USMLE Step 2 CK Medical Prep Exam Questions & Answers 2026 (21–30)

✓ Correct answer: D. PPI, discontinuation of NSAIDs, and triple therapy for H. pylori

This patient has a gastric ulcer with positive H. pylori testing and NSAID use as contributing factors. First-line therapy includes proton pump inhibitor, discontinuation of NSAIDs, and H. pylori eradication therapy (typically with clarithromycin, amoxicillin, and a PPI for 14 days).

✓ Correct answer: C. Crohn's disease

The presentation of patchy inflammation with deep ulcerations and cobblestoning involving the terminal ileum and ascending colon is classic for Crohn's disease. The skip lesions (patchy involvement) and transmural inflammation are distinguishing features of Crohn's disease as opposed to ulcerative colitis.

✓ Correct answer: B. None of the listed values indicate poor prognosis per Ranson's criteria

This patient has acute pancreatitis. Ranson's criteria are used to assess severity. Poor prognostic indicators at admission include age >55, WBC >16,000/mm³, glucose >200 mg/dL, LDH >350 IU/L, and AST >250 IU/L. While this patient has several concerning factors, none of the values meet the threshold for poor prognosis according to Ranson's criteria among the options provided.

✓ Correct answer: A. Antibiotics and urgent ERCP

This patient presents with Charcot's triad (RUQ pain, fever, and jaundice) suggestive of ascending cholangitis, a medical emergency. The most appropriate next step is ERCP to decompress the biliary system and remove the obstructing stone, after starting antibiotics and supportive care.

✓ Correct answer: D. Alcoholic cirrhosis with decompensation

This patient presents with classic findings of decompensated cirrhosis, including ascites (increasing abdominal girth, fluid wave), hepatic encephalopathy (confusion), and portal hypertension (edema). The physical exam findings of spider angiomata and palmar erythema are characteristic of chronic liver disease. Alcohol is a common cause of cirrhosis.

✓ Correct answer: C. Gluten-free diet

This patient has celiac disease, as evidenced by symptoms of chronic diarrhea and weight loss associated with wheat consumption, and positive celiac-specific antibodies. The initial management is a strict gluten-free diet, which is the cornerstone of treatment for celiac disease.

✓ Correct answer: B. Upper endoscopy with biopsy

This patient presents with progressive dysphagia (initially for solids, then liquids) and weight loss, which are concerning for esophageal cancer, especially given his risk factor of smoking. Upper endoscopy (EGD) is the most appropriate initial test as it allows direct visualization and biopsy of any suspicious lesions.

✓ Correct answer: A. Acute diverticulitis

The presentation of hematochezia and left lower quadrant pain in an elderly patient, along with CT findings of sigmoid colon wall thickening with surrounding inflammation, is most consistent with acute diverticulitis. Diverticular disease is common in older adults, and inflammation of diverticula (diverticulitis) can cause these symptoms and imaging findings.

✓ Correct answer: D. Lactulose and identification of precipitating factors

This patient is presenting with hepatic encephalopathy, as evidenced by altered mental status, asterixis, fetor hepaticus, and elevated ammonia in a patient with cirrhosis. Initial management includes lactulose, which reduces ammonia production and absorption in the gut, and identification and treatment of precipitating factors such as GI bleeding, infection, medications, or electrolyte abnormalities.

✓ Correct answer: C. Laparoscopic cholecystectomy

This patient has symptomatic cholelithiasis (gallstones) with biliary colic triggered by fatty meals. The most appropriate management is laparoscopic cholecystectomy, which is the definitive treatment for symptomatic gallstone disease to prevent recurrent attacks and complications such as cholecystitis, pancreatitis, or cholangitis.