deficiency (know the catalase+ organisms well; they gave a bug that was not common
here), a question on Wiskott-Aldrich syndrome, a question Dx an image of thymoma, a physio
question relating congenital heart disease to an immune disorder, but they wrote lots of clinical
jargon in the vignette and you had to pick the cardiovascular changes that were reflective;
question on transfusion-related lung injury; question on ABO mismatch; one easy question on
influenza vaccination; easy question on pneumococcal vaccination; question on
immunodeficiency due to nephrotic syndrome; question on HIV in pregnancy (having read
UpToDate a few days before my exam saved me here because MTB2 was wrong and said the
exact opposite; make sure you know HIV in pregnancy cold going into the real deal); a couple
on next step in Mx of asthma and COPD; difficult question about picking the mechanism of
disease in a patient, where four of the answers made absolutely no sense, but the fifth would
have equated to a very bizarre presentation of Addison disease (basically you had to realize that
autoimmune conditions go together, so a patient with a propensity toward autoimmune
phenomena can have concurrent Sx from more than one autoimmune disorder); question on
seafood allergy.
Micro: Had about 5 questions where I had to pick the organism as the answer. One was on
picking Group B Strep and was so absurdly simple that I had to reread it to make sure there
wasnt some sort of catch; one super-easy question on the endocarditis organism in a patient
with congenital heart disease; two easy questions that relied on identifying the image of a
fungus (one wanted the organism but the other was picking the Tx based on the picture); one
question that involved picking the organism looking at a picture of tinea capitis, but the answer
was the only fungus listed (felt cheated here); question asking the Tx for golden Staph infection;
one easy question on Dx PID then picking the likely organism; clever question on Dx vaginal
candidiasis then picking the most likely risk factor; fungal infection question that required you
knew the staining method to get it right.
Biostats/Ethics: Biostats was actually really heavy on my exam. One block I think may have had
four questions. I had THREE that were calculating number needed to treat (one was the first of
three questions in a drug ad) and THREE on attributable risk. It occurred to me that this is
probably the clinical aspect of biostats that they wanted to emphasize on 2CK, versus Step 1
where most of the Qs are basic sensitivity, specificity, etc. Whereas some questions were just

picking out the number, many were about drawing a conclusion based on a study. For instance,
on Step 1, they might ask in a path question simply whats the diagnosis? Whereas on 2CK,
its implied that you can get the Dx, but then they want the Mx. Well its kind of the same for
biostats. Its somewhat implied that you know how to calculate NNT, NPV, etc., but then you
need to be able to apply that information to a study/clinical scenario (e.g., two hospitals are
doing this and that, what conclusion can be drawn?). Had two easy questions on what would
happen to sensitivity/specificity if you changed the cutoff point for a study. Had one question
where you had to calculate both specificity and PPV, where the answers were two different %s
that you had to choose from; one on generalizability, one on selection bias, one on confidence
interval in relation to precision. There was only one biostats question that Im not sure
whether I got right. I was able to pull the conclusion from the vignette, but it was
borderline/subjective as to whether no conclusion could be drawn based on the low-medium
power of the study; in the end, I tried not to over-think it and just went with the conclusion I
drew from the scenario.
Behavioral/ethics: One question on how to respond politely to a patient about something; one
minutia question on the role of parental consent for a minor participating in a research study;
question on HIV and MSM; tough question regarding motives for ending ventilator care that I
basically had to guess on (and no, this wasnt the standard withdrawal = withholding scenario).
Safety science: Had two questions in this category and got them both wrong. I dont really
know what to say. One of them was on hand washing, which makes me feel like a bogan. In
general, hand washing is always the answer if its listed as an answer choice to any question.
But this particular vignette threw a curveball in that the disease you had to Dx isnt really
transmitted like that. Either way, I knew going into the exam Id likely over-think at least one
easy question, and this was that question on my form. The second safety science question was
about limb marking in wrong limb surgery. I dont really consider this a surgery question; it was
more just a question about safety protocols.
Psych: I had tons of psych on my exam. This was my strongest subject going in but some of the
questions were long and ambiguous. Had lots of questions on depression presented in
different ways, brief psychotic disorder, schizotypal, bipolar disorder, borderline, avoidant,
OCPD, GAD, panic disorder, malingering, fibromyalgia, delusional disorder, panic disorder;
question on benzo toxicity, question on inhalant toxicity; a few questions on delirium
tremens/WKS; question on marijuana addiction; question on presentation of child abuse;
couple questions on heroin toxicity; straightforward question on PANDAS (i.e., if you knew what
that is); tricky question on electrolyte derangement in anorexia; question on refeeding
syndrome in a patient with a normal BMI; tricky question needing to differentiate between
schizoaffective disorder and depression with psychotic Sx; question on depression secondary to

a general medical disorder; two questions on pseudodementia; question on neuroleptic

malignant syndrome.
Neuro: toughest subject on my exam, but it was fair. This was definitely a step up from Step 1
in terms of difficulty in that they really made sure you knew your presentations; question on
supranuclear palsy (if you knew the basic presentation this was easy; youll find that for
obscure conditions they always give classic presentations); really hard question on normal
pressure hydrocephalus that did not present with the classic triad and instead had a few other
odd findings that could have been mistaken for a different condition (I would exhort reading up
on how this can present; Wiki is fine for this); recondite brain image question where I basically
had to conjecture that I was looking at an oncogenic process; brain image question on diffuse
axonal injury; question on transverse myelitis; tough question on botulism (know the possible
presentations of this!); question on ALS; question on myasthenia gravis; question on LambertEaton syndrome secondary to small cell; question on Guillain-Barre; question on Meniere
disease; tough question on hearing loss where you had to identify the location of a
neurosensory lesion based on the Rinne and Weber tests, but the locations they gave were
hyper-specific (make sure you know the neurosensory pathway for hearing and at what level
things decussate, etc.); very clever question on restless leg syndrome (I was impressed with
how they asked this question; know how this disease works and how to Tx it); question on
idiopathic intracranial hypertension; question on congenital TORCHeS syndrome w/ intracranial
findings; easy question on Tx of Alzheimer disease; basic question on optic neuritis; question
about preventing amaurosis fugax (know which meds to give a patient based on his or her risk
factors); a crapload of questions on lower back pain (know your presentations!); one hard
question on B12 deficiency where the pattern of neurological dysfunction was nothing I had
ever seen before, but I was certain none of the other answers could have been correct, so I just
went with the answer that seemed least asinine; question on hypomagnesemia; question on
tuberous sclerosis; question on NF1; question on cerebellar lesion.
Ophthalmology: question making sure you could differentiate between two conditions on
fundoscopy (it was an ambiguous vignette so you needed to know what you were looking at
straight-up; even if you knew the verbal descriptions, that wasnt good enough; my advice is to
not ignore the exhibits in the explanations in UWorld; I got this question right only because I
had remembered the UWorld image); question on glaucoma, question on macular
degeneration (know how vision appears with this condition; I got this right because of UWorld).
Nothing on hordeolum/chalazion/orbital/preseptal cellulitis or anything like that.
Dermatology: two questions on Tx/Mx of melanoma (pretty much the same question
repeated); tough question on identifying a skin lesion with absolutely no vignette (what made it
hard is that it didnt fit the classic verbal descriptions and was a total toss-up; even location

didnt help; my advice is to look at images of BCCs and SCCs and really pin down the different
ways they can look); easy question on identifying herpes zoster; very clever question on Lyme
disease (i.e., the appearance was not classic; its my impression the USMLE is trying to do its
best to steer away from classic review book descriptions); question on toxic epidermal
necrolysis; easy question describing erythema nodosum (know what its associated with);
question on strawberry hemangioma; question on pellagra.
MSK/Rheum: Several questions on rheumatoid and osteoarthritis; question on septic arthritis;
question on gouty arthritis; couple of questions on SLE; question on Marfan syndrome;
question on bone cysts (make sure you know the different types!); two questions on congenital
hip dysplasia; question on Legg-Calve-Perthes disease; question on slipped capital femoral
epiphysis; question on polymyositis; question on dermatomyositis; question asking about
recovery in leg trauma; question identifying the type of knee injury; question on identifying the
type of shoulder injury; question on Becker muscular dystrophy; question on Paget disease; two
questions on hernias, where one was basic but the next was a WTF question where they listed
like 12 different obscure eponymous hernias as answers (I narrowed it down to two but
ultimately guessed and got it wrong).
Cardio: question on venous ulcer; question on stasis dermatitis; question on vasovagal syncope;
three heart sound questions; two questions on rheumatic fever; two endocarditis prophylaxis
questions; two physiology questions comparing oxygen sats at different locations and you had
to deduce the pathologies; question on CHADS2 score; question on Dx of atrial thrombus;
question on Dx of carotid stenosis; question on Mx of carotid stenosis; question on reducing
risk factors in diabetes; dirty question on renin/aldosterone that I found hard (and this is
probably one of the most basic concepts in medicine; basically everything you know about
renin and aldosterone you can defenestrate); question on Kawasaki disease; question Dx
congenital heart disorder; question where you needed to make a conclusion in a physiological
sense based on clinical findings; three questions where you had to make a Dx based on an ECG
strip (this wasnt bad, dont worry; I get paranoid about this stuff; question on Eisenmenger
syndrome; question on aortic coarctation; question on fetal alcohol syndrome; question on
aortic dissection; question on mesenteric ischemia; two questions on tamponade; question on
traumatic aortic rupture; question on pericarditis; a few questions on cardiomyopathies;
question on Wegener; question on HSP; question on calcium channel blockers; question on
statins; question on SVC syndrome; question on vascular rings (easy if you were ready for it).
Pulm: question on obstructive sleep apnea; question on emphysema, question on chronic
bronchitis; question on croup; question on bronchiolitis; question on home oxygen and COPD; a
few questions on pneumothoraces; question where you had to Dx improper NG tube
placement; question on asthma; various questions on different lung cancers and neoplastic

syndromes (the USMLE is obsessed with the physio in these types of questions); couple of
questions on ARDS (know the causes and how this type of stuff relates to PCWP); question on
NRDS; question on basic V/Q mismatch; couple of questions on pulmonary embolism; question
on fat embolism; question on bronchiectasis; question on cystic fibrosis; two questions on
foreign body aspiration; question on pneumoconiosis; question on cor pulmonale; question on
pleural effusion; two questions on pneumonia; two questions on pulmonary edema (including
one during pregnancy, so know the causes/management for that); question on mediastinitis;
question on PEEP settings.
GIT: tough question on esophageal cancer (really think about how this would present in a GIT
sense relative to other DDx); question on achalasia; question on diffuse esophageal spasm;
question on esophagitis; question on varices; question on Boerhaave; question on Zenker
diverticulum; question on Meckel diverticulum; question on Barrett; question on GERD;
question on gastric bypass surgery (really understand the post-surgical management and
adverse possibilities); a Step 1-type question on H. pylori mechanisms; question on Schilling
test; very tough question differentiating lactase deficiency from Celiac disease; question on
hemochromatosis; question on mesenteric ischemia; question on diverticulitis; question on
cholecystectomy; question on cholecystitis; question on choledocholithiasis; question on
pancreatitis; various questions on IBD; question on IBS; question on splenic injury; question on
hiatal hernia; couple of questions on scleroderma; question on NSAIDs and GI bleeding;
question on Hirschsprung; question on intussusception in an adult; question on adhesions and
SBO; couple of questions on colon cancer screening; question on colonic polyp Mx; couple of
questions on hepatitis; question on hepatic encephalopathy; question on spontaneous bacterial
peritonitis; question on Gilbert.
Heme: Question on thalassemia; question on vWD; hard question on acquired VIII deficiency in
a patient with an ambiguous presentation; one on Tx of sepsis in sickle cell; at least 4-5
questions integrating concepts of sepsis in general (the 2CK is absolutely obsessed with sepsis);
a few questions integrating concepts of different types of shock; one on sideroblastic anemia,
one on anemia of chronic disease, one question on macrocytosis secondary to alcoholism;
question on TTP, question on ITP; question on agranulocytosis secondary to a drug; question on
warfarin bleeding diathesis secondary to P-450 inhibition caused by second drug; minutia
biochemistry question on methemoglobinemia regarding a detail I had never encountered
before (biochemistry was my strongest subject going into Step 1 and I had to guess the answer
to this question).
OBGYN/andrology: Question on SERMs; question on Pap smear Mx; question on leiomyoma;
question on fibroadenoma; question on Leydig-Sertoli cell tumor; two on breast lesion Mx;
question protective factors against ovarian cancer; question on hydrocele; question on

testicular cancer; strange question on penile HSV with a presentation that was somewhat
nebulous; question on vitamins and pregnancy; question on mastitis; question on twin-twin
transfusion syndrome; absolute BS question on diabetes and pregnancy that made absolutely
no sense grammatically (i.e., I didnt know if they were asking about the fetus or mom, and Im
pretty sure I got it wrong as a result); several questions regarding pregnancy Mx (e.g., pelvic
ultrasounds, non-stress tests, decelerations, tocolysis, etc.); question on cord blood sampling;
question on androgen insensitivity syndrome; one on hematocolpos; one on primary
dysmenorrhea; one on endometriosis; couple of questions on contraceptive methods; one on
BPH; question on prostate cancer; one on PID; one on premature ovarian failure; one on
vasomotor Sx; question on Klinefelter; question on Turner; question on choriocarcinoma;
question on hydatidiform mole; couple of questions on preeclampsia and HELLP syndrome; one
on abruption placentae; one on placenta previa; one on ectopic pregnancy; couple of questions
on anovulation/PCOS; question on ovarian cyst (know the different types and how to Tx them!);
question on peripheral edema in pregnancy.
Peds: question on bronchiolitis; question on PANDAS; strange question on Sturge-Weber
syndrome; question on strawberry hemangioma; question on vascular rings; question on child
abuse; question on constitutional growth delay; one on adolescent substance abuse; one on
Down syndrome; one on rickets; a few questions on sickle cell; one on otitis media; one on
cerebral palsy; one on ALL; one on infant of diabetic mother; one on juvenile idiopathic
arthritis; one on lead toxicity; one on PSGN; one on meningitis; one on acne vulgaris; one on
ADHD; one on Osgood-Schlatter; one on torticollis; one on Kawasaki; two questions on foreign
body aspiration; one on neonatal jaundice; know what PHACES syndrome is.
Renal/GU: question on nephrectomy; question on Beckwith-Wiedemann syndrome; one on
pyelonephritis, one on asymptomatic bacteriuria; one on ureteric stones; one on basic ACEi
physio in relation to the kidneys; various questions on diuretics and drugs acting on the kidney;
question on NSAIDs and the kidneys; a few questions on acidosis/alkalosis-related stuff; one on
diffuse proliferative glomerulonephritis; one on PSGN; one on tubulointerstitial nephritis; one
on acute tubular necrosis; one on dialysis; question on renal tubular necrosis; question on
bladder cancer; question on urethral injury; couple of questions on UTIs; question on pre-renal
azotemia; question on post-renal azotemia.
Endocrine: plenty of questions integrating concepts of ADH (i.e., SIADH, DI), aldosterone, PTH,
T3/T4, LH/FSH, prolactin, cortisol (pretty much all hormones you can think of, they showed up);
lots of questions integrating diabetes mellitus. Endocrine was pretty much the easiest subject
on the exam because it was most heavily tied into physio, which felt a lot like Step 1 stuff.
I felt pretty blasted upon finishing the exam way more tired than after I had finished Step 1. I
knew of three questions I got wrong before even leaving the testing centre. I really had no idea

whatsoever where I fell in terms of score because the entire exam felt so subjective. Well
anyway, so I just got the score back today (on my birthday):
USMLE Step 1: 262
USMLE Step 2CK: 260
I feel fine about this outcome. I hadnt felt nearly as prepared going in as I had for Step 1, so I
wouldnt have been surprised if I had tanked it somehow. I was expecting anything between
240 and 270, so I cant complain about a 260 since NBME 7 two days before matched that. So I
dont really think theres anything more to say about that. It is what it is.
Study resources
Internal medicine:
I own Step-Up to Medicine. This is an internal medicine book, not a comprehensive USMLE
book. I had heard this was really good for the USMLE, but quite honestly, its really dense with
text. If youre the type who likes to read endless text, feel free. This book didnt help me
though. I looked at it maybe five times randomly for no more than two minutes. I personally
learn better through tables, diagrams, flow charts and questions, not ongoing, superfluous text.
I found having studied hard for Step 1 was sufficient to cover internal medicine for 2CK.
Bottom line is: practice questions are sufficient for IM for 2CK. But if you want a text for this
subject, Step-Up to Medicine is probably the best compendium you can get. There are two 50question internal medicine Clinical Mastery Series blocks on the NBME website. Make sure you
do those.
Surgery:
I found Pestanas Surgery Notes to be good while I was on my surgery rotation. This book is
super-short, so even if you are somewhat close to your 2CK and need a quick surgery review,
this will do the trick. It has 180 (or so) questions in the back of the book, which I went through
first and then went back and read the corresponding areas from the text. Id consider Pestanas
notes to be sufficient for fast surgery review, but its not essential so dont lose sleep over it.
I own Case Files Surgery as well and went through about ten of the cases, but it wasnt concise
enough for USMLE purposes so I jettisoned it. And especially regarding topics like breast
cancer, the information was vague and desultory. This book is OK to use during your clinical
rotation, but Id choose Pestanas over this one.

Most of my surgery I probably learned through practice questions and UpToDate. If I got a
surgery question that I wanted a little bit more elaboration on, Id just reference UpToDate,
which was always very helpful.
Bottom line: practice questions and UpToDate are the core elements of surgery prep. Pestanas
is a good review but not essential. I do not recommend going through a tome. That might help
for a surgery rotation, but not for the USMLE. There are two 50-question surgery Clinical
Mastery Series blocks on the NBME website. These questions were just like the ones on my
USMLE. Think of studying for surgery like studying for anatomy for the Step 1 theres a
million things we could possibly know but consolidation is key.
Psychiatry:
Case Files Psychiatry was solid for this subject. I would read this on public trans to and from the
hospital during my rotation and learned/reviewed quite a bit from it. It also helped me clarify
some things that I had been confused about for a while. I did find a couple errors in it, but they
dont undermine the value that the rest of the text has to offer.
I have a friend who strongly recommended FA Psychiatry (and the reviews on Amazon are really
good), but I personally did not read this because I found Case Files to be good enough.
Bottom line: practice questions and Case Files are all you need for psychiatry. FA Psychiatry is
an alternative to Case Files that has received strong reviews. There are two 50-question
psychiatry Clinical Mastery Series blocks on the NBME website; I assume these are just as
valuable as the internal med and surgery ones, but I did not complete these because psych was
my best subject going in and I didnt feel I needed to review it anymore.
Pediatrics and OBGYN:
Two different rotations, but Im grouping them together here because I prepped for them the
same way. As I said earlier, I sat my 2CK not having undertaken these rotations, so these were
the two subjects I was most paranoid about.
I found the combination of MTB2 and MTB3 to present a decent introduction to these topics,
but these two texts alone are not nearly sufficient for the 2CK. If you already own these texts,
the combination of them can be a decent opener if you have absolutely no background in
peds/OBGYN, but if you dont already own these, theyre not necessary.
The way I learned the vast majority of my peds and OBGYN was through practice questions
(including the Clinical Mastery Series) and UpToDate.

Case Files Pediatrics and Case Files Obstetrics and Gynecology were solid, but I only went
through about one-third of each. I really liked them but just didnt have enough time to finish
them.
On my real USMLE 2CK, I felt I was able to handle the peds and OBGYN questions just fine. I
had encountered two very obscure peds questions, but its tough to say if any
resource/rotation would have even covered these.
I had heard UWise (thats right, UWise, not UWorld) questions were good for OBGYN, so I did
the free 10-question sampler and really liked it (granted only n=10), but I didnt end up using
UWise because I didnt have enough time.
Bottom line: practice questions and Case Files is the way to go for peds and OBGYN. If you own
MTB2/3, the combination of these provides a good intro to peds/OBGYN but is not essential.
UpToDate is ideal for learning more after going through QBank explanations. And 100% make
sure you do the Clinical Mastery Series questions; these were very similar to the actual 2CK
questions. UWise is known to provide a strong QBank of OBGYN questions for those who want
extra help in this subject.
Critical Care/Emergency Medicine:
Critical care/emergency medicine is exceedingly HY for 2CK. This was really frustrating actually
because no one I had spoken to beforehand about the 2CK had ever mentioned this subject as
being core to the exam. And furthermore, even standard threads on SDN never emphasized
this subject; you always see people freaking out about surgery or peds, etc., but emergency
medicine is possibly the highest yield subject on 2CK. That being said, I had no idea this subject
was so HY until I got to UWorld and it seemed like every 6th question was guy comes in after a
MVA with BP of 90/60, RR30, HR120, etc. Heres his chext x-ray. And the real deal was similar.
At least every 10th question on my real deal was emergency medicine. In turn, the only
preparation I did was practice questions and UpToDate. That was it. Even FA 2CK, MTB2 and
MTB3 dont really touch upon critical care.
Bottom line: Fortunately these questions on 2CK are largely problem-solving/intuition-based, so
practice questions + UTD are enough. Just make sure you know how to manage common
cardiopulm pathologies and can interpret basic CXRs.
Biostats / ethics:
I didnt study this subject for the 2CK. As long as you adequately covered this stuff for Step 1,
doing lots of 2CK practice questions will more than sufficiently cover your bases here.
Question and answer

Q: So everyone feels like that, good to know I guess lol :/. Do you think the NBME's are worth
it? I was planning on doing all of them and UWSA1 before I go in for the real thing. I noticed
that you only did the UWSA.
A: I think it is wise to do the NBMEs. They are the USMLE.
Q: Phloston, what you think helped you the most throughout your preparation? You still think
UW & uptodate and NBME?
A: Yeah. UW, UpToDate, the NBMEs, the clinical mastery series and Free-131 were the staple.
I'm mixed about the MTBs. On my real 2CK yesterday, had I adhered to MTB, I would have
answered at least one question incorrectly. For instance, they had an HIV(+) pregnant woman
with a normal CD4 count; MTB says initiate ART if CD4<400 (IIRC); UpToDate, however, says "All
pregnant HIV-infected women should receive a combination antiretroviral drug regimen,
regardless of CD4 cell count or plasma HIV RNA copy number, to prevent perinatal
transmission." So on my exam, I went with UpToDate.
The only extent to which I'd vouch for the MTBs would be to merely be aware of certain
conditions/findings (e.g., umbilical hernia is associated with congenital hypothyroidism), but do
not, by the pain of death, memorize the algorithms/Txs in MTB as though those are the
answers/correct sequence of things. The correct answer on the exam is almost always based on
the specific patient scenario they give (and that can be extremely varied). In MTB, there is some
strange obsession with best initial test vs most diagnostic test. On the real exam though, they
pretty much always ask for "the most appropriate next step in management." And sometimes,
the most diagnostic test is the first test you'd do.
Q: so you recommend only reading certain sections of MTB or can I completely skip it. Also
you mentioned earlier that the clinical mastery series are very difficult and picky, do you still
recommend doing that? do those questions reflect what the actual exam is like
A: Now that I've taken the actual 2CK, I would say it's OK to read MTB2 and MTB3, as I said,
to get a mere idea of the topics that could show up, but do not memorize the treatment
algorithms, diagnostic test sequences, or screening guidelines as though they're what you
should answer on the test. Be aware that certain imaging modalities or pharmacologies have
been useful for certain conditions, for instance, but don't, by the pain of death, memorize the
MTBs. A lot of the information is significantly outdated. As I said earlier with the HIV example, I
would have gotten a question wrong plain and simple had I gone with MTB over UpToDate.
UpToDate is way more accurate. It even got me a potentially nebulous pediatrics question right
because it comes out and makes firm guidelines/recommendations, so I didn't have to hesitate

when answering the question.

And YES YES YES to doing the clinical mastery series questions. I had several questions on my
exam that were very similar to vignettes I had in those. In fact, doing those questions definitely
got me points.
Q: I have some other doubts if you don't mind. I have already finished 1 around of UW. What I
have found for a lot of questions (that were recently updated) contain a lot of long algorithms
with a lot of arrows (a lot in endocrinology) and a lot of tables for certain conditions e.g.
hemachromatosis, primary sclerosing cholangitis, etc. Do you have to remember ALL THOSE?
A: Regarding UW, I generally do trust their algorithms if they've been updated within the past
month or so. It's not that a particular imaging modality would all of a sudden become
inappropriate a month later as much as it is that current recommendations are subject to
change. UW algorithms for things like blunt abdominal trauma and screening guidelines are
pretty good. But I ALWAYS checked anything from UWorld against UpToDate, especially for
things like cervical cancer screening (and all of the technicalities about pap smears and
LGSIL/HGSIL for the different age groups, etc.), regardless of when they were supposedly
updated.
Q: In obgyn, cervical cancer screening and prevention. Like when do u screen for cervical
cancer, and if its normal what u do, how many years you would repeat it if its abnormal then
what you do (eg like do you repeat the test few years, depending if its just atypical cells or CIN?
or do you do another diagnostic test, stuff like that). Do you have to know all those algorisms?
A: Funny that you mention cervical cancer, because UpToDate was brilliant for that stuff. I
recommend having UpToDate open as a tab on your browser and then checking it after you've
read an important topic in UW. UpToDate is especially important for stuff like the current
recommendations on endocarditis prophylaxis. I was glad I read UpToDate's info on this a few
days before my exam because I had two borderline-tricky questions on prophylaxis
recommendation on the real 2CK that I didn't have to second guess. Be very clear going in
exactly when you'd use prophylaxis vs when you wouldn't.
Q: What I hate the most about doing questions is the fact when they ask "the next step in
management". They may have already included the 1st step, 2nd, 3rd step in management,
then if you ask what is the next best step in management, u have to recognize the steps that
have already been done to the pt, and now you have to know the 4th step in management, you
know what I meanDoes the actual exam ask a lot of stuff like that

A: The actual exam is a F-fest in terms of "what's the most appropriate next step in
management?" That line was a joke for me during prep and also during the exam. I remember
the 5th and 6th blocks I was notably tight on time, and then I'd click to the next question and it
would be a massive, 12-line paragraph ending in "what's the next best step in management?"
Then I'd pray for the following question to be slimmer, but it would be another 15-line
paragraph asking the same thing. It was pretty much wave after wave. One had an exhibit
taking up the right half of the screen so the question was greater than the vertical length of the
whole page; it was a joke. In terms of the actual answers, it was really subjective and mostly
based on gut instinct. There wasn't a pattern to it other than just needing to get the gist of the
patient's unique story and then choosing what seemed least unreasonable. You reach a point
during the final few blocks where you realize you don't really have time to analyze anything or
reread. You kind of have to blitz through the questions, go with your gut and then move on. As I
said, the whole thing was a booty bang / banana festival.
Q: You think a lot of step 1 concepts showed up? Do you recommend skimming through FA step
1 again?
A: The congenital immune syndromes are exceedingly HY on Step 2 (e.g., WAS, XGA, CGD, etc.).
I would briefly look at those if you have time. Otherwise FA Step 1 doesn't really have
high direct utility. Iow, the content of FA Step 1 is obviously important as a foundation (which is
why we took Step 1), but I wouldn't recommend looking at it before the 2CK. Just breeze over
the immuno diseases.
Q: Would you recommend doing kaplan qbank or rx having completed ck now?
A: Unlike Step 1, where I had finished Kaplan QBank, for 2CK, I did about 2-300 questions
before realizing that all of the questions I was getting wrong were lame tricks or minutiae, so I
didnt bother with the rest. I definitely learned a lot through Kaplan QBank for Step 1, but after
I had sat the actual Step 1, it was very clear that the real USMLE questions were nothing
remotely like Kaplans. So for 2CK, I took this as an indicator not to waste my time.
The reason this proved to be extremely ironic, however, is that during my 2CK, there were two
questions I got right specifically because of those 2-300 Kaplan questions I had done. In other
words, as much as I hated Kaplan, they got me two questions on my real deal (this was notable
such that mid-exam I was like wow, this was in Kaplan QBank; in retrospect, I believe I may
have been able to reason through one of them, but the second I know I would have gotten
wrong had it not been for Kaplan). So (un)fortunately Im going to have to say that I do
recommend Kaplan QBank for 2CK.
Overall, in terms of question quality, Id say UWorld > Rx Kaplan. Rx was definitely higher

quality for Step 1 than for Step 2, which is why Id say either Kaplan or Rx could be done prior to
UWorld. That being said, its important to save UWorld for reinforcement after youve done a
different QBank first (whether you choose Rx or Kaplan [or both], it doesnt matter).
Q: I'm weak in these Heart sounds and Lung breath sounds. I had done Litmann's Cardiac audios
for my step 1 which were kinda helpful. But now these Lung sounds are a lil confusing.. Does
anyone know of a good resources to get a hang of 'em ?
A: I had three heart sound questions on my exam. The first was absurdly obvious such that even
people who are deaf could have picked it up. The second didn't require listening to the sound at
all to answer the question correctly (even though it corroborated the vignette accordingly). The
third actually required you to listen intently and then make a clinical decision based off of it; in
this case, there was no murmur and I said the patient was healthy.
I had no lung sound questions (thank Gd). Quite honestly, I wouldn't even bother obsessing
over heart/lung sounds during prep. If they present you with something on the real deal, it will
be flamingly obvious.
Q: Phloston how exactly did you use UpToDate? Did you read all of the information in a topic or
just the summary/recommendations section at the end? Also, if you had to pick one of either
Rx or Kaplan, which one would you recommend? Thanks!
A: I'd usually start with the summary/recommendation section and then work backwards to
whatever I was looking for (if needed). Searching a key word (using Ctrl + F on a PC) was
sometimes helpful.
Rx vs Kaplan is hard to say. Two days ago (i.e., before my exam) I would have hands-down said
Rx over Kaplan because I was so sick and tired of Kaplan's minutiae and irrelevance to Step
prep. However there were two questions I got right because of Kaplan (and I only did 2-300 Qs
in their QBank), whereas with Rx, there was no point during my exam where I was like "oh
wow, Rx saved me here." In fact, one of the incorrect answer choices in Rx on a certain question
was correct on the real exam; in this particular question, they didn't list the correct answer that
was in Rx and it actually frustrated me.
So to answer your question: I'd say Kaplan over Rx.
Q: What did you think of the OBGYN on the exam? It's the only subject I'm worried about going
into the test. Did you feel as if UWorld and UpToDate were good enough?
A: Funny that you ask this because I was petrified of obgyn and peds going in (worst subjects in
UW and I haven't done obgyn or peds rotations yet).

Prep for these subjects was really scattered for me, especially since there's no fully trustworthy
compendium for 2CK like there is for Step 1 (i.e., you can't rely on FA for 2CK). All of the obgyn
and peds I learned came from the smallish sections in MTB2, MTB3 and FA 2CK, as well as from
Case Files Peds, Case Files OBGYN (went through ~1/3 of each of the Case Files books but didn't
have time to finish them; I do recommend them though), USMLE Rx, UW, the Clinical Mastery
Series questions, the NBMEs and UW. When I was going through UW, I'd frequently source
UpToDate, which helped a lot. But furthermore, the questions I got on my exam I answered
based on multiple sources, so no, UW + UTD are not enough for peds and obgyn on 2CK. I've
heard UWise (that's right, not UWorld) has really really good obgyn questions. You should
check those out if you're freaking out about obgyn. I had done the 10-question sampler on their
website and liked it, but I didn't have time so I didn't go through their QBank.
On my actual exam, obgyn was pretty HY. My first 6 blocks and 8th block were 44 questions; my
7th block was 42 questions = 350 questions total. I think every 10th question or so was in
obgyn, which = 350/10 = ~35 questions on my 2CK (Or I'd say there were at least 4
questions/block on it = 32-35 Qs on my form). It's hard to gauge "how hard it was" because so
many of the scenarios seemed subjective rather than objective. But put it this way: compared
to my other subjects, I sucked at obgyn going in and I felt fine about it walking out.
However I got one really stupid question wrong that was the first in a 3-question sequence
where I couldn't change my answer. It was 11 questions into my exam so I think I was still
waking up / not sure how to best use my time, and I made the decision that instead of going
back to the sequence at the end of the block that I'd just answer it straight-up then and there
(kind of like someone on Who Wants to be a Millionaire? who isn't sure of the 1000-dollar
question but just answers it straight-up w/o a lifeline cuz it's too early in the game). Anyway,
when I got it wrong I was like "well there goes my 280" (which was an obvious joke), but it is
what it is.
Q: Besides knowing UW cold (which seems to be the most important) and testing yourself w
NBMES. Is there anything else you recommend as must haves for CK prep , even CK has a lot of
resources , but I feel its best to stick to 1-2 resources and know em cold. Im currently working
through UW first pass and am gonna do it again , goal for CK is 230-240 . Thanks and congrats
again
A: Make sure you do the Clinical Mastery Series questions on the NBME website. These come
with extended feedback and are gold. They are subject-specific, with two blocks of 50 questions
per subject. At the minimum, I recommend doing the 100 questions for IM, surgery, peds and
OBGYN = 8 50-question blocks = 400 questions. Do these before the NBMEs. And I recommend

putting your incorrects as PrntScr images into a PPT. I had a PPT that I reviewed prior to my
exam that had all of my incorrects from the Clinical Mastery Series, Free-131 (that's right, not
150 like with Step 1) and the NBMEs.
There are also Clinical Mastery Series questions for psych and neuro but I didn't do these cuz
psych was my strongest subject going in and neuro isn't HY at all for 2CK (and I'm also not
terrible in it). But yeah, definitely do the IM, surg, peds and OBGYN Clinical Mastery Series
questions, at a minimum, in addition to the NBMEs, free-131 and UW.
Q: Phloston, how were the drug ads and the abstracts on the real exam like? You think the ones
in UW and Fred are enough to prepare?
Also in UW there were a few questions regarding lipid lowering therapy. There's print screen of
the risk calculator e.g. if the risk is > 7.5% or less than, what you would do e.g. give high
intensity statin or low intensity. So on the actual exam you never have to do such calculations
right? Thanks
A: I always ignored the 7.5% pedanticism in UW because I knew that was only for teaching
purposes and that it would be horribly unlikely to show up on the real deal. In real life, no
physician on a ward round stands there and plugs a patient's risk factors into a calculator and
says "ohh yeah..we're at 7.2% today, better change that statin." The things that factor into
which statin someone gets are usually cost, feasibility and subjectivity on the part of the
physician. What you need to know for the 2CK is merely when to give astatin (e.g., 40-yr-old
diabetic w/ high blood pressure; where niacin, aspirin, a statin, etc. are answers, and risk is
decreased with a statin).
I had one 3-question-long drug ad sequence on my real deal and it was in the 7th (penultimate)
block. The first question was a biostats one based on the results in the ad. The second question
was a little strange, but you could see that one answer choice made no sense, three of them
"worked together" and then there was an odd one out. The third question I can't remember
(which means it didn't give me an issue). If I were you, I would never once care or freak out
about the drugs ads going into the exam because there's nothing you can do but wing them
anyway. The only thing I recommend though is saving the drug ad sequence for the end of the
block rather than doing it mid-block. This way you know whether you have enough time to
critically read or just skim the ad.
Q: Would u say to do clinical mastery series questions after 2 runs of UW to have a solid base ?
A: I wouldn't recommend doing two runs of UWorld. UWorld trains you to over-think. I'd spend
any time you're considering on a second pass of UW instead critically analyzing NBME, Clinical
Mastery Series and Free-131 questions; these are the USMLE! UWorld is not the USMLE.

Q: Whats the best order to do the NBMES , clinical mastery series and the free 131 ??? After we
have done UW at least once ??? And how close to the actual exam ?
A: I'd recommend finishing UWorld outright no closer than 10 days from the exam. The clinical
mastery series questions can be done concurrent to UWorld (i.e., intermittently on days you
don't feel like doing UWorld) or after; it doesn't really matter. I did the CMS questions
concurrently to UWorld. Then I did UWSA, then NBME 4, then NBME 6, then free-131, then
NBME 7.
Q: Hi Pholston, I had to register and thank you for your detailed feedback. I have a few
questions for you when you have time and to anyone who can spare some moments . When
you may have gotten a wrong question in the NBME+Clinical Mastery , how did you go back to
study what might be the right or better answer?If I recall, you're just told that the question is
incorrect only? I think you said you used UpToDate a lot but I'm wondering how I would
keyword or search for this. There is a library nearby me that has access to this software to use
for free.
A: Typing a sentence from the question you got wrong + "NBME" into Google will often bring up
a page/forum w/ people discussing it. That will help you get the answer.
Q: would you recommend redoing UW Step 1 or just reading First Aid Step 1 altogether just to
rejog my memory on terminology/what the diseases are (I remember many but there's a lot of
finer points which seem to build from having some recent step 1 knowledge).
A: No, don't redo UW1. Reading FA1 is too much indirect studying and won't help you. 2CK
relies on you having a strong Step 1 foundation, but studying FA1 directly veers from the focus
of the 2CK. I'd say the only part of FA1 that's really HY on the 2CK is the congenital
immunodeficiency syndromes (e.g., WAS, CGD, etc.). The 2CK somewhat assumes you can Dx a
condition but then instead wants the Mx (e.g., you'll get a vignette on lupus, but they want to
know the Tx for a flare --> steroids; not just what's the diagnosis). The questions they ask you
straight-up for the Dx are usually clinical (eg. tension pneumothorax, aortic rupture, mesenteric
ischemia), not basic science-oriented (eg Duchenne), although yeah, obviously you do get
the occasional Q like that.
Q: Would I benefit instead in just really going through MTB CK + MTB 3 in its entirety really fast
to get a general overview on things (without memorizing algorithms/next step managements)?
A: Yeah, MTB2 and MTB3 without obsessing/memorizing Txs can be a good approach. Use any
Mx info in those books as mere ideas for how to Tx something (ie. if he lists 3 drugs and 2
different surgeries as Tx, just be aware that they exist as possible Tx, but don't say "oh yeah, I
do this first, then this, then this." That will really screw you over if you do that).

Q: How about MCQs-portion only (not CCS) from UW Step 3 (since it has more psych-pedsobgyn-surgery questions) and/or the UW IM questions? Would they help or is that way too
advanced for this exam? I was only considering this as an alternative to doing kaplan qbank
since I'd be still in UWorld mode....
A: I didn't venture into Step 3 questions/assessment. I originally thought about it because I tend
to get OCD about stuff / love learning, but 1) I just didn't have time, and 2) it's summer here in
Australia, so you try sitting inside without getting ADD.
Q: Do you think another CK question bank or question books like the members used for their
shelf prep in the clinical rotations forum can help rebuild a weak step 1 foundation? I can
understand how pure step 1 studying can veer from CK exam requirement focus. I was thinking
as an alternative maybe to just purchase UW S1 and re-read through the explanation
discussions only for topics in path-pathophys-pharm-micro-behavior and then skip any
molecular bio/pure step 1 questions but I think this will take more than 2 months to do and I
have about 2 months total for CK. I'm not sure if a lot of the CK explanations go into a lot of the
background disease info like one learns from Step 1.
A: As I said, I think going through UW1 again is a lot of time that should instead just be focused
on 2CK material (i.e., all of that time could be spent meticulously learning UW2, which is way
higher yield). But I can't tell you you're wrong. Do what you need to do for yourself.
Q: Ok, so heres what I think about approaching questions: 1- Read the last sentence and
quickly glance at the answers, so you know what to look out for when reading the stem. 2- Give
me your opinion on this: I think it may be reasonable to go back to the stem if you read the
stem very quickly, which I do. I cant imagine reading the stem once and not looking at it again.
I think they were hinting that you shouldnt read the whole stem again. 3- Timing question is
how fast is fast enough? All my friends who have taken it say they were short on time. I try to
finish with at least 8 minutes left in the block, but I dont always manage that.
A: On the real deal I did point #1 as you've mentioned, then went through and read it once
quickly, then went through a second time and glanced around at finer details. The reason the
stems take so much time is because there aren't really buzz words like Step 1. For Step 1, there
would be a paragraph with a bunch of nonsense, then the last sentence would say "oh and by
the way, CXR shows bilateral hilar lymphadenopathy. What's the diagnosis?" But Step 2 is more
about the story. I put that in italics because I'm sarcastic about how I don't really care what the
actual story is in the stem. I think the best bet is to just try to sleep well and then bring several
diet Red Bulls to the exam. I brought 4 with me to the exam (only ended up having 3). My
perspective was that I would rather have gone into AF and essentially on an amphetamine high

than have been cracked out and fatigued from the stems. That's what I did for Step 1 and it
worked well.
Q: My MTB is heavily annotated with UWorld notes so for that reason I'm going through it
again. As for best initial test, most accurate, best initial therapy, and next best step, do you
have all those down for all the major diseases and conditions? I don't... so I need to go through
my MTB/UWorld notes for that again. I have no idea how broad this may be or if it will even be
like UWorld. You seem to be confident, and I would be too with the percentages you're getting
on UWorld. I'm still in the 70s.. But again, I just want to pass this exam. I won't know anything
till I take an assessment. Do you think the UWSA is a good way to go or should I do an NBME?
And how did you approach Biostats? I'm using SUTS2 which is ****.
A: I read MTB2 and MTB3 and was obsessing initially over best initial vs most diagnostic test,
but the 2CK questions interestingly aren't like that at all. I don't know why Fischer makes it
seem that way. The 2CK questions are pretty much either "what's the diagnosis?" or "what's
the most appropriate next step in management?" The test you choose is usually just based on
gut instinct (e.g., if you've got an epidural abscess of the spine, you'd visualize that with an MRI
not a plain x-ray).
I would do all UW/UWSA material before touching the NBMEs because UW trains us to overthink. Kinda just have to deal with it because it's not like there's any better resource out there,
but I think people significantly overlook the difference between UW and the NBMEs. End on the
NBMEs for sure. The questions are more straightforward, and after calibrating to those, we're
less inclined to over-think stuff.
I can't really comment on biostats. I didn't review it at all for 2CK because I've seemed to
remember it all from Step 1. And most of the questions just seem like you can infer based on
what's there. I wouldn't go venturing into resources for it. Just review the QBank questions.
That's all you need, seriously.
Q: Im a week out from my exam. I've made flashcards of all these different conditions and
treatments but unfortunately, I'm STILL making these flashcards and am not even reviewing
them the way I need to. My dilemma is this: I have only covered Infecto, Endocrine, Cardio,
Hemato/Onc, GI, and Nephro thus far from MTB and my UWorld notes. I have seen Peds and
Ob/Gyn very recently. I think Pulmonary and Emergency warrant a reread.But do you think I
could just do U World questions on the other subjects and be ok? My biggest fear is relying too
much on U World.
A: I honestly think the best use of time during the final week is just focusing on the
NBME/clinical mastery series/free-131 questions and figuring out why you get them wrong. It's

really hard to say what studying any one particular subject is going to do for you because the
exam is so varied, but the one thing that's certain is that reviewing these questions is vital. In
terms of what you've done with flashcards, that tends to be my experience too. You make all of
them and then don't necessarily review them. I had done that for MTB2 a while back. I made
tons of them, reviewed them and uploaded them into PPTs, but it ultimately became too timeconsuming and I had stacks that I had never ended up touching again or reviewing. If anyone
actually has time to review flashcards then that's a luxury quite honestly. Flashcards are good,
but if you think of them as mini-questions, I'd say focusing that same amount of time on real
NBME questions is better anyway. I remember thinking that with the time I was spending
reviewing my own flashcards, that was really just time I could have spent doing an additional
question bank.
Q: I'm gonna do a review of NBME questions tomorrow. I found a .zip file online with the
answers. Did you find the same thing? And is it reliable?
A: The way I do research on the NBME questions is just by typing in the first sentence of the
question into Google and adding "NBME" on the end, and the forums pop up with discussions
of the questions. I haven't relied on answer keys or anything.
Q: I just ordered the Kaplan books. I'd like to see how the Ob/Gyn in that is. Btw, did you have
time to actually work out those drug ad questions you had in your 7th block? And reading the
stem quickly and then rereading them again. Is this even a possibility on the real 2CK?
A: The drug ad didn't give me a problem. I went back to it at the end of the block and just
tackled it then. I'm just glad there was only one because I would have had mega ADD on any
others I'd needed to have dealt with.
I didn't use Kaplan books so I can't comment on them. I generally don't like Kaplan's
method/philosophy of minutiae and superfluous, off-target info. But maybe the obgyn text will
help you. And it's hard to say about what you need to review at this stage. I would say just
focus on questions and leave it at that. Stop doing reading. Seriously. If I were you though, I'd
do the UWise questions >>> Kaplan notes for obgyn. The only thing that's going to get you
points on the exam is questions. There's a big difference between reading stuff and actually
applying it. Obgyn is one of those areas where questions are hardcore key. And make sure
youre using UpToDate to clarify the details if you arent already.
Q: In terms of knowing peds vaccines, do you think knowing how far apart they're spaced is
important? Tbh, that's where I struggle the most with those vaccines. I'll know them the
scheduling and then forget it a few days later.

A: Yeah, knowing the spacing/timing of the peds vaccines is very important. I found it was
easier to memorize certain time points (e.g., "what do I give at 2, 4 and 6 months?") as opposed
to memorizing the separate timings for a single type of vaccine (e.g., "when are all of the times
that I give pneumococcal?"). I'd say the yield of this stuff for 2CK would be the equivalent of the
embryo (e.g., aortic arch derivatives, clefts, arches, pouches, etc.) for Step 1. That is, they
could easily tell you what a 12-month-old's vaccination Hx is and then ask what he needs to be
given now. I just think you'd end up kicking yourself if you were posed with a straightforward
question on this and couldn't quite remember. There are enough nebulous questions on the
2CK that it's actually a relief if you can just say "wow, I know there's a clear-cut answer here." I
didnt have any peds vaccines questions on my exam, but I just got lucky because I hated that
stuff too.
Q: How were the AIDS/HIV on your exam? Should I be very specific about CD4 counts in my
preparation?
A: And yeah, MTB2 would have ****** me on the real deal because IIRC, it says something like
you only give HAART in pregnancy if the CD4 is <400 (can't remember exactly). But before my
exam, I checked UpToDate, and they said you give HAART to pregnant women regardless of
CD4 count. The only difference is that if her CD4 count is normal, you can start HAART after 14
wks gestation, whereas if CD4 is down, you start HAART in first trimester. If I were you I'd make
sure you know HIV and pregnancy ultra-hardcore going into the exam. UpToDate was preterclutch. You'll get at least one question on it, and not to mention it's HY on the NBMEs.
In terms of "should you be specific about CD4 counts in preparation.." The answer is a
generalized yes. Know that you wouldn't see MAI or CMV colitis, for instance, unless you were
CD4<50. The USMLE really really likes that. And know prophylaxis and Tx for MAI is
azithromycin (rifabutin, clarithromycin are alternatives). And TMP/SMX is Tx and prophylaxis for
PCP under CD4 of 200, and TMP/SMX is also the prophylaxis for Toxoplasmosis at CD4 of 200;
the only difference is you Tx Toxo with sulfadiazine/pyrimethamine.