USMLE Step 2 CK Exam 2026: Format, Passing Score & MCQs
USMLE Step 2 CK Quick Summary
USMLE Step 2 CK (Clinical Knowledge) is a one-day, 9-hour computer-based exam of about 316 multiple-choice questions, now delivered in sixteen 30-minute blocks. It tests how you apply clinical knowledge to diagnose and manage patients, and the minimum passing score is 218.
USMLE Step 2 CK Exam
Step 2 CK is the second of the three USMLE Steps and, together with Step 1, a requirement for ECFMG Certification and US residency for international medical graduates (IMGs). Where Step 1 tests the basic sciences, Step 2 CK asks what you would do next for the patient — diagnosis, investigations, management, and prevention across medicine, pediatrics, obstetrics & gynecology, psychiatry, and surgery. Because Step 1 is now pass/fail, your Step 2 CK score is the main numeric score residency programs see.
Eligibility criteria for USMLE Step 2 CK
International medical students and graduates can apply for Step 2 CK if they meet the following:
Doctors from Pakistan can check our USMLE eligibility requirements for Pakistani doctors for country-specific guidance.
How USMLE Step 2 CK is scored
USMLE Step 2 CK syllabus and subject weightage
The official USMLE test specifications give the following share of questions for each clinical science:
By system and topic, the largest areas are nutrition (15-20%); legal and ethical issues, professionalism, and patient safety (10-15%); renal, urinary & reproductive systems (7-13%); and cardiovascular and musculoskeletal/skin (6-12% each). By physician task, diagnosis (16-20%), lab and diagnostic studies (13-17%), and management (12-16%) lead, followed by pharmacotherapy (8-12%). These ranges overlap because one question can cover several categories — for example, a pediatric renal case testing both diagnosis and management.
USMLE Step 2 CK exam format
Step 2 CK is a closed-book, computer-based exam taken at Prometric test centers. From May 7, 2026, it is delivered in sixteen 30-minute blocks of up to 20 questions each (previously eight 60-minute blocks of up to 40), with 55 minutes of break time for the day. Every question is single best answer, usually a patient vignette asking for the most likely diagnosis, the best next step, or the most appropriate treatment. Unanswered questions count as wrong, so always mark an answer before a block ends. The USMLE website offers free sample questions and a tutorial of the new test software.
How to apply for USMLE Step 2 CK
- Confirm your medical school is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.
- Create your account and submit your Step 2 CK application through the FSMB via the USMLE website.
- Choose the eligibility period during which you want to test, and pay the exam fee.
- Once your application is approved, use your scheduling permit to book a date at a Prometric test center.
- Sit the exam and receive your three-digit score, usually within four weeks.
- With Step 1 and Step 2 CK passed, complete the remaining ECFMG Certification requirements (an ECFMG Pathway and the OET Medicine test) before residency.
Not sure when to sit Step 2 CK? See our USMLE exam timeline for the ideal time to start each Step.
Preparation tips for USMLE Step 2 CK
USMLE Step 2 CK sample practice MCQs
Test your knowledge with these original clinical vignette-style questions, reflecting the format used in the actual exam. Tap a question to reveal the answer.
> Question 1: Medicine
A 62-year-old man presents to the emergency department 40 minutes after the onset of crushing chest pain radiating to his left arm. ECG shows ST-segment elevation in leads II, III, and aVF. The hospital has a cardiac catheterization lab available within 60 minutes. He has received aspirin. What is the most appropriate next step in management?
A) Exercise stress test
B) CT coronary angiography
C) Primary percutaneous coronary intervention (PCI)
D) Repeat troponin in 6 hours before deciding
Correct answer: C) Primary percutaneous coronary intervention (PCI)
This is an acute inferior ST-elevation myocardial infarction. When a catheterization lab is available promptly, primary PCI is the preferred reperfusion strategy. Waiting for repeat troponin delays reperfusion, and stress testing is contraindicated in an acute infarction.
> Question 2: Pediatrics
A 4-week-old boy has had worsening projectile, non-bilious vomiting after every feed for 5 days but remains hungry. He appears dehydrated. Labs show a hypochloremic, hypokalemic metabolic alkalosis. Which of the following is the best initial test to confirm the diagnosis?
A) Abdominal ultrasound
B) Upper GI endoscopy
C) CT scan of the abdomen
D) Plain abdominal X-ray
Correct answer: A) Abdominal ultrasound
The picture is classic for hypertrophic pyloric stenosis. Abdominal ultrasound showing a thickened, elongated pylorus is the diagnostic test of choice. Dehydration and electrolyte abnormalities must be corrected before pyloromyotomy.
> Question 3: Psychiatry
A 26-year-old woman reports 4 weeks of low mood, loss of interest in her hobbies, poor sleep, low energy, and difficulty concentrating at work. She has occasional thoughts that life is not worth living but no plan or intent. She has no history of mania or psychosis. In addition to psychotherapy, what is the most appropriate first-line treatment?
A) Lithium
B) A selective serotonin reuptake inhibitor (SSRI)
C) Electroconvulsive therapy
D) A benzodiazepine
Correct answer: B) A selective serotonin reuptake inhibitor (SSRI)
She meets the criteria for a major depressive episode without psychotic features or a history of mania. An SSRI combined with psychotherapy is first-line treatment. Electroconvulsive therapy is reserved for severe, refractory, or psychotic depression, and benzodiazepines do not treat depression.
Frequently asked questions
> What is the passing score for USMLE Step 2 CK?
The minimum passing score is 218 for exams taken on or after July 1, 2025; it was previously 214. Step 2 CK is reported as a three-digit score, unlike Step 1, which is pass/fail.
> How many questions are on USMLE Step 2 CK, and how long is it?
About 316 multiple-choice questions in one 9-hour day. From May 7, 2026, they are split into sixteen 30-minute blocks of up to 20 questions each, with 55 minutes of break time.
> Can I take Step 2 CK before Step 1?
Yes. If you meet the eligibility requirements, you can take Step 1 and Step 2 CK in any order. Both must be passed for ECFMG Certification, and both before you can take Step 3.
> Which subjects carry the most weight on Step 2 CK?
Medicine (55-65% of questions) is by far the largest, followed by pediatrics (17-27%), obstetrics & gynecology (10-20%), psychiatry (10-15%), and surgery (5-15%).
> How should I prepare for USMLE Step 2 CK?
Combine a structured review of medicine, pediatrics, obstetrics & gynecology, psychiatry, and surgery with timed practice on management-focused questions. Our Step 2 CK Qbank and Live Online USMLE course are built around the current exam format, and our Step 1 Qbank covers the basic sciences.
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