Score 250+ on Step 2 CK · built for med students
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Get you to a 250 or plus on Step 2.

Active-recall flashcards, vignette-driven case quizzes, and high-yield notes — built around how the exam actually tests you.

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Study notes
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Case vignettes
92+
Algorithms
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Algorithm Library

Pick your battle.

92 interactive clinical decision trees, organized by specialty. Tap one to read the full flowchart with pearls.

Showing 92 of 92
EmergencyEasy

Acetaminophen Intoxication

Charcoal early; NAC if level above the Rumack–Matthew line.

4 decisionsOpen
EmergencyEasy

Anaphylaxis Diagnosis

IM epinephrine is the only life-saving intervention — give it now.

1 decisionOpen
EmergencyHard

Adult Cardiac Arrest (ACLS)

Shockable vs non-shockable → epinephrine cadence + reversible causes.

2 decisionsOpen
EmergencyHard

Suspected Aortic Dissection

Tearing pain, pulse deficit, BP differential — image with CTA or TEE.

2 decisionsOpen
NeurologyMedium

Initial Management of Stroke

Non-contrast CT to triage ischemic vs hemorrhagic.

3 decisionsOpen
EmergencyEasy

Management of Drowning

Rescue breaths come FIRST in drowning arrest. Observe asymptomatic patients ≥8 h.

2 decisionsOpen
Infectious DiseaseMedium

Rabies Postexposure Prophylaxis

Animal type and availability decide PEP.

3 decisionsOpen
CardiologyMedium

Initial Stabilization of STEMI

MONA-BASH plus PCI in 90 minutes (or thrombolytics in 120).

2 decisionsOpen
CardiologyMedium

Outpatient Chest Pain (Pretest Probability)

Pretest probability of CAD selects the testing strategy.

3 decisionsOpen
EmergencyMedium

Chest Pain in the Emergency Department

ECG + CXR + cardiac markers, with hemodynamics first.

3 decisionsOpen
CardiologyHard

Wide-Complex Tachycardia

AV dissociation/fusion = VT. Then ask stable vs unstable.

2 decisionsOpen
CardiologyMedium

Adult Tachycardia (ACLS)

Unstable = cardioversion. Stable narrow = adenosine/vagal. Stable wide = consider VT.

3 decisionsOpen
CardiologyEasy

Sinus Bradycardia

Atropine → pacing/chronotropes if unresponsive.

3 decisionsOpen
CardiologyMedium

Electrical Alternans → Pericardial Tamponade

Alternating QRS amplitude → think large pericardial effusion.

2 decisionsOpen
EmergencyMedium

Unstable Abdominal Aortic Aneurysm

Stable + AAA on CT vs unstable + bedside US → OR.

3 decisionsOpen
TraumaMedium

Blunt Chest Trauma

Unstable → resuscitate + eFAST + CT. Stable + high-risk → CT.

4 decisionsOpen
TraumaMedium

Blunt Abdominal Trauma

Unstable + free fluid = OR. Stable = CT.

5 decisionsOpen
TraumaMedium

Penetrating Abdominal Trauma

Most require laparotomy; some stable stab wounds can be observed.

3 decisionsOpen
MusculoskeletalMedium

Supracondylar Fracture Complications

Watch for median nerve and brachial artery injury.

2 decisionsOpen
PulmonaryMedium

Suspected Pulmonary Embolism (Initial Approach)

Stabilize, check anticoagulation contraindications, then risk-stratify.

6 decisionsOpen
PulmonaryEasy

Diagnostic Strategy in Suspected PE

Wells score → D-dimer or CTPA.

4 decisionsOpen
PulmonaryMedium

Hemoptysis Evaluation

Massive bleeding = airway, bleeding side down.

3 decisionsOpen
Infectious DiseaseMedium

Ventilator-Associated Pneumonia

Culture, empiric broad coverage, then narrow to results.

3 decisionsOpen
PulmonaryEasy

Lung Cancer Screening

Annual low-dose CT in heavy smokers age 50–80.

2 decisionsOpen
PediatricsMedium

Neonatal Cholestasis

Conjugated hyperbilirubinemia → US splits the workup.

2 decisionsOpen
PediatricsEasy

The Straining Infant

Red flags vs functional constipation vs infant dyschezia.

2 decisionsOpen
GastroenterologyEasy

Suspected Appendicitis

Imaging tailored to age and pregnancy.

2 decisionsOpen
OncologyMedium

Staging of Gastric Adenocarcinoma

CT first, then EUS + PET + laparoscopy for full staging.

3 decisionsOpen
GastroenterologyHard

Suspected Gastrinoma (Zollinger–Ellison)

Multiple ulcers + thick gastric folds → check gastrin off PPI.

4 decisionsOpen
GastroenterologyEasy

GERD Management

PPI trial vs endoscopy depending on alarm features.

4 decisionsOpen
GastroenterologyMedium

Elevated Alkaline Phosphatase

GGT distinguishes hepatobiliary from bone origin.

3 decisionsOpen
GastroenterologyMedium

Hyperbilirubinemia in Adults

Conjugated vs unconjugated, then enzyme pattern.

3 decisionsOpen
GastroenterologyEasy

Minimal Bright Red Blood Per Rectum

Age + red flags decide anoscopy vs colonoscopy.

2 decisionsOpen
GastroenterologyMedium

Dysphagia Evaluation

Oropharyngeal vs esophageal; mechanical vs motility.

3 decisionsOpen
GastroenterologyHard

Variceal Hemorrhage

Octreotide + abx + urgent endoscopic ligation.

2 decisionsOpen
GastroenterologyMedium

Cirrhosis Management

Surveillance for HCC and varices; treat each decompensation.

2 decisionsOpen
Infectious DiseaseMedium

HIV Odynophagia / Esophagitis

Empirical fluconazole for mild; endoscopy for severe.

2 decisionsOpen
Infectious DiseaseMedium

Vertebral Osteomyelitis

Suspect with fever + back pain + focal spinal tenderness.

3 decisionsOpen
HematologyMedium

Treatment of Deep Vein Thrombosis

Proximal DVT → anticoag; check for thrombolysis/IVC filter triggers.

3 decisionsOpen
HematologyMedium

Anemia Evaluation

MCV splits the workup; reticulocyte count clarifies normocytic anemia.

3 decisionsOpen
OncologyEasy

Cancer Pain Management (WHO Ladder)

WHO ladder: non-opioid → weak opioid → strong opioid.

2 decisionsOpen
EndocrineMedium

Hypercalcemia Workup

PTH splits PTH-dependent vs PTH-independent.

4 decisionsOpen
EndocrineMedium

Hypocalcemia Workup

Always check magnesium before chasing PTH.

3 decisionsOpen
EndocrineEasy

Thyroid Nodule Evaluation

TSH + ultrasound; iodine scan only if TSH is low.

3 decisionsOpen
EndocrineMedium

Hyperthyroidism Evaluation

TSH + free T3/T4 → RAIU pattern.

5 decisionsOpen
EndocrineHard

Water Deprivation Test

Distinguish primary polydipsia, central DI, nephrogenic DI.

3 decisionsOpen
EndocrineMedium

Suspected Polyuria

Confirm volume, then classify diuresis.

3 decisionsOpen
EndocrineEasy

Hypertriglyceridemia

Secondary causes → lifestyle; >500 → fibrate/fish oil.

2 decisionsOpen
RenalHard

Hyponatremia Evaluation

Serum osm → urine osm → volume status.

4 decisionsOpen
RenalEasy

Proteinuria Diagnosis

First-morning urine to confirm; orthostatic is benign.

3 decisionsOpen
PediatricsMedium

Hematuria in Children

Glomerular vs nonglomerular splits the workup.

2 decisionsOpen
NeurologyEasy

Unilateral Facial Weakness

Bell palsy vs red-flag mimics.

2 decisionsOpen
MusculoskeletalEasy

Carpal Tunnel Tests

Phalen + Tinel; diagnosis confirmed with nerve conduction.

2 decisionsOpen
DermatologyEasy

Visual Assessment of Melanoma

ABCDE, 7-point checklist, ugly duckling sign.

1 decisionOpen
OB/GYNHard

Primary Amenorrhea

Uterus presence + FSH/karyotype guide the workup.

5 decisionsOpen
OB/GYNMedium

Secondary Amenorrhea

β-hCG → prolactin/TSH/FSH/testosterone.

3 decisionsOpen
OB/GYNEasy

AUB / Secondary Amenorrhea — Age-Based

<45 vs ≥45 changes the workup tier.

3 decisionsOpen
OB/GYNMedium

Hydatidiform Mole Management

Suction curettage + β-hCG surveillance until undetectable.

3 decisionsOpen
OB/GYNMedium

Suspected Ectopic Pregnancy

TVUS + quantitative β-hCG drive decisions.

4 decisionsOpen
OB/GYNEasy

Gestational Diabetes 2-Step Screening

1-h 50 g, then 3-h 100 g if abnormal.

3 decisionsOpen
OB/GYNEasy

HSV in Pregnancy

Suppression at 36 weeks; C-section if active lesions in labor.

2 decisionsOpen
OB/GYNEasy

CIN 3 Management

Excisional treatment then surveillance.

2 decisionsOpen
OB/GYNHard

Postpartum Hemorrhage (Atony)

Step-wise: massage, TXA, uterotonics, balloon, surgery.

5 decisionsOpen
OB/GYNEasy

Migraines in Pregnancy

Step-wise: lifestyle → acetaminophen → antiemetics/butalbital → NSAIDs (2nd trimester) → opioids.

5 decisionsOpen
OB/GYNEasy

Menopause Treatment

Hormones if no contraindication; intact uterus needs progestin.

3 decisionsOpen
OB/GYNHard

Preterm Prelabor ROM

Gestational age + presence of infection guide management.

3 decisionsOpen
OB/GYNEasy

Endometriosis Management

NSAIDs + OCPs vs laparoscopy for definitive diagnosis.

2 decisionsOpen
OB/GYNMedium

Preterm Birth Prevention

Prior preterm vs cervical length.

3 decisionsOpen
OB/GYNEasy

Normal Postpartum Lochia

Three stages: rubra → serosa → alba.

1 decisionOpen
BreastEasy

Palpable Breast Mass

Age decides imaging modality.

2 decisionsOpen
BreastEasy

Breast Pain Management

Cyclic/bilateral usually benign; noncyclic/focal warrants imaging.

4 decisionsOpen
BreastEasy

Nipple Discharge

Bloody/serous = pathologic. Milky = endocrine workup.

3 decisionsOpen
BreastEasy

Breast Discharge Evaluation

Bilateral vs unilateral; age-based imaging for unilateral.

1 decisionOpen
BreastEasy

Breast Cyst Management

Simple cyst: observe if asymptomatic. Complex: biopsy.

2 decisionsOpen
PediatricsEasy

Acute Pharyngitis in Children

Viral features → supportive. Otherwise rapid strep.

3 decisionsOpen
Infectious DiseaseEasy

Pharyngitis in Adults (Centor)

Centor criteria: 0–1 none, 2–3 RADT, 4 empiric.

2 decisionsOpen
PediatricsEasy

Food Protein-Induced Allergic Proctocolitis (FPIAP)

Eliminate triggers, reintroduce around 1 year.

2 decisionsOpen
PediatricsMedium

Suspected Foreign Body Ingestion

X-rays first; endoscopy for high-risk objects.

3 decisionsOpen
PediatricsMedium

Ingestion of Multiple Magnets

Multiple magnets = surgical emergency risk.

2 decisionsOpen
PediatricsHard

Bilious Emesis in the Neonate

Always abnormal — rule out malrotation with volvulus.

4 decisionsOpen
CardiologyMedium

Stable Narrow-Complex Tachycardia

Vagal → adenosine → rate control.

3 decisionsOpen
EndocrineHard

Thyroid Storm

Block synthesis, release, and conversion all at once.

1 decisionOpen
EndocrineHard

Diabetic Ketoacidosis

Fluids → insulin → potassium replacement.

3 decisionsOpen
EmergencyMedium

Hypertensive Emergency

Lower MAP by 10–25% in first hour; choice depends on end-organ.

2 decisionsOpen
RenalMedium

Acute Kidney Injury

Pre-renal vs intrinsic vs post-renal; FENa and UA help.

3 decisionsOpen
EmergencyMedium

Sepsis / Septic Shock

Hour-1 bundle: lactate, cultures, abx, fluids, vasopressors.

2 decisionsOpen
NeurologyHard

Intracranial Hemorrhage Management

Reverse anticoagulation + BP control + ICP management.

2 decisionsOpen
GastroenterologyMedium

Ascites Evaluation

SAAG splits portal hypertension from non-portal causes.

4 decisionsOpen
MusculoskeletalEasy

Acute Low Back Pain

Red flags decide imaging; otherwise conservative.

1 decisionOpen
PulmonaryMedium

Acute Asthma Exacerbation

SABA + ICS/oral steroids + adjuncts by severity.

1 decisionOpen
EmergencyMedium

Alcohol Withdrawal

Benzodiazepines first-line; CIWA-guided.

2 decisionsOpen
OB/GYNMedium

Infertility — couple's workup

When to start the workup, what to order first, then branch by cause: anovulation, tubal, male factor, or unexplained.

7 decisionsOpen
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