USMLE STEP 2 MAIN EXAMINATION 2026 QUESTIONS
AND ANSWERS GRADED A+
✔✔Low grade squamous intraepithelial lesions (mild dysplasia, CIN I)
1. Adolescent
2. Pre-menopausal
3. Postmenopausal - ✔✔1. repeat pap smear in 12 months
2. colposcopy
3. HPV testing, if (+) then colposcopy
✔✔What to rule out in secondary amenorrhea? - ✔✔1. Pregnancy
2. Hyperprolactinemia
3. Hypothyroid
4. Low estrogen - progestin stimulation test
✔✔What is asherman's syndrome? - ✔✔Uterine adhesions causing secondary
amenorrhea
Usually a result of scarring and fibrosis due to intrauterine instrumentation
✔✔Preferred method of birth control for a lactating mom? - ✔✔Progesterone only pill
✔✔DUB, non-active moderate bleeding >35 yo
Best first step in management?
Then what? - ✔✔endometrial biopsy
cyclic progestins
✔✔Gold standard for evaluating possible cervical incompetence in pregnancy? -
✔✔Transvaginal US
✔✔Levels of FSH and LH in Klinefelter syndrome - ✔✔both high
✔✔MCC of communicating hydrocephalus? - ✔✔Subarachnoid hemorrhage
✔✔Primary amenorrhea, (-) B-hcg
First step in management? - ✔✔Measure FSH level
Low FSH = central cause --> GnRH stimulation test
High FSH = peripheral cause --> Karyotyping
✔✔Serum BUN and Cr are increased or decreased in pregancy? - ✔✔Decreased
Renal plasma flow and GFR are both increased in pregnancy therefore BUN and Cr are
decreased
✔✔Developmental disorder characterized by a forward slip of vertebrae.
Dx?
,PE? - ✔✔Spondylolisthesis
Chronic back pain, neuro dysfunction (urinary incontinence), step-off palpation palpable
(MC L5, S1)
✔✔MC preventable cause of fetal growth restriction? - ✔✔smoking
✔✔3 P's of McCune-Albright syndrome? - ✔✔Precious puberty
Pigmentation
Polyostotic fibrous dysplasia
+ associated w/ endocrine disorders
✔✔Endometriosis
When is pain worse? pre, -intra, or post menstrual?
BDT?
Risk of developing what Obs/Gyn complication? - ✔✔Premenstrual
Laparoscopy
Infertility
✔✔Rx for central precocious puberty?
Why delay puberty? - ✔✔GnRH agonist therapy
Prevent premature closure of epiphyseal plates
✔✔Fetal growth restriction
Symmetric
- When does insult to fetus occur?
- What type of insult?
Aysmmetric
- Head or abd is smaller?
- What type of insult? - ✔✔Symmetric
- <28 wks gestation
- fetal factors: chr. abnormalities, congenital infections, congenital anomalies
Asymmetric
- Head is N size. blood is shunted to vital organs (brain, heart)
- Non-ideal maternal factors (HTN, hypoxemia, toxins)
✔✔Gestational Diabetes
When to test?
BIT? - ✔✔High-risk, 1st prenatal visit
Everyone else 24-28 weeks gestation
BIT: 1 hour 50 gram oral glucose. If >140 after 1 hour, then do 3 hr 100 gram lest. if
<140, test is (-)
✔✔External Cephalic Version
When to perform?
, What to do prior? - ✔✔37 wks - labor
Allow breeched babies to spontaneously move to cephalic
Ensure fetus is healthy and emergency CS is ready
✔✔DUB: 16 yo w/ severe, current bleed
Rx? - ✔✔High dose estrogen
✔✔Trichomonas or Gardenerella cause pruritus and and inflammation?
Which 1 raises pH - ✔✔Trichomonas
Both will raise vaginal pH (5.0-6.0)
✔✔An impaired gas exchange (eg PE) will result in an elevated or normal A-a gradient -
✔✔elevated
✔✔Discovery of an incidental pulmonary nodule.
What is next best step in management? - ✔✔1. If possible, compare to old CXR
2. If no previous imaging, than assign low, high, or intermediate probability of
malignancy.
Low: 3, 6, 9, 18, 24 month CT scans
Intermediate: PET and/or biopsy
High: surgical removal
✔✔Pulmonary embolism
PE:
Diagnostic tests? - ✔✔PE: Dyspnea, tachypnea, pain worse on inspiration, cough
Dx Tests:
V/Q scan
Spiral CT (MC)
Pulmonary angiography (Au standard)
✔✔Mycoplasma Pneumoniae
Pt?
Rx?
BDT?
Skin lesion? - ✔✔Young and healthy
Macrolide or quinolone or doxycycline
Cold agglutinin serology
target lesion
✔✔Hypoxemia
Define:
Causes: - ✔✔PaO2 < 80
1. Hypoventilation (N A-a gradient, only one w/ increased PaCO2)
AND ANSWERS GRADED A+
✔✔Low grade squamous intraepithelial lesions (mild dysplasia, CIN I)
1. Adolescent
2. Pre-menopausal
3. Postmenopausal - ✔✔1. repeat pap smear in 12 months
2. colposcopy
3. HPV testing, if (+) then colposcopy
✔✔What to rule out in secondary amenorrhea? - ✔✔1. Pregnancy
2. Hyperprolactinemia
3. Hypothyroid
4. Low estrogen - progestin stimulation test
✔✔What is asherman's syndrome? - ✔✔Uterine adhesions causing secondary
amenorrhea
Usually a result of scarring and fibrosis due to intrauterine instrumentation
✔✔Preferred method of birth control for a lactating mom? - ✔✔Progesterone only pill
✔✔DUB, non-active moderate bleeding >35 yo
Best first step in management?
Then what? - ✔✔endometrial biopsy
cyclic progestins
✔✔Gold standard for evaluating possible cervical incompetence in pregnancy? -
✔✔Transvaginal US
✔✔Levels of FSH and LH in Klinefelter syndrome - ✔✔both high
✔✔MCC of communicating hydrocephalus? - ✔✔Subarachnoid hemorrhage
✔✔Primary amenorrhea, (-) B-hcg
First step in management? - ✔✔Measure FSH level
Low FSH = central cause --> GnRH stimulation test
High FSH = peripheral cause --> Karyotyping
✔✔Serum BUN and Cr are increased or decreased in pregancy? - ✔✔Decreased
Renal plasma flow and GFR are both increased in pregnancy therefore BUN and Cr are
decreased
✔✔Developmental disorder characterized by a forward slip of vertebrae.
Dx?
,PE? - ✔✔Spondylolisthesis
Chronic back pain, neuro dysfunction (urinary incontinence), step-off palpation palpable
(MC L5, S1)
✔✔MC preventable cause of fetal growth restriction? - ✔✔smoking
✔✔3 P's of McCune-Albright syndrome? - ✔✔Precious puberty
Pigmentation
Polyostotic fibrous dysplasia
+ associated w/ endocrine disorders
✔✔Endometriosis
When is pain worse? pre, -intra, or post menstrual?
BDT?
Risk of developing what Obs/Gyn complication? - ✔✔Premenstrual
Laparoscopy
Infertility
✔✔Rx for central precocious puberty?
Why delay puberty? - ✔✔GnRH agonist therapy
Prevent premature closure of epiphyseal plates
✔✔Fetal growth restriction
Symmetric
- When does insult to fetus occur?
- What type of insult?
Aysmmetric
- Head or abd is smaller?
- What type of insult? - ✔✔Symmetric
- <28 wks gestation
- fetal factors: chr. abnormalities, congenital infections, congenital anomalies
Asymmetric
- Head is N size. blood is shunted to vital organs (brain, heart)
- Non-ideal maternal factors (HTN, hypoxemia, toxins)
✔✔Gestational Diabetes
When to test?
BIT? - ✔✔High-risk, 1st prenatal visit
Everyone else 24-28 weeks gestation
BIT: 1 hour 50 gram oral glucose. If >140 after 1 hour, then do 3 hr 100 gram lest. if
<140, test is (-)
✔✔External Cephalic Version
When to perform?
, What to do prior? - ✔✔37 wks - labor
Allow breeched babies to spontaneously move to cephalic
Ensure fetus is healthy and emergency CS is ready
✔✔DUB: 16 yo w/ severe, current bleed
Rx? - ✔✔High dose estrogen
✔✔Trichomonas or Gardenerella cause pruritus and and inflammation?
Which 1 raises pH - ✔✔Trichomonas
Both will raise vaginal pH (5.0-6.0)
✔✔An impaired gas exchange (eg PE) will result in an elevated or normal A-a gradient -
✔✔elevated
✔✔Discovery of an incidental pulmonary nodule.
What is next best step in management? - ✔✔1. If possible, compare to old CXR
2. If no previous imaging, than assign low, high, or intermediate probability of
malignancy.
Low: 3, 6, 9, 18, 24 month CT scans
Intermediate: PET and/or biopsy
High: surgical removal
✔✔Pulmonary embolism
PE:
Diagnostic tests? - ✔✔PE: Dyspnea, tachypnea, pain worse on inspiration, cough
Dx Tests:
V/Q scan
Spiral CT (MC)
Pulmonary angiography (Au standard)
✔✔Mycoplasma Pneumoniae
Pt?
Rx?
BDT?
Skin lesion? - ✔✔Young and healthy
Macrolide or quinolone or doxycycline
Cold agglutinin serology
target lesion
✔✔Hypoxemia
Define:
Causes: - ✔✔PaO2 < 80
1. Hypoventilation (N A-a gradient, only one w/ increased PaCO2)
