USMLE STEP 2 EVALUATION EXAM 2026 QUESTIONS
AND ANSWERS GRADED A+
✔✔Polymyalgia rheumatica - ✔✔An elderly female presents with pain and stiffness of
the shoulders and hips; she cannot lift her arms above her head. Labs show anemia
and ↑ ESR.
✔✔Osgood-Schlatter disease - ✔✔An active 13-year-old boy has anterior knee pain.
Diagnosis?
✔✔Distal radius (Colles' fracture) - ✔✔Bone is fractured in fall on outstretched hand.
✔✔Avascular necrosis - ✔✔Complication of scaphoid fracture.
✔✔Wrist drop, loss of thumb abduction - ✔✔Signs suggesting radial nerve damage with
humeral fracture.
✔✔Duchenne muscular dystrophy - ✔✔A young child presents with proximal muscle
weakness, waddling gait, and pronounced calf muscles.
✔✔Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain
abduction - ✔✔A first-born female who was born in breech position is found to have
asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
✔✔Slipped capital femoral epiphyses. AP and frog-leg lateral view - ✔✔An 11-year-old
obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
✔✔Multiple myeloma - ✔✔The most common 1° malignant tumor of bone.
✔✔Cluster headache - ✔✔Unilateral, severe periorbital headache with tearing and
conjunctival erythema.
✔✔β-blockers, Ca2+ channel blockers, TCAs - ✔✔Prophylactic treatment for migraine.
✔✔Prolactinoma. Dopamine agonists (e.g., bromocriptine) - ✔✔The most common
pituitary tumor. Treatment?
✔✔Broca's aphasia. Frontal lobe, left MCA distribution - ✔✔A 55-year-old patient
presents with acute "broken speech." What type of aphasia? What lobe and vascular
distribution?
✔✔Trauma; the second most common is berry aneurysm - ✔✔The most common cause
of SAH.
, ✔✔Subdural hematoma—bridging veins torn - ✔✔A crescent-shaped hyperdensity on
CT that does not cross the midline.
✔✔Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation - ✔✔A
history significant for initial altered mental status with an intervening lucid interval.
Diagnosis? Most likely etiology? Treatment?
✔✔Elevated ICP, RBCs, xanthochromia - ✔✔CSF findings with SAH.
✔✔Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count) -
✔✔Albuminocytologic dissociation.
✔✔Normal - ✔✔Cold water is flushed into a patient's ear, and the fast phase of the
nystagmus is toward the opposite side. Normal or pathological?
✔✔Lung, breast, skin (melanoma), kidney, GI tract - ✔✔The most common 1° sources
of metastases to the brain.
✔✔Absence seizures - ✔✔May be seen in children who are accused of inattention in
class and confused with ADHD.
✔✔Headache - ✔✔The most frequent presentation of intracranial neoplasm.
✔✔Infection, febrile seizures, trauma, idiopathic - ✔✔The most common cause of
seizures in children (2-10 years).
✔✔Trauma, alcohol withdrawal, brain tumor - ✔✔The most common cause of seizures
in young adults (18-35 years).
✔✔IV benzodiazepine - ✔✔First-line medication for status epilepticus.
✔✔Wernicke's encephalopathy due to a deficiency of thiamine - ✔✔Confusion,
confabulation, ophthalmoplegia, ataxia.
✔✔Seventy percent if the stenosis is symptomatic - ✔✔What % lesion is an indication
for carotid endarterectomy?
✔✔Alzheimer's and multi-infarct - ✔✔The most common causes of dementia.
✔✔ALS - ✔✔Combined UMN and LMN disorder.
✔✔Parkinson's disease - ✔✔Rigidity and stiffness with resting tremor and masked
facies.
AND ANSWERS GRADED A+
✔✔Polymyalgia rheumatica - ✔✔An elderly female presents with pain and stiffness of
the shoulders and hips; she cannot lift her arms above her head. Labs show anemia
and ↑ ESR.
✔✔Osgood-Schlatter disease - ✔✔An active 13-year-old boy has anterior knee pain.
Diagnosis?
✔✔Distal radius (Colles' fracture) - ✔✔Bone is fractured in fall on outstretched hand.
✔✔Avascular necrosis - ✔✔Complication of scaphoid fracture.
✔✔Wrist drop, loss of thumb abduction - ✔✔Signs suggesting radial nerve damage with
humeral fracture.
✔✔Duchenne muscular dystrophy - ✔✔A young child presents with proximal muscle
weakness, waddling gait, and pronounced calf muscles.
✔✔Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain
abduction - ✔✔A first-born female who was born in breech position is found to have
asymmetric skin folds on her newborn exam. Diagnosis? Treatment?
✔✔Slipped capital femoral epiphyses. AP and frog-leg lateral view - ✔✔An 11-year-old
obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?
✔✔Multiple myeloma - ✔✔The most common 1° malignant tumor of bone.
✔✔Cluster headache - ✔✔Unilateral, severe periorbital headache with tearing and
conjunctival erythema.
✔✔β-blockers, Ca2+ channel blockers, TCAs - ✔✔Prophylactic treatment for migraine.
✔✔Prolactinoma. Dopamine agonists (e.g., bromocriptine) - ✔✔The most common
pituitary tumor. Treatment?
✔✔Broca's aphasia. Frontal lobe, left MCA distribution - ✔✔A 55-year-old patient
presents with acute "broken speech." What type of aphasia? What lobe and vascular
distribution?
✔✔Trauma; the second most common is berry aneurysm - ✔✔The most common cause
of SAH.
, ✔✔Subdural hematoma—bridging veins torn - ✔✔A crescent-shaped hyperdensity on
CT that does not cross the midline.
✔✔Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation - ✔✔A
history significant for initial altered mental status with an intervening lucid interval.
Diagnosis? Most likely etiology? Treatment?
✔✔Elevated ICP, RBCs, xanthochromia - ✔✔CSF findings with SAH.
✔✔Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count) -
✔✔Albuminocytologic dissociation.
✔✔Normal - ✔✔Cold water is flushed into a patient's ear, and the fast phase of the
nystagmus is toward the opposite side. Normal or pathological?
✔✔Lung, breast, skin (melanoma), kidney, GI tract - ✔✔The most common 1° sources
of metastases to the brain.
✔✔Absence seizures - ✔✔May be seen in children who are accused of inattention in
class and confused with ADHD.
✔✔Headache - ✔✔The most frequent presentation of intracranial neoplasm.
✔✔Infection, febrile seizures, trauma, idiopathic - ✔✔The most common cause of
seizures in children (2-10 years).
✔✔Trauma, alcohol withdrawal, brain tumor - ✔✔The most common cause of seizures
in young adults (18-35 years).
✔✔IV benzodiazepine - ✔✔First-line medication for status epilepticus.
✔✔Wernicke's encephalopathy due to a deficiency of thiamine - ✔✔Confusion,
confabulation, ophthalmoplegia, ataxia.
✔✔Seventy percent if the stenosis is symptomatic - ✔✔What % lesion is an indication
for carotid endarterectomy?
✔✔Alzheimer's and multi-infarct - ✔✔The most common causes of dementia.
✔✔ALS - ✔✔Combined UMN and LMN disorder.
✔✔Parkinson's disease - ✔✔Rigidity and stiffness with resting tremor and masked
facies.
