Question Types on the USMLE Step 2 – CK: What You Need to Know

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When you are preparing to take the Clinical Knowledge component of Step 2 of the U.S. Medical Licensing Exam — also known as the USMLE Step 2 – CK — your success depends on your familiarity with two things: the content on which you will be tested and the format of the exam. In a previous post, we provided a general overview of the exam that included a description of both. Today, we’re going to do a deep dive into the formatting of the questions you will find on the USMLE Step 2 – CK. That way, on test day, you won’t be surprised by any of the questions you come across.

When it comes to formatting, there are two different ways you can divide up the questions on the USMLE Step 2 – CK. You can divide the questions between Single-Item Questions and Sequential Item Sets, or you can divide them between Patient Vignette questions and Abstract Format questions. Read on to learn more about the different types of questions you will find on the USMLE Step 2 – CK.

Single-Item Questions vs. Sequential Item Sets

If you take the USMLE Step 2 – CK after you take the USMLE Step 1 (which is the way most foreign medical graduates do it, although it is not required), you will recognize the Single-Item Question format. And even if you haven’t taken the USMLE Step 1 yet, the Single Item Question format will be familiar because it is exactly what you would expect from a multiple choice question: a short text background followed by a single question. Pretty simple.

The one thing that does distinguish the Single-Item Questions from traditional multiple choice questions you might have seen at other points in your education is the formatting of the answer options. There can be as few as 3 answer options or as many as 26. They are lettered (A, B, C, D, etc), and the options are arranged in either alphabetical order or logical order. It is important to note that some of the options might be partially correct, but you can only select one, so you have to choose the best possible answer.

When it comes to question formats, the primary difference between the USMLE Step 1 and the USMLE Step 2 – CK is that the latter exam also contains sequential item sets. That means that a single text — that is, either a Patient Vignette or an Abstract (both of which we will get to later) — must be used to answer either two or three consecutive questions, instead of just one. Like the Single Item Questions, these questions are multiple choice questions with 3 to 26 possible options, and you have to choose the single best answer.

Although each question in the Sequential Item Set directly relates to the text, they are designed to test your knowledge of different aspects of the text. Also, it is important to note that they are designed to be answered in sequential order, so a question may build on the one preceding it. Because of this design element, you will not be able to change your answer to an earlier question after you click the button to move on to the next question.

Patient Vignette Questions vs. Abstract Format Questions

The majority of the questions on the USMLE Step 2 – CK are Patient Vignette questions. The Patient Vignettes provide an overview of a clinical situation that you might encounter in your practice as a physician. Then, you are asked one or more multiple-choice questions about it (depending on whether it is associated with a Single-Item Question or a Sequential Item Set). For instance, you might be given a brief medical history of a patient followed by a description of an abnormal test result and then asked to identify the most likely cause of the result.

While the Patient Vignette questions test your ability to apply your knowledge and skills to clinical situations, the Abstract Format questions examine your ability to understand and interpret information from clinical investigation. Each of these items consists of a summary of an experiment or investigation in the form of an abstract — the kind you would find for a peer-reviewed research study published in a medical journal. It is essential for doctors to be able to read, understand, and analyze abstracts in order to effectively engage in evidence-based practice.

On the USMLE Step 2 – CK, you will be required to interpret an abstract in relation to various relevant topics. For instance, you may find questions about:

  • Biostatistics and epidemiology
  • Pharmacology and therapeutics
  • How to use diagnostic studies in clinical practice
  • How to use the information from the abstract to make decisions about care for an individual patient


Every step of the US medical residency application process — including the three Steps of the USMLE — can be challenging for foreign medical graduates, but FMG Portal is here to help. Contact us today for more information about our services!

Preparing for the USMLE Step 2 – CS: What NOT To Do


Over the last few weeks, we’ve been talking about the USMLE exams, which are essential for earning ECFMG certification and becoming eligible to apply for a medical residency program in the United States. In one of these posts, we introduced you to the USMLE Step 2 – CS, which tests your clinical skills. In another post, we took a more specific look at what you can expect in the two types of encounters on the USMLE Step 2 – CS: the Standardized Patient and Physical Examination and the Telephone Patient Encounter. Going into the USMLE Step 2 – CS, it is important for you to know what the examiners expect you to do — but you also need to know what NOT to do. That way, you can avoid making mistakes that cost you valuable time and/or points off your score. Read on to get tips on what NOT to do on the USMLE Step 2 – CS patient encounters.

What NOT To Do On the Standardized Patient and Physical Examination Encounters

Here are a few things that you definitely want to avoid during the in-person encounters on the USMLE Step 2:


  • Do NOT perform any of the prohibited tests. The testmakers specify that you should not conduct rectal, pelvic, genitourinary, inguinal hernia, female breast, or corneal reflex examinations. Also, you should not swab the patient’s throat for a throat culture. If you think that the patient needs any of these tests, you can call for them in the diagnostic workup you propose in your Patient Note.
  • Do NOT ask the patient for consent for other physical examinations. Aside from the above-mentioned prohibited tests, you can assume that you already have patient consent for all physical examinations. This includes femoral pulse exams, inguinal node exams, back exams, and axilllary exams. Asking for the patient’s consent on any of these exams will unnecessarily take up valuable time.
  • Do NOT be overly forceful with the patient with the patient. You need to be gentle during the physical examination avoid being too forceful when conducting maneuvers that involve palpating or percussing. You will lose points if you apply more than the appropriate amount of pressure when conducting an abdominal examination, examining the gallbladder or liver, using an otoscope to examine the ears, examining the throat with a tongue depressor, or examining the gall bladder and liver.
  • Do NOT forget about the patient’s modesty. During the exam, you must treat the patient just the way you would treat a patient in a real-life situation. Therefore, it is important to take the time to consider their personal comfort during the physical examination. For instance, if part of the exam requires a female patient’s bra to be moved or loosened, you should ask her before doing it yourself. It only takes a few seconds, and it will demonstrate your ability to remain courteous and professional, regardless of the time constraints of the exam.

What NOT To Do On the Telephone Patient Encounters

These are some things to avoid on the Telephone Patient Encounters:


  • Do NOT play around with the buttons on the phone. During the Telephone Patient Encounter, all you need to do to place the call is  press the yellow speaker button. After that, touching any buttons could disconnect your call. When you are ready to end the call, press the yellow speaker button again.
  • Do NOT try to call the patient back after ending the call. Once you end the call, the encounter is over. Even if you think of another question for the patient, you cannot reach them again. Trying to call the patient back will only cut into the time you have for the Patient Note, so you should just do your best with the information you have.
  • Do NOT make assumptions based on your previous test experiences. This tip actually goes for both the Standardized Patient and Physical Examination Encounters and the Telephone Patient Encounters. If you are taking the USMLE Step 2 – CS for a second time, you may notice similarities between an encounter on your exam and an encounter on one you have taken before. However, you should NOT assume that the correct diagnosis or treatment strategy is the same as the one on your previous examination, as the test preparers often make slight changes between exams.
  • Do NOT make assumptions about whether or not an encounter counts toward your score. You may know that some of the twelve patient encounter are unscored — that is, they are only used for test development purposes. However, it is a bad idea to try to guess which encounters are unscored. Even if a particular encounter seems to stand out as easier or harder than the others, it may not be one of the unscored encounters. You should treat each one of the encounters — including both the in-person and telephone encounters — with equal seriousness.



Following these tips can help you avoid potential pitfalls when taking the USMLE Step 2 – CS. For more help preparing for a U.S. medical residency program, contact FMG Portal today!

Getting Ready for the USMLE Step 2 CK: A General Overview


Over the last few weeks, we’ve been talking about the USMLE Step 1 and Step 2. As an aspiring medical resident, you have to pass both of these exams before you can move on to USMLE Step 3. Success on all three USMLE exams is a prerequisite for ECFMG certification. Therefore, if you’re a foreign medical graduate looking to get matched to a residency program in the United States, passing these exams should be one of your top priorities.

The USMLE Step 2 consists of two parts. As we discussed in two previous posts, the USMLE Step 2 – CS tests your clinical skills during real-life patient encounters. The second part of Step 2 is the Clinical Knowledge (CK) section. Like the USMLE Step 1, the USMLE Step 2 – CK is a written test that requires you to demonstrate your expertise in the field of medicine. Read on to learn more about the content of the test and the format of the questions.

The Content of the USMLE Step 2 – CK: What To Expect

Put simply, the USMLE Step 2 – CK tests your knowledge of the concepts of clinical science that the USMLE committee members have decided are the most important for medical residents to possess. The specific material can vary slightly from year to year, but the general content tends to remain the same. There are two ways that the the content of the exam can be broken down: in terms of Scientific Topics and in terms of Physician Tasks and Competencies.

Scientific Topics

When approached from the perspective of Scientific Topics, the USMLE Step 2 – CK can be broken down into three categories, each accounting for a certain proportion of the exam. The first category, General Principles of Foundational Science, typically takes up 1 to 3 percent of the exam. The second category includes Biostatistics, Epidemiology, Population Health, and Interpretation of the Medical Literature. These topics typically take up 1 to 5 percent of the exam. That means that the vast majority of the USMLE Step 2 – CK is dedicated to the third category, which encompasses body systems and tissues. This category accounts for 85 to 95 percent of the exam. The topics that fall within this category include:

  • Behavioral health
  • Cardiovascular system
  • Circulatory system
  • Endocrine system
  • Gastrointestinal system
  • Lymphoreticular system
  • Musculoskeletal system
  • Nervous system and special senses
  • Pregnancy, childbirth, and the puerperium
  • Renal System
  • Reproductive system (male and female)
  • Respiratory System
  • Skin and subcutaneous tissue
  • Urinary system
  • Multisystem processes and disorders

Physician Tasks and Competencies

Another way to divide up the content of the USMLE Step 2 – CK is in terms of Physician Tasks and Competencies. Approaching the exam from this perspective can help you understand exactly what aspects of the Scientific Topics you will be tested on. Each of the four competencies accounts for a significant proportion of the exam.

  1. Medical Knowledge / Scientific Concepts

This competency makes up 10 to 15 percent of the test. Questions that fall in this category are direct, straightforward questions about the Scientific Topics listed above.

  1. Patient Care / Diagnosis

This competency makes up 40 to 50 percent of the test. Questions that fall within this category examine your ability to:

  • Interpret information from a patient’s medical history and physical examination
  • Interpret information from laboratory and diagnostic studies
  • Make a diagnosis
  • Provide a prognosis
  • Determine expected patient outcomes
  1. Patient Care: Management Health Maintenance / Disease Prevention

This competency makes up 30 to 35 percent of the test. The questions that fall within this category will test your knowledge of:

  • Clinical intervention strategies
  • Pharmacotherapy
  • Mixed management
  • Surveillance techniques to prevent disease recurrence
  1. Professionalism

This competency takes up only a small proportion of the exam: between 3 and 7 percent. Questions within this category will assess your knowledge of:

  • Professional conduct for health care providers
  • System-based practice
  • Patient safety
  • Practice-based learning and skill development

Question Types on the USMLE Step 2 – CK

All of the questions on the USMLE Step 2 – CK are multiple choice questions. Some of the questions are single-item questions, while others are sequential item sets. For the single-item questions, you will be provided with a short vignette that ends with a question, and you will need to choose the best answer from among a set of lettered choices. For the sequential item sets, you will be given a vignette that is followed by several multiple-choice questions that assess your knowledge of different aspects.

The way that the questions are framed can vary depending on the scientific topic or physician competency that is being assessed. Some questions ask you directly for information about a scientific concept. Others provide a story about a clinical situation that you might encounter as a physician. Still others provide a research abstract that you will need to interpret. Being prepared to see all of these question types is crucial for success on test day.
Looking for more advice on the steps you have to take to get matched to a U.S. medical residency program? Contact FMG Portal today!

Preparing for the Two Types of Patient Encounters on the USMLE Step 2 CS


Last week on the blog, we talked about the United States Medical Licensing Examination (USMLE) Step 2 – Clinical Skills (CS). In order to earn ECFMG certification, which is required for all foreign medical graduates who are applying for a residency in the United States, you need to pass all three steps of the USMLE. The USMLE Step 2 – CS tests your ability to perform professionally and effectively in clinical settings.

After the On-Site Orientation to the exam, you will be faced with twelve patient encounters. Each encounter will last for fifteen minutes. Most of the encounters will be Standardized Patient & Physical Examinations, but some of them will be Telephone Patient Encounters. Read on to learn what you can expect — and what is expected of you — in each of these two types of encounters.

The Standardized Patient & Physical Examination

In the Standardized Patient encounters, you will meet with a live patient. Within the fifteen-minute encounter, the you will be expected to do three things: come up with a preliminary diagnosis (or several diagnoses) for the patient, develop a basic work-up plan, and establish a positive and effective relationship with the patient.

In order to make the correct diagnosis and propose an appropriate treatment plan, you will need to utilize multiple strategies, including:

  • Asking the patient questions about their current condition
  • Asking the patient questions about their medical history
  • Conducting a physical examination

However, because you only have fifteen minutes available for each patient encounter, you will not have time to get a complete picture of the patient’s medical history or even conduct a comprehensive physical examination. Instead, you have to be strategic and pursue the most promising leads as you obtain more information from the patient.

However, coming up with the correct diagnosis and an adequate preliminary treatment plan is not the only thing you are being evaluated on when you take the USMLE Step 2 – CS. You also need to demonstrate your professional and interpersonal skills. That means relating well with the patient and establishing a good rapport, regardless of the time pressure. Some of the keys to earning a good score include:

  • Speaking to the patient in a courteous manner
  • Exhibiting empathy toward the patient
  • Responding appropriately to the patient’s questions, comments, and body language
  • Maintaining an awareness of the patient’s modesty during the physical examination

The Telephone Patient Encounter

In the United States, telemedicine — that is, the provision of remote clinical services, often by phone — is becoming increasingly common. Through some telemedicine platforms, it is possible for a patient to call a doctor from their home to discuss a medical issue without having to come to a clinic. In other cases, a physician might talk on the phone to a patient who is at a medical facility where staff and services are limited, such as a clinic in a rural area. As the prominence of telemedicine grows, a doctor’s ability to communicate effectively with patients on the phone is an ever more relevant skill — which is why it is important to perform well on the Telephone Patient Encounters on the USMLE Step 2 – CS.

For the Telephone Patient encounters, the general expectations are the same as they are for the Standardized Patient encounters. Specifically, you are expected to develop a basic diagnosis and treatment plan, and you need to communicate with the patient in an appropriate, effective, and caring manner. The main difference between the two types of encounters is that it will not be possible for you to perform a physical examination during the Telephone Patient encounters. Instead, you will have to rely solely on oral communication with the patient. This can may seem like a major obstacle but rest assured that the USMLE Step 2 – CS is designed so that the Telephone Patient encounters are challenging — but not impossible. Still, as long as you can quickly assess the relevant information and identify the most promising leads, you can come to a conclusion that will earn you a passing score.

The Patient Note

After each one of the twelve patient encounters — including both the Standardized Patient Encounters and the Telephone Patient encounters — you will have ten minutes to write a patient note. The content of the note is expected to be the same as what a practicing physician would write in a patient’s medical record after an in-person or telephone meeting. Just like the patient encounters, you will be under pressure to complete the note within the allotted time, but if you finish a patient encounter early, you will have extra time to write the note.

Ultimately, success on the USMLE Step 2 CS is one of many steps on the way to getting matched to a U.S. medical residency. For more help with the process, contact FMG Portal today!