Exam Prep
Step 2 CK Prep and Checklist
Apr 9, 20265 min read
By Mike
By MikeDisclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content below is not medical or clinical advice and is intended for educational purposes and general guidance only.
New Block Format (effective May 7, 2026): The Step 2 CK exam now uses 16 blocks of up to 20 questions each, with 30 minutes per block. The previous format was 8 blocks of 40 questions at 60 minutes each. The total number of questions (316), total exam duration (9 hours), and content are unchanged. The updated testing software also includes improved keyboard navigation and an image contrast adjustment tool for clinical images.
Passing Score Increase (effective July 1, 2025): The passing score for Step 2 CK increased from 214 to 218.
What this means for your prep: Set your UWorld and practice blocks to 20 questions, 30 minutes, timed. The content and difficulty are identical. The change is structural, not conceptual. Plan your break strategy for 16 transitions instead of 8, and practice reaching focus quickly within each shorter block.
For the most current information, visit: USMLE Test Delivery Software Updates
While preparing for your shelf exams, make sure to complete UWorld and if possible, the associated Dorian Anki cards for that shelf. These topics and similar questions will repeatedly come up on the rotations and on the NBMEs and Step 1 & 2. On each rotation, try to read about the management of your patients (I usually used UpToDate or Pubmed), especially for "bread and butter" cases for the specialty (pancreatitis, DKA in your pediatrics rotations, CHF, COPD, cirrhosis, sepsis in your medicine rotation, gallbladder pathology, post-op complications, appendicitis, hernias, hemorrhoids on your surgery rotation).
Take 2-4 weeks for dedicated study if possible. Often a 3-4 week step 2 prep prior to your true dedicated period consisting of completing 2-4 blocks of 20 questions of UWorld daily will help you identify your weaknesses. I would recommend creating Anki cards based on your incorrect questions or unsuspending your incorrects from the Anking Deck.
The Step 2 CK exam contents can be found here: Step 2 CK Content Outline Specifications
The USMLE Sample test questions (New Free 120) can be found at the bottom of the page here, either as pdf or interactive testing mode: Step 2 CK Overview
During dedicated itself, you will want to complete this checklist prior to taking Step 2:
For each pathology you are routinely getting incorrect, try to consider the pathophysiology of the disorder and be able to describe a clinical vignette as if you were writing the question. Consider what the next step in management would be in the acute setting, what the management and maintenance/surveillance (medications, lifestyle modification, rehabilitation, preventative care including vaccination) would be in the chronic setting, and what risk factors for this pathology would entail.
When approaching questions, take into account what the question writer is trying to assess. Typically, I read and highlight the first sentence of the vignette and the last sentence, which is the clinical question you are being asked. I then will read the question with that in mind. I usually start with a differential diagnosis based on the chief complaint and history and work to narrow the diagnosis based on information given in the question (just like in real life).
Using Anki can be a good way to form a preliminary differential diagnosis based on certain "buzzwords" or exam findings. For example, if a patient has "tearing" chest pain, you will be more inclined to consider aortic pathology. However, using context is more important on Step 2/NBMEs, as the prompts will often only give a few symptoms, so you will be asked to determine what pathology this presentation is most consistent with.
Questions can be separated into three categories: diagnosis, next steps/management, and prevention/risk factors/healthcare maintenance. The NBME forms and UWorld practice exams are representative of the distribution of topics and question formats.
Lastly, confidence is important on these exams. It is important to know going into and during the exam that you are fully prepared. You can always theoretically "study more", but know that NBMEs and UWorld tend to be a very accurate predictor of the content that will show up on Step 2. If you complete the checklist from earlier, you will be well prepared for the exam.
If you are interested in predicting a score, predictmystepscore.com is a good resource.
Best of luck!
— Mike