USMLE STEP 2 UPDATED 2026 EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔PT - ✔✔The coagulation parameter affected by warfarin.
✔✔Hypertrophic cardiomyopathy - ✔✔A young patient with a family history of sudden
death collapses and dies while exercising.
✔✔Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before
and amoxicillin after - ✔✔Endocarditis prophylaxis regimens.
✔✔Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia - ✔✔The 6 P's of
ischemia due to peripheral vascular disease.
✔✔Stasis, hypercoagulability, endothelial damage - ✔✔Virchow's triad.
✔✔OCPs - ✔✔The most common cause of hypertension in young women.
✔✔Excessive EtOH - ✔✔The most common cause of hypertension in young men.
✔✔Seborrheic keratosis - ✔✔"Stuck-on" appearance.
✔✔Psoriasis - ✔✔Red plaques with silvery-white scales and sharp margins.
✔✔Basal cell carcinoma - ✔✔The most common type of skin cancer; the lesion is a
pearly-colored papule with a translucent surface and telangiectasias.
✔✔Impetigo - ✔✔Honey-crusted lesions.
✔✔Cellulitis - ✔✔A febrile patient with a history of diabetes presents with a red, swollen,
painful lower extremity.
✔✔Pemphigus vulgaris - ✔✔+ Nikolsky's sign.
✔✔Bullous pemphigoid - ✔✔- Nikolsky's sign.
✔✔Acanthosis nigricans. Check fasting blood sugar to rule out diabetes - ✔✔A 55-year-
old obese patient presents with dirty, velvety patches on the back of the neck.
✔✔Varicella zoster - ✔✔Dermatomal distribution.
✔✔Lichen planus - ✔✔Flat-topped papules.
,✔✔Erythema multiforme - ✔✔Iris-like target lesions.
✔✔Contact dermatitis - ✔✔A lesion characteristically occurring in a linear pattern in
areas where skin comes into contact with clothing or jewelry.
✔✔Pityriasis rosea - ✔✔Presents with a herald patch, Christmas-tree pattern.
✔✔Alopecia areata (autoimmune process) - ✔✔A 16-year-old presents with an annular
patch of alopecia with broken-off, stubby hairs.
✔✔Pityriasis versicolor - ✔✔Pinkish, scaling, flat lesions on the chest and back. KOH
prep has a "spaghetti-and-meatballs" appearance.
✔✔Asymmetry, border irregularity, color variation, large diameter - ✔✔Four
characteristics of a nevus suggestive of melanoma.
✔✔Actinic keratosis - ✔✔Premalignant lesion from sun exposure that can → squamous
cell carcinoma.
✔✔Lesions of 1° varicella - ✔✔"Dewdrop on a rose petal."
✔✔Seborrheic dermatitis. Treat with antifungals - ✔✔"Cradle cap."
✔✔Acne vulgaris - ✔✔Associated with Propionibacterium acnes and changes in
androgen levels.
✔✔Herpes simplex - ✔✔A painful, recurrent vesicular eruption of mucocutaneous
surfaces.
✔✔Lichen sclerosus - ✔✔Inflammation and epithelial thinning of the anogenital area,
predominantly in postmenopausal women.
✔✔Squamous cell carcinoma - ✔✔Exophytic nodules on the skin with varying degrees
of scaling or ulceration; the second most common type of skin cancer.
✔✔Hashimoto's thyroiditis - ✔✔The most common cause of hypothyroidism.
✔✔High TSH, low T4, antimicrosomal antibodies - ✔✔Lab findings in Hashimoto's
thyroiditis.
✔✔Graves' disease - ✔✔Exophthalmos, pretibial myxedema, and ↓ TSH.
✔✔Iatrogenic steroid administration. The second most common cause is Cushing's
disease - ✔✔The most common cause of Cushing's syndrome.
, ✔✔Hypoparathyroidism - ✔✔A patient presents with signs of hypocalcemia, high
phosphorus, and low PTH.
✔✔Signs and symptoms of hypercalcemia - ✔✔"Stones, bones, groans, psychiatric
overtones."
✔✔1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) -
✔✔A patient complains of headache, weakness, and polyuria; exam reveals
hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic
alkalosis.
✔✔Pheochromocytoma - ✔✔A patient presents with tachycardia, wild swings in BP,
headache, diaphoresis, altered mental status, and a sense of panic.
✔✔α-antagonists (phentolamine and phenoxybenzamine) - ✔✔Should α- or β-
antagonists be used first in treating pheochromocytoma?
✔✔Nephrogenic diabetes insipidus (DI) - ✔✔A patient with a history of lithium use
presents with copious amounts of dilute urine.
✔✔Administration of DDAVP ↓ serum osmolality and free water restriction -
✔✔Treatment of central DI.
✔✔SIADH due to stress - ✔✔A postoperative patient with significant pain presents with
hyponatremia and normal volume status.
✔✔Metformin - ✔✔An antidiabetic agent associated with lactic acidosis.
✔✔1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids,
mineralocorticoids, and IV fluids - ✔✔A patient presents with weakness, nausea,
vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and
hyperkalemia. Treatment?
✔✔< 7.0 - ✔✔Goal hemoglobin A1c for a patient with DM.
✔✔Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+) - ✔✔Treatment
of DKA.
✔✔They can mask symptoms of hypoglycemia - ✔✔Why are β-blockers contraindicated
in diabetics?
✔✔Observational bias - ✔✔Bias introduced into a study when a clinician is aware of the
patient's treatment type.
ANSWERS GRADED A+
✔✔PT - ✔✔The coagulation parameter affected by warfarin.
✔✔Hypertrophic cardiomyopathy - ✔✔A young patient with a family history of sudden
death collapses and dies while exercising.
✔✔Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before
and amoxicillin after - ✔✔Endocarditis prophylaxis regimens.
✔✔Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia - ✔✔The 6 P's of
ischemia due to peripheral vascular disease.
✔✔Stasis, hypercoagulability, endothelial damage - ✔✔Virchow's triad.
✔✔OCPs - ✔✔The most common cause of hypertension in young women.
✔✔Excessive EtOH - ✔✔The most common cause of hypertension in young men.
✔✔Seborrheic keratosis - ✔✔"Stuck-on" appearance.
✔✔Psoriasis - ✔✔Red plaques with silvery-white scales and sharp margins.
✔✔Basal cell carcinoma - ✔✔The most common type of skin cancer; the lesion is a
pearly-colored papule with a translucent surface and telangiectasias.
✔✔Impetigo - ✔✔Honey-crusted lesions.
✔✔Cellulitis - ✔✔A febrile patient with a history of diabetes presents with a red, swollen,
painful lower extremity.
✔✔Pemphigus vulgaris - ✔✔+ Nikolsky's sign.
✔✔Bullous pemphigoid - ✔✔- Nikolsky's sign.
✔✔Acanthosis nigricans. Check fasting blood sugar to rule out diabetes - ✔✔A 55-year-
old obese patient presents with dirty, velvety patches on the back of the neck.
✔✔Varicella zoster - ✔✔Dermatomal distribution.
✔✔Lichen planus - ✔✔Flat-topped papules.
,✔✔Erythema multiforme - ✔✔Iris-like target lesions.
✔✔Contact dermatitis - ✔✔A lesion characteristically occurring in a linear pattern in
areas where skin comes into contact with clothing or jewelry.
✔✔Pityriasis rosea - ✔✔Presents with a herald patch, Christmas-tree pattern.
✔✔Alopecia areata (autoimmune process) - ✔✔A 16-year-old presents with an annular
patch of alopecia with broken-off, stubby hairs.
✔✔Pityriasis versicolor - ✔✔Pinkish, scaling, flat lesions on the chest and back. KOH
prep has a "spaghetti-and-meatballs" appearance.
✔✔Asymmetry, border irregularity, color variation, large diameter - ✔✔Four
characteristics of a nevus suggestive of melanoma.
✔✔Actinic keratosis - ✔✔Premalignant lesion from sun exposure that can → squamous
cell carcinoma.
✔✔Lesions of 1° varicella - ✔✔"Dewdrop on a rose petal."
✔✔Seborrheic dermatitis. Treat with antifungals - ✔✔"Cradle cap."
✔✔Acne vulgaris - ✔✔Associated with Propionibacterium acnes and changes in
androgen levels.
✔✔Herpes simplex - ✔✔A painful, recurrent vesicular eruption of mucocutaneous
surfaces.
✔✔Lichen sclerosus - ✔✔Inflammation and epithelial thinning of the anogenital area,
predominantly in postmenopausal women.
✔✔Squamous cell carcinoma - ✔✔Exophytic nodules on the skin with varying degrees
of scaling or ulceration; the second most common type of skin cancer.
✔✔Hashimoto's thyroiditis - ✔✔The most common cause of hypothyroidism.
✔✔High TSH, low T4, antimicrosomal antibodies - ✔✔Lab findings in Hashimoto's
thyroiditis.
✔✔Graves' disease - ✔✔Exophthalmos, pretibial myxedema, and ↓ TSH.
✔✔Iatrogenic steroid administration. The second most common cause is Cushing's
disease - ✔✔The most common cause of Cushing's syndrome.
, ✔✔Hypoparathyroidism - ✔✔A patient presents with signs of hypocalcemia, high
phosphorus, and low PTH.
✔✔Signs and symptoms of hypercalcemia - ✔✔"Stones, bones, groans, psychiatric
overtones."
✔✔1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) -
✔✔A patient complains of headache, weakness, and polyuria; exam reveals
hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic
alkalosis.
✔✔Pheochromocytoma - ✔✔A patient presents with tachycardia, wild swings in BP,
headache, diaphoresis, altered mental status, and a sense of panic.
✔✔α-antagonists (phentolamine and phenoxybenzamine) - ✔✔Should α- or β-
antagonists be used first in treating pheochromocytoma?
✔✔Nephrogenic diabetes insipidus (DI) - ✔✔A patient with a history of lithium use
presents with copious amounts of dilute urine.
✔✔Administration of DDAVP ↓ serum osmolality and free water restriction -
✔✔Treatment of central DI.
✔✔SIADH due to stress - ✔✔A postoperative patient with significant pain presents with
hyponatremia and normal volume status.
✔✔Metformin - ✔✔An antidiabetic agent associated with lactic acidosis.
✔✔1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids,
mineralocorticoids, and IV fluids - ✔✔A patient presents with weakness, nausea,
vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and
hyperkalemia. Treatment?
✔✔< 7.0 - ✔✔Goal hemoglobin A1c for a patient with DM.
✔✔Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+) - ✔✔Treatment
of DKA.
✔✔They can mask symptoms of hypoglycemia - ✔✔Why are β-blockers contraindicated
in diabetics?
✔✔Observational bias - ✔✔Bias introduced into a study when a clinician is aware of the
patient's treatment type.
