USMLE STEP 2 STUDY GUIDE 2026 QUESTIONS AND
ANSWERS GRADED A+
✔✔Long-term analgesic abuse will show what type of pathology in kidney? -
✔✔papillary necrosis and chronic tubulointerstitial nephritis
✔✔MCC of painless hematuria in adults? - ✔✔bladder cancer
✔✔Treatment in goodpasture's syndrome - ✔✔emergency plasmapheresis
✔✔Uremic coagulopathy
PTT
PT
BT
Platelet count
Rx? - ✔✔PTT normal
PT normal
BT increased
Platelet count normal
Rx: DDAVP, Tranfused platelets do not work cause platelets quickly become inactive
✔✔Varicocele:
MOA
Transillumination
PE - ✔✔MOA: swelling of pampinoform plexus of veins
Tranillumination (-)
PE: dull aching fullness of scrotum "bag of worms"
✔✔Hydrocele:
MOA
Transillumination - ✔✔MOA: fluid in tunica vaginalis
Transillumination (+)
✔✔PE: S/S of nephrotic syndrome + suddenly develops R-sided abdominal pain, fever,
gross hematuria
Most likely diagnosis? - ✔✔Renal vein thrombosis secondary to Membranous
glomerulonephritis (MCC of renal vein thrombosis of the nephrotic syndromes)
✔✔BDT if RCC is suspected? - ✔✔CT of abdomen
✔✔Treatment for urge incontinence - ✔✔Oxybutynin
Anticholinergic that inhibits smooth muscle contraction
,✔✔Blood smear shows bite cells. Suspected pathology? - ✔✔G6PD
Ax w/ primaquine or sulfa drugs
(G6PD may appear normal in lab results during crisis)
✔✔PAS (+)
TdT (+)
Predominate blast cells - ✔✔ALL
✔✔Indications of TTP? - ✔✔Renal failure
Neurological symptoms (eg H/A, confusion)
Anemia
Thrombocytopenia
Fragmented RBC
✔✔Tartrate Resistant Acid Phosphatase (+)
CD11c
What disease?
Rx? - ✔✔Hairy cell leukemia
Cladribine
✔✔Low leukocyte alkaline phosphatase + leukocytosis
Dx? - ✔✔Chronic myelogenous leukemia
✔✔Treatment for warm autoimmune hemolytic anemia? - ✔✔steroids
if not successful, splenectomy
✔✔Tumor Lysis Syndrome
Rx to prevent?
Hyper or Hypo: Ca, P, K, Uric acid - ✔✔Allopurinol
Hypocalcemia, Hyperphosphatemia, Hyperkalemia, increased uric acid
Phosphate is intracellular --> cell death --> P released --> binds Ca --> hypocalcemia
✔✔Hemolytic anemia
Venous thrombosis
Diminished hematopoeisis
Dx? - ✔✔PNH
✔✔1st line therapy for chemotherapy induced N/V?
What drug can be added to help decrease vomiting? - ✔✔- Serotonin antagonists eg
odansetron
- Steroids
, ✔✔Test to confirm CLL? - ✔✔Flow cytometry of peripheral blood
✔✔JAK2 is associated w/ what myeloproliferative disease? - ✔✔Polycythemia ruba
vera
✔✔Progressive bone marrow failure
Skin hypopigmentation
Congenital abnormalities (microcephaly, abnormal thumbs)
Predisposition to Ca - ✔✔Fanconi's anemia
PE: young teen w/ anemia, poor growth, skin hypopigmentation....
✔✔Rx of hereditary spherocytosis - ✔✔Folic acid supplementation and splenectomy
✔✔What should a patient w/ high homocysteine levels take? - ✔✔pyridoxine (B6) and
folate
✔✔Wiskott-Aldrich triad - ✔✔thrombocytopenia
eczema
recurrent bacterial infections (encapsulated)
✔✔Chlorambucil and prednisone treats what? - ✔✔CLL
✔✔CHOP treats what? - ✔✔NHL
✔✔What nephrotic syndrome is associated w/ hodgkin's lymphoma? - ✔✔Minimal
change disease
✔✔27 yo. CXR shows large mediastinal mass.
Labs report elevated B-HCG and elevated AFP
Dx?
What if labs report elevated B-HCG, normal AFP? - ✔✔Germ cell tumor, Non-
seminomatous
Germ cell tumor, seminomatous
✔✔PE: barking cough, stridor, hoarseness
Dx?
In ER pt rapidly deterioates. next best step? - ✔✔Croup
Epi
If no improvement intubate
✔✔PE: protrusion of bright red intestines at birth
Dx? - ✔✔Gastroschisis
Surgical emergency
ANSWERS GRADED A+
✔✔Long-term analgesic abuse will show what type of pathology in kidney? -
✔✔papillary necrosis and chronic tubulointerstitial nephritis
✔✔MCC of painless hematuria in adults? - ✔✔bladder cancer
✔✔Treatment in goodpasture's syndrome - ✔✔emergency plasmapheresis
✔✔Uremic coagulopathy
PTT
PT
BT
Platelet count
Rx? - ✔✔PTT normal
PT normal
BT increased
Platelet count normal
Rx: DDAVP, Tranfused platelets do not work cause platelets quickly become inactive
✔✔Varicocele:
MOA
Transillumination
PE - ✔✔MOA: swelling of pampinoform plexus of veins
Tranillumination (-)
PE: dull aching fullness of scrotum "bag of worms"
✔✔Hydrocele:
MOA
Transillumination - ✔✔MOA: fluid in tunica vaginalis
Transillumination (+)
✔✔PE: S/S of nephrotic syndrome + suddenly develops R-sided abdominal pain, fever,
gross hematuria
Most likely diagnosis? - ✔✔Renal vein thrombosis secondary to Membranous
glomerulonephritis (MCC of renal vein thrombosis of the nephrotic syndromes)
✔✔BDT if RCC is suspected? - ✔✔CT of abdomen
✔✔Treatment for urge incontinence - ✔✔Oxybutynin
Anticholinergic that inhibits smooth muscle contraction
,✔✔Blood smear shows bite cells. Suspected pathology? - ✔✔G6PD
Ax w/ primaquine or sulfa drugs
(G6PD may appear normal in lab results during crisis)
✔✔PAS (+)
TdT (+)
Predominate blast cells - ✔✔ALL
✔✔Indications of TTP? - ✔✔Renal failure
Neurological symptoms (eg H/A, confusion)
Anemia
Thrombocytopenia
Fragmented RBC
✔✔Tartrate Resistant Acid Phosphatase (+)
CD11c
What disease?
Rx? - ✔✔Hairy cell leukemia
Cladribine
✔✔Low leukocyte alkaline phosphatase + leukocytosis
Dx? - ✔✔Chronic myelogenous leukemia
✔✔Treatment for warm autoimmune hemolytic anemia? - ✔✔steroids
if not successful, splenectomy
✔✔Tumor Lysis Syndrome
Rx to prevent?
Hyper or Hypo: Ca, P, K, Uric acid - ✔✔Allopurinol
Hypocalcemia, Hyperphosphatemia, Hyperkalemia, increased uric acid
Phosphate is intracellular --> cell death --> P released --> binds Ca --> hypocalcemia
✔✔Hemolytic anemia
Venous thrombosis
Diminished hematopoeisis
Dx? - ✔✔PNH
✔✔1st line therapy for chemotherapy induced N/V?
What drug can be added to help decrease vomiting? - ✔✔- Serotonin antagonists eg
odansetron
- Steroids
, ✔✔Test to confirm CLL? - ✔✔Flow cytometry of peripheral blood
✔✔JAK2 is associated w/ what myeloproliferative disease? - ✔✔Polycythemia ruba
vera
✔✔Progressive bone marrow failure
Skin hypopigmentation
Congenital abnormalities (microcephaly, abnormal thumbs)
Predisposition to Ca - ✔✔Fanconi's anemia
PE: young teen w/ anemia, poor growth, skin hypopigmentation....
✔✔Rx of hereditary spherocytosis - ✔✔Folic acid supplementation and splenectomy
✔✔What should a patient w/ high homocysteine levels take? - ✔✔pyridoxine (B6) and
folate
✔✔Wiskott-Aldrich triad - ✔✔thrombocytopenia
eczema
recurrent bacterial infections (encapsulated)
✔✔Chlorambucil and prednisone treats what? - ✔✔CLL
✔✔CHOP treats what? - ✔✔NHL
✔✔What nephrotic syndrome is associated w/ hodgkin's lymphoma? - ✔✔Minimal
change disease
✔✔27 yo. CXR shows large mediastinal mass.
Labs report elevated B-HCG and elevated AFP
Dx?
What if labs report elevated B-HCG, normal AFP? - ✔✔Germ cell tumor, Non-
seminomatous
Germ cell tumor, seminomatous
✔✔PE: barking cough, stridor, hoarseness
Dx?
In ER pt rapidly deterioates. next best step? - ✔✔Croup
Epi
If no improvement intubate
✔✔PE: protrusion of bright red intestines at birth
Dx? - ✔✔Gastroschisis
Surgical emergency
