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!