I will say, the Pretest questions were EXCELLENT for clerkships.
The clinical nuances and subtleties were all tested and my preceptors all asked me concepts of management there.
The thing is, Pretest is not for Step 2 preparation because the USMLE tests broader concepts of pathophysiology and management.
Be warned: attempting these qusetions will be very frustrating.
The only way you could possibly know these things is if you were a diligent TEXTBOOK reader. (because the questions and answers cite textbooks)
But reading TEXTBOOKS is not conducive to good USMLE scores.
Moreover, there are so MANY TEXTBOOKS, that it is not possible for any medical student to get 100% on all the Pretest questions
Logically, a student should just do and learn from Pretest to be a better doctor long term.