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USMLE Step 2 CK High-Yield Screening & Vaccinations Topics
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Screening and Vaccinations
High Yield USMLE Step 2 CK Notes
Welcome to the Screening and Vaccinations High-Yield Notes for Step 2 CK.
These are the most commonly tested topics on the exam—ideal for quick review in your last 2 weeks before the exam, when you’re short on time, or when you’re just starting out and want to focus on what is high yield. Created and peer-reviewed by physicians who scored 260+ on Step 2 CK in a Q&A style to reinforce active learning.
How to use this file
- Read the question ➔ cover the answer ➔ self-quiz before revealing.
- Review the NOTES ➔ they include high-yield details you don’t want to miss.
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Table of Contents
Screening
1. A 47-year-old man with no significant medical history presents for a routine health check. He has no family history of colon cancer and no symptoms. What is the next step in management?
➔ Colonoscopy (Average-risk individual ≥45 years → Start colon cancer screening → with Colonoscopy every 10 years)
- Note: Continue colonoscopy screening until age 75
2. A 38-year-old man presents for a routine exam. His father was diagnosed with colon cancer at age 48. He is asymptomatic. What is the next step in management?
➔ Colonoscopy (First-degree relative with CRC → Start screening at age 40 or 10 years before relative’s diagnosis → whichever comes first)
- Note: Repeat every 5 years
- If first-degree relative diagnosed at >60 years → screen every 10 years
- Also applies if the first-degree relative had a high-risk adenomatous polyp:
○ ≥10 mm
○ High-grade dysplasia
○ Villous features
3. A 35-year-old man with a 9-year history of ulcerative colitis presents for follow-up. He has no current symptoms. What is the next step in management?
➔ Colonoscopy (Ulcerative colitis for >8-10 years → Start colon cancer screening)
- Note: Repeat colonoscopy every 1–3 years
4. A 12-year-old boy with a family history of familial adenomatous polyposis (FAP) presents for evaluation. He is asymptomatic. What is the next step in management?
➔ Colonoscopy (Familial adenomatous polyposis → Start screening at age 10–12 with annual colonoscopy)
- Note: FAP = 100% risk of colorectal cancer if untreated
- Definitive treatment is prophylactic colectomy
5. A 58-year-old man underwent colonoscopy, which revealed one small (<1 cm) tubular adenoma. When should his next colonoscopy be scheduled?
➔ In 5 to 10 years (The patient has low-risk adenomas (1–2 tubular adenomas <10 mm) → repeat colonoscopy in 5–10 years)
- Note: High-risk adenomas (≥3 adenomas, size ≥10 mm, villous histology, high-grade dysplasia) → repeat in 3 years
- Sessile serrated polyps with dysplasia or ≥10 mm → also repeat in 3 years
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6. A 48-year-old man with no symptoms or known risk factors presents for a routine check-up. Colonoscopy was normal 2 years ago. What is the next best step in management?
➔ Screen for diabetes (All adults ≥35 should undergo diabetes screening)
- Note: Also screen <35 if BMI ≥25 + ≥1 risk factor (see the following question)
- Repeat screening every 3 years if normal
7. A 30-year-old woman with a BMI of 32 and a history of gestational diabetes presents for a routine visit. She is asymptomatic. What is the next step in management?
➔ Screen for diabetes (Age <35 + risk factors → Requires diabetes screening)
- Note: Screen <35 if BMI ≥25 + ≥1 risk factor:
○ First-degree relative with diabetes
○ History of gestational diabetes
○ Hypertension, dyslipidemia
○ African American, Hispanic, Native American
8. A 10-year-old boy presents for a routine checkup. He has no significant past medical history, and his BMI is in the 60th percentile. What screening test should be offered at this visit?
➔ Lipid panel (universal lipid screening)
- Note: Universal lipid screening is recommended once between the ages of 9–11 and again between the ages of 17–21
9. A 38-year-old asymptomatic man with no known medical conditions presents for a routine checkup. What is the appropriate recommendation for lipid screening in this patient?
➔ Fasting or nonfasting serum lipid panel (Begin routine screening for men ≥35 and women ≥40–45)
- Note: Interval: Every 4–6 years if normal and no increased risk
- Screening may be indicated earlier if high-risk factors are present:
○ Family history of premature coronary artery disease
○ Known familial hyperlipidemia
○ Other ASCVD risk factors (eg, diabetes, hypertension, smoking)
10. A 67-year-old man with a 30-pack-year smoking history presents for a routine visit. He is asymptomatic. What is the next step in management?
➔ Abdominal ultrasound (Male age 65–75 with smoking history → Screen once for Abdominal aortic aneurysm)
- Note: One-time screening with abdominal ultrasound
11. A 60-year-old man with a 25-pack-year smoking history who quit 10 years ago presents for a routine visit. He is asymptomatic. What is the next step in management?
➔ Low-dose CT chest (Age 50–80 with ≥20 pack-year who quit <15 years ago → Screen for lung cancer)
- Note: Annual screening with low-dose CT chest
12. A 67-year-old woman with a 30-pack-year smoking history who quit 17 years ago presents for a routine visit. She is asymptomatic. What is the next step in management?
➔ No screening (Quit ≥15 years ago → No lung cancer screening indicated)
- Note: Screening is not recommended if:
○ Quit ≥15 years ago
○ Severe comorbidities limiting life expectancy
13. A 24-year-old woman presents after being diagnosed with chlamydia. She is sexually active and has no additional symptoms. What additional screening is recommended at this visit?
➔ HIV, syphilis, gonorrhea, and hepatitis B testing
- Note: All patients diagnosed with an STI should be screened for HIV, syphilis, gonorrhea, chlamydia, and hepatitis B, even if asymptomatic
- Additional tests:
○ Trichomonas vaginalis screening → only in women
○ Herpes simplex virus screening → only when history of characteristic lesions
○ Any sexually active young female should be screened for → chlamydia and gonorrhea
14. A newly diagnosed HIV-positive 32-year-old man presents for initial evaluation. What infectious disease screenings should be performed?
➔ Screen for coinfections common in HIV patients (STIs, hepatitis, TB)
- Note: HIV Coinfection Screening includes screening for:
○ Sexually transmitted infections: Syphilis, Gonorrhea & Chlamydia
○ Hepatitis viruses: Hep A, B, C
○ Latent tuberculosis
15. A 23-year-old woman presents for a routine well-woman exam. She is sexually active and has no medical conditions. What is the most appropriate next step in management?
➔ Cervical cytology (Pap test) alone every 3 years
- Note: In average risk individuals:
○ Start Pap smear alone at age 21, regardless of sexual activity
○ No HPV cotesting if age <30
16. A 33-year-old woman presents for cervical cancer screening. She has no symptoms and no significant medical history. What is the most appropriate screening method?
➔ Pap test with HPV cotesting every 5 years (If age between 30–65 → Do HPV cotesting)
- Note: If the age is between 30–65 → either of the following is acceptable:
○ Pap + HPV testing every 5 years (preferred)
○ Pap alone every 3 years - Continue until age 65, if prior screens were adequate
17. A 19-year-old woman recently diagnosed with HIV presents for initial evaluation. She is sexually active. When should she begin cervical cancer screening?
➔ Now, with cervical cytology (Pap test) (In HIV patients → HPV screening (via Pap test) begins at onset of sexual activity or at HIV diagnosis, whichever is earlier)
- Note: Screen annually until ≥3 normal results, then routine testing
18. A 17-year-old girl with systemic lupus erythematosus (SLE) on chronic immunosuppressive therapy presents for a routine checkup. She is sexually active. When should she begin cervical cancer screening?
➔ Now, with annual Pap test and HPV co-testing (Immunosuppressed patients begin screening at onset of sexual activity, regardless of age)
- Note: Use Pap + HPV cotesting annually
19. A 28-year-old woman presents for a routine annual checkup. She is not currently pregnant and has no complaints. Vitals and exams are normal. What important screening should be performed during today’s visit?
➔ Intimate partner violence screening (Recommended for all women of childbearing age during routine visits)
20. A 28-year-old woman presents for her first prenatal visit. She is monogamous, has no STI history, and no high-risk behaviors. What infections should she be routinely screened for during pregnancy?
➔ HIV, syphilis, hepatitis B, and asymptomatic bacteriuria (Done for all pregnant women, regardless of risk at initial prenatal visit)
- Note: Screen for asymptomatic bacteriuria with → urine culture
- No repeat screening needed unless a new risk arises
21. A 22-year-old woman at her first prenatal visit reports a history of gonorrhea and multiple sexual partners. What STI tests should be performed?
➔ HIV, syphilis, hepatitis B, gonorrhea, and chlamydia now and again in the third trimester (Done for high-risk pregnancy)
- Note: High-risk pregnancy: age <25, prior STI, multiple partners, or sex work
22. A full-term newborn is born via vaginal delivery without complications. Apgar scores are 8 and 9 at 1 and 5 minutes. What screening tests should be performed before discharge?
➔ Newborn metabolic/genetic screen, hyperbilirubinemia, hearing screen, pre- & post-ductal pulse oximetry, hypoglycemia (if at risk)
- Note: Screen for hypoglycemia only in at-risk infants:
○ Small for gestational age
○ Large for gestational age
○ Infant of a diabetic mother, preterm
23. A 2-year-old boy presents for a routine well-child visit. What routine screening should be performed at this age, related to neurodevelopment?
➔ Autism screening (Done at 18 months and 24 months)
- Note: Early detection → early intervention = improved outcomes
24. A 16-year-old girl comes for a routine checkup. She is healthy, and her immunizations are up to date. What routine screenings should be performed at this visit?
➔ Confidential sexual health discussion, HIV testing, and gonorrhea/chlamydia testing if sexually active (This is routine adolescent sexual health screening)
- Note: Add gonorrhea & chlamydia screen only if sexually active, regardless of symptoms
- Part of the annual routine adolescent screening, which also includes:
○ Mental health screening
○ Substance use screening
○ Safety/violence risk screening
25. A 15-year-old boy comes for an annual well-child visit. He has no complaints. What routine screening should be performed regarding substance use?
➔ Confidential discussion about exposure, use, and abuse of substances (Routine adolescent substance use screening)
26. A 15-year-old boy presents for an annual well visit. He is healthy and has no medical concerns. What routine safety and violence-related screenings should be performed during this visit?
➔ Inquiry about bullying, seatbelt use, and helmet use (routine adolescent safety/violence screening)
27. A 14-year-old boy comes to the clinic for a routine health maintenance exam. He is up to date on immunizations and has no complaints. What routine mental health screening should be performed at this visit?
➔ Screening for depression and mental health concerns (routine adolescent mental health screening)
- Note: Begin annual depression screening at age ≥12.
28. A 50-year-old woman with no significant medical history presents for a routine checkup. She has no breast complaints. What is the recommended breast cancer screening strategy for this patient?
➔ Mammography every two years starting at age 40 until age 74 (Done for all women with average risk)
- Note: Consider earlier screening for high-risk patients (eg, BRCA mutation, strong family history)
29. A 32-year-old woman comes for a routine checkup. Her mother was diagnosed with ovarian cancer at age 50, and her maternal aunt had breast cancer at age 45. She is asymptomatic and has no prior surgeries. What is the next best step in management?
➔ Genetic counseling for BRCA mutation screening (Indicated for women with a family history of breast or ovarian cancer, especially at a young age)
- Note: Helps guide prophylactic options.
30. A 66-year-old postmenopausal woman with no medical problems presents for an annual wellness visit. She is physically active and has no history of fractures. What screening test is recommended at this visit?
➔ DEXA scan for bone mineral density (Women ≥65 undergo routine BMD screening → repeat every 10 to 15 years if normal)
- Note: If woman <65 → Screen only if high risk (eg, low body weight, smoking, family history, chronic steroid use)
- Men → Not routinely screened unless signs of osteoporosis (eg, fractures, risk factors like steroids)
31. A 60-year-old man presents for a routine visit and asks to be screened for prostate cancer. He has no urinary symptoms and no family history of prostate cancer. What is the next best step in management?
➔ Discuss the risks and benefits of PSA screening (shared decision-making)
- Note: Men aged 55–69: Offer shared decision-making (not automatic screening
32. A 67-year-old woman with no known chronic conditions reports gradually worsening difficulty understanding speech, especially in noisy environments. What is the next step?
➔ Screen hearing with audiometry (Patients with language or communication difficulties → Evaluate with formal audiometry)
33. A 52-year-old man with no significant medical history presents for a routine checkup. He has never been tested for hepatitis C. What is the most appropriate next step in management?
➔ Screen for HCV (All adults age 18–79 should be screened once for hepatitis C, regardless of risk factors)
- Note: Repeat screening if ongoing risk (e.g., IV drug use)
34. A 46-year-old man on chronic hemodialysis for ESRD has received multiple blood transfusions. What viral infection should he be screened for?
➔ Screen for hepatitis B (Patients on dialysis or with frequent transfusions → screen for HBV)
- Note: Dialysis patients should also receive HBV vaccination
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Vaccinations
35. A 40-year-old man presents for evaluation after a superficial cut on his hand from a clean kitchen knife. He has no chronic illnesses but is unsure of his tetanus vaccination history. What is the next step?
➔ Tetanus toxoid-containing vaccine only (If clean wound & history <3 doses or unknown → give Td/Tdap only)
| Wound Type | <3 Doses / Unknown History | ≥3 Doses |
|---|---|---|
| Clean, minor wound | Td/Tdap only | Td/Tdap if ≥10 years since last dose |
| Dirty / severe wound | Td/Tdap + TIG | Td/Tdap if ≥5 years since last dose |
- Note: TIG = Tetanus Immune Globulin
- Tdap is given once in adulthood, then Td boosters every 10 years
- Always perform wound cleaning and debridement as needed
36. A 35-year-old man presents to the emergency department after stepping on a rusty nail. The wound is deep and contaminated. He is unsure of his tetanus vaccination history. What is the next step?
➔ Tetanus toxoid-containing vaccine + tetanus immune globulin (If wound is severe & immunization history is uncertain or <3 doses → give both vaccine & TIG)
37. A 50-year-old man presents for a routine checkup. He reports that he has not received any vaccines since childhood and is unsure of his immunization history. What tetanus-containing vaccine should he receive now?
➔ Tdap (Every adult should receive Tdap once and have a Td every 10 years.)
38. A 30-year-old woman, G2P1, presents for prenatal care. Routine labs reveal chronic hepatitis C infection. Serologic testing shows she is not immune to hepatitis A or B. What is the next step in management?
➔ Administer hepatitis A and B vaccines (Chronic HCV → ↑ risk of fulminant hepatitis with HAV or HBV co-infection)
39 A 22-year-old woman presents after exposure to a roommate diagnosed with chickenpox 2 days ago. She is healthy, non-pregnant, and has no prior history of varicella infection or vaccination. What is the next step?
➔ Administer the varicella vaccine (Immunocompetent + no prior infection or vaccination give → Varicella vaccine within 5 days of exposure)
- Note: PEP for Immunocompetent patients give → Varicella vaccine.
- PEP Immunocompromised, pregnant, or infants <1 year give → VZIG (live vaccine contraindicated).
- If already immune (history of 2 doses or prior infection), no action is required.
- A mild maculopapular or vesicular rash (≤5 lesions) may occur after varicella within 2 weeks
40. A 28-year-old unvaccinated woman is exposed to a child with varicella. She is 10 weeks pregnant and has no history of chickenpox or vaccination. What is the post-exposure prophylaxis?
➔ Varicella-zoster immune globulin (VZIG) (pregnant patient + no no prior infection or vaccination → Give VZIG within 10 days of exposure)
41. A newborn is delivered to a mother who developed a vesicular rash and fever 2 days before delivery. Examination of the infant is normal. What is the next step?
➔ Administer varicella-zoster immune globulin (VZIG) (Neonates are at highest risk if maternal varicella occurs 5 days before to 2 days after delivery)
- Note: No VZIG needed if maternal varicella >5 days before or >2 days after delivery
- If rash appears in an infant → treat with IV acyclovir
42. A 13-year-old girl presents for a routine check-up and has not received the HPV vaccine. What is the next step in management?
➔ Administer the HPV vaccine (Indicated for all girls & boys age 11–26 if not vaccinated)
- Note: Doses:
○ <15 yrs → 2 doses (0, 6–12 months)
○ ≥15 yrs / immunocompromised → 3 doses (0, 1–2, 6 months) - Safe in → Immunocompromised (e.g., HIV)
- Not given during → Pregnancy
43. A 50-year-old man with chronic liver disease presents for routine care. He has never received a pneumococcal vaccine. What is the most appropriate vaccination strategy?
➔ Give PPSV23 now
- Note: Age 19:64 yrs with chronic conditions (eg, liver, heart, lung disease; diabetes; smoking): → PPSV23 alone (preferred)
- If Age 19:64 with → very high risk (Immunocompromised, CSF leak, cochlear implant, asplenia, chronic kidney disease):→ Prefer PCV15 → PPSV23 ≥8 weeks later
44. A 68-year-old woman with no significant medical history presents for routine care. She has never received any pneumococcal vaccines. What is the next step?
➔ Give PCV15 now, followed by PPSV23 in ≥1 year
- Note: Age ≥65, no prior pneumococcal vaccine:
→ Option 1: PCV20 alone
→ Option 2: PCV15 now → PPSV23 ≥1 year later
45. A 2-month-old infant presents for a routine well-child visit. The mother reports the infant was hospitalized at birth for treatment of intussusception. What vaccine should be avoided during today’s visit?
➔ Rotavirus (Contraindicated in patients with a history of intussusception and severe combined immunodeficiency)
- Note: 1st dose: Given between 6–14 weeks (latest by 14 weeks + 6 days).
- The series must be completed by 8 months of age.
- Contraindicated if starting after 15 weeks → Can lead to intussusception.
46. A healthy 11-year-old boy presents for a routine well-child visit. He is up to date on all previous childhood vaccinations. What vaccine should be administered at this visit to protect against bacterial meningitis?
➔ Meningococcal conjugate vaccine (Primary dose is given at Age 11–12 years)
- Note: Booster dose: Age 16 years
- This indicates the routine schedule; you also need to vaccinate patients who are > 2 months of age if they are a high-risk group → see the following Q
47. A 6-month-old infant with congenital asplenia is brought for a routine well-baby visit. He is up to date on all standard immunizations. What additional vaccine should he receive due to his underlying condition?
➔ Meningococcal vaccination (quadrivalent conjugate) ( High-risk patients should receive meningococcal vaccination starting at age ≥2 months)
- Note: These groups include:
○ Asplenia, terminal complement deficiency (C5-C9)
○ HIV infection, travel to endemic areas
○ College students in residential housing, military recruits
48. A 30-year-old woman is 34 weeks pregnant and presents for a routine prenatal visit. She has no significant past medical history. Which vaccines should she receive during this pregnancy?
➔ Tdap, inactivated influenza, and RSV vaccine
- Note: Routinely recommended vaccines during pregnancy:
○ Tdap → in the third trimester
○ Inactivated influenza vaccine → in any trimester
○ Rho(D) immunoglobulin → Given at ~28 weeks to Rh-negative mothers (not a vaccine, but often grouped here)
49. A 25-year-old pregnant woman at 20 weeks of gestation recently immigrated and has chronic hepatitis B infection. What additional vaccines may be indicated during her pregnancy?
➔ Hepatitis A (recommended for those at risk of infection, such as chronic liver disease or exposure risk.)
- Note: Vaccines that can be given to a high risk pregnant patient include:
○ Hepatitis B, Hepatitis A
○ Pneumococcal, H. influenzae type b (Hib), Meningococcal
○ Varicella-zoster immunoglobulin (VZIG)
50. A 28-year-old woman presents for preconception counseling. She is unsure about her vaccine history. Which vaccines are contraindicated if she becomes pregnant?
➔ HPV, MMR, live attenuated influenza vaccine, and varicella
- Note: Contraindicated vaccines during pregnancy:
○ HPV vaccine → Not recommended during pregnancy
○ MMR, Varicella → Live virus — contraindicated
○ Live attenuated intranasal influenza vaccine → Use inactivated version instead
51. A 32-year-old man with newly diagnosed type 2 diabetes presents for routine care. He has no known history of hepatitis B vaccination. What is the next best step?
➔ Administer the hepatitis B vaccine series
- Note: Adults at increased risk (diabetes, men who have sex with men [MSM], injection drug users [IVDU], healthcare workers) should receive → the hepatitis B vaccine.
52. A 24-year-old medical student accidentally splashes blood into his eye. The source patient is later found to have active hepatitis B infection. The student reports no prior hepatitis B vaccinations. What is the most appropriate next step in management?
➔ Administer both the hepatitis B vaccine and the hepatitis B immune globulin
- Note: Hepatitis B Exposure – Post-Exposure Prophylaxis (PEP):
○ Indication: Mucous membrane or percutaneous exposure to blood from a patient with active HBV (positive HBsAg).
○ Unvaccinated individuals → Give HBV vaccine + HBIG immediately
53. A 34-year-old hiker is bitten by a raccoon while camping. The animal ran away and is unavailable for testing. What is the next step?
➔ Rabies vaccine + Rabies immune globulin (Rabies post-exposure prophylaxis is indicated if a high-risk animal is unavailable for testing)
- Note: High-risk wild animals: Bats, raccoons, foxes, skunks
- If an animal is available → Euthanize and test the brain for rabies
○ If negative → No PEP needed
○ If positive or inconclusive → Start PEP - If unavailable → Start PEP immediately
54. A 25-year-old man presents after being bitten on the hand by a healthy rabbit at a petting zoo. He has no significant past medical history and is unsure if the skin was broken. What is the next best step in management?
➔ Reassure and provide wound care only No rabies PEP needed (Rabies PEP is not indicated for low-risk animals such as rabbits, squirrels, or rodents)
- Note: Focus on wound cleaning, tetanus update
55. A 6-month-old infant had a brief generalized seizure one day after receiving the second dose of the DTaP vaccine. The child quickly returned to baseline a. What is the next step regarding the scheduled DTaP dose?
➔ Administer the DTaP vaccine as scheduled (Uncomplicated seizure (brief, no encephalopathy) after vaccination is not a contraindication to further DTaP doses)
- Note: True contraindications to pertussis-containing vaccines:
○ Anaphylaxis
○ Encephalopathy
○ Uncontrolled epilepsy or progressive neurologic disorder (postpone until stable)
56. A 2-year-old boy presents for routine vaccination. He has nasal congestion, mild cough, and a low-grade fever. He is active and feeding well. Should he receive his vaccines today?
➔ Yes, give the vaccine (Vaccines are safe with mild illness)
- Note: Postpone only if → Moderate/severe illness (eg, high fever, systemic symptoms)
57. A 45-year-old man with diabetes presents for routine care in September. What immunization is recommended at this time of year?
➔ Influenza vaccine (Recommended annually for all individuals ≥6 months)
- Note: Best given before influenza season (fall/winter)
58. A 6-year-old boy with a history of urticaria and wheezing after eating eggs is brought in for his annual flu shot. What is the next step?
➔ Administer inactivated influenza vaccine as scheduled (NOT a contraindication, even with severe egg allergy)
- Note: The true contraindication is → anaphylaxis to prior influenza vaccine or a non-egg component (e.g., gelatin, antibiotics)
59. A 50-year-old woman with no significant past medical history presents for routine care. She has never had shingles. What vaccine should she receive?
➔ Administer recombinant zoster vaccine (Indicated for all adults ≥50)
- Note: Also given to immunocompromised adults ≥19
60. A healthy newborn is delivered vaginally to an HBsAg-negative mother. What is the next step regarding hepatitis B vaccination?
➔ Give hepatitis B vaccine within 24 hours
- Note: Universal: All newborns get 1st dose within 24 hrs
- Then → 2nd dose at 1–2 months, 3rd dose at 6–18 months
61. A newborn is born to a mother who is HBsAg positive. What is the next step?
➔ Administer hepatitis B vaccine + HBIG within 12 hours
62. A 17-month-old is brought for routine care. He has received all vaccines except MMR and varicella. What is the next step?
➔ Give MMR and varicella now
- Note: First doses of MMR/varicella given at age 12–15 months
- Second doses at 4–6 years
63. A 3-year-old child with asplenia is up to date on routine vaccines. What additional vaccines are recommended?
➔ Meningococcal, PPSV23, Hib booster (if not already given)
- Note: Asplenia = high risk → early meningococcal & pneumococcal vaccination
🏁 Final Thoughts
You made it to the end—well done! These high-yield notes are designed to save you time and keep you focused on what actually matters for Step 2 CK. Review these vignettes regularly—steady practice beats cramming.
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Disclaimer
Version 1.0 August 2025. No part of this document may be reproduced or distributed without written permission. For personal study only. Medical information herein is for educational purposes and does not constitute clinical advice. Always confirm with current guidelines and your institution’s policies.
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