USMLE STEP 2 FINAL EXAM 2026 ACTUAL QUESTIONS
AND ANSWERS GRADED A+
✔✔High reliability, low validity - ✔✔Describe a test that consistently gives identical
results, but the results are wrong.
✔✔Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds
ratio (OR). Case-control studies can be used to calculate an OR - ✔✔Difference
between a cohort and a case-control study.
✔✔The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed -
✔✔Attributable risk?
✔✔The IR of a disease in a population exposed to a particular factor ÷ the IR of those
not exposed - ✔✔Relative risk?
✔✔The likelihood of a disease among individuals exposed to a risk factor compared to
those who have not been exposed - ✔✔Odds ratio?
✔✔1 ÷ (rate in untreated group − rate in treated group) - ✔✔Number needed to treat?
✔✔Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary
nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives
with adenomatous polyps (< 60 years of age) or colorectal cancer - ✔✔In which patients
do you initiate colorectal cancer screening early?
✔✔Prostate cancer is the most common cancer in men, but lung cancer causes more
deaths - ✔✔The most common cancer in men and the most common cause of death
from cancer in men.
✔✔68%, 95.5%, 99.7% - ✔✔The percentage of cases within one SD of the mean? Two
SDs? Three SDs?
✔✔Number of live births per 1000 population - ✔✔Birth rate?
✔✔Number of live births per 1000 women 15-44 years of age - ✔✔Fertility rate?
✔✔Number of deaths per 1000 population - ✔✔Mortality rate?
✔✔Number of deaths from birth to 28 days per 1000 live births - ✔✔Neonatal mortality?
✔✔Number of deaths from 28 days to one year per 1000 live births - ✔✔Postnatal
mortality?
,✔✔Number of deaths from birth to one year of age per 1000 live births (neonatal +
postnatal mortality) - ✔✔Infant mortality?
✔✔Number of deaths from 20 weeks' gestation to birth per 1000 total births - ✔✔Fetal
mortality?
✔✔Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
- ✔✔Perinatal mortality?
✔✔Number of deaths during pregnancy to 90 days postpartum per 100,000 live births -
✔✔Maternal mortality?
✔✔False. Patients may change their minds at any time. Exceptions to the requirement
of informed consent include emergency situations and patients without decision-making
capacity - ✔✔True or false: Once patients sign a statement giving consent, they must
continue treatment.
✔✔No. Parental consent is not necessary for the medical treatment of pregnant minors
- ✔✔A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her
parents be informed?
✔✔Conflict of interest - ✔✔A doctor refers a patient for an MRI at a facility he/she owns.
✔✔The patient is a danger to self, a danger to others, or gravely disabled (unable to
provide for basic needs) - ✔✔Involuntary psychiatric hospitalization can be undertaken
for which three reasons?
✔✔False. Withdrawing and withholding life are the same from an ethical standpoint -
✔✔True or false: Withdrawing life-sustaining care is ethically distinct from withholding
sustaining care.
✔✔When there is no rationale for treatment, maximal intervention is failing, a given
intervention has already failed, and treatment will not achieve the goals of care -
✔✔When can a physician refuse to continue treating a patient on the grounds of futility?
✔✔Treat immediately. Consent is implied in emergency situations - ✔✔An eight-year-
old child is in a serious accident. She requires emergent transfusion, but her parents are
not present.
✔✔Real threat of harm to third parties; suicidal intentions; certain contagious diseases;
elder and child abuse - ✔✔Conditions in which confidentiality must be overridden.
, ✔✔When treatment noncompliance represents a serious danger to public health (e.g.,
active TB) - ✔✔Involuntary commitment or isolation for medical treatment may be
undertaken for what reason?
✔✔Treat because the disease represents an immediate threat to the child's life. Then
seek a court order - ✔✔A 10-year-old child presents in status epilepticus, but her
parents refuse treatment on religious grounds.
✔✔A patient's family cannot require that a doctor withhold information from the patient -
✔✔A son asks that his mother not be told about her recently discovered cancer.
✔✔Emergent laparotomy to repair perforated viscus, likely stomach - ✔✔Patient
presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal
signs and AXR reveals free air under the diaphragm. Management?
✔✔Diverticulosis - ✔✔The most likely cause of acute lower GI bleed in patients > 40
years old.
✔✔HIDA scan - ✔✔Diagnostic modality used when ultrasound is equivocal for
cholecystitis.
✔✔Acute pancreatitis - ✔✔Sentinel loop on AXR.
✔✔Fat, female, fertile, forty, flatulent - ✔✔Risk factors for cholelithiasis.
✔✔Murphy's sign, seen in acute cholecystitis - ✔✔Inspiratory arrest during palpation of
the RUQ.
✔✔Campylobacter - ✔✔Identify key organisms causing diarrhea: ■ Most common
organism
✔✔Clostridium difficile - ✔✔Identify key organisms causing diarrhea: ■ Recent antibiotic
use
✔✔Giardia - ✔✔Identify key organisms causing diarrhea: ■ Camping
✔✔ETEC - ✔✔Identify key organisms causing diarrhea: ■ Traveler's diarrhea
✔✔S. aureus - ✔✔Identify key organisms causing diarrhea: ■ Church
picnics/mayonnaise
✔✔E. coli O157:H7 - ✔✔Identify key organisms causing diarrhea: ■ Uncooked
hamburgers
AND ANSWERS GRADED A+
✔✔High reliability, low validity - ✔✔Describe a test that consistently gives identical
results, but the results are wrong.
✔✔Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds
ratio (OR). Case-control studies can be used to calculate an OR - ✔✔Difference
between a cohort and a case-control study.
✔✔The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed -
✔✔Attributable risk?
✔✔The IR of a disease in a population exposed to a particular factor ÷ the IR of those
not exposed - ✔✔Relative risk?
✔✔The likelihood of a disease among individuals exposed to a risk factor compared to
those who have not been exposed - ✔✔Odds ratio?
✔✔1 ÷ (rate in untreated group − rate in treated group) - ✔✔Number needed to treat?
✔✔Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary
nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives
with adenomatous polyps (< 60 years of age) or colorectal cancer - ✔✔In which patients
do you initiate colorectal cancer screening early?
✔✔Prostate cancer is the most common cancer in men, but lung cancer causes more
deaths - ✔✔The most common cancer in men and the most common cause of death
from cancer in men.
✔✔68%, 95.5%, 99.7% - ✔✔The percentage of cases within one SD of the mean? Two
SDs? Three SDs?
✔✔Number of live births per 1000 population - ✔✔Birth rate?
✔✔Number of live births per 1000 women 15-44 years of age - ✔✔Fertility rate?
✔✔Number of deaths per 1000 population - ✔✔Mortality rate?
✔✔Number of deaths from birth to 28 days per 1000 live births - ✔✔Neonatal mortality?
✔✔Number of deaths from 28 days to one year per 1000 live births - ✔✔Postnatal
mortality?
,✔✔Number of deaths from birth to one year of age per 1000 live births (neonatal +
postnatal mortality) - ✔✔Infant mortality?
✔✔Number of deaths from 20 weeks' gestation to birth per 1000 total births - ✔✔Fetal
mortality?
✔✔Number of deaths from 20 weeks' gestation to one month of life per 1000 total births
- ✔✔Perinatal mortality?
✔✔Number of deaths during pregnancy to 90 days postpartum per 100,000 live births -
✔✔Maternal mortality?
✔✔False. Patients may change their minds at any time. Exceptions to the requirement
of informed consent include emergency situations and patients without decision-making
capacity - ✔✔True or false: Once patients sign a statement giving consent, they must
continue treatment.
✔✔No. Parental consent is not necessary for the medical treatment of pregnant minors
- ✔✔A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her
parents be informed?
✔✔Conflict of interest - ✔✔A doctor refers a patient for an MRI at a facility he/she owns.
✔✔The patient is a danger to self, a danger to others, or gravely disabled (unable to
provide for basic needs) - ✔✔Involuntary psychiatric hospitalization can be undertaken
for which three reasons?
✔✔False. Withdrawing and withholding life are the same from an ethical standpoint -
✔✔True or false: Withdrawing life-sustaining care is ethically distinct from withholding
sustaining care.
✔✔When there is no rationale for treatment, maximal intervention is failing, a given
intervention has already failed, and treatment will not achieve the goals of care -
✔✔When can a physician refuse to continue treating a patient on the grounds of futility?
✔✔Treat immediately. Consent is implied in emergency situations - ✔✔An eight-year-
old child is in a serious accident. She requires emergent transfusion, but her parents are
not present.
✔✔Real threat of harm to third parties; suicidal intentions; certain contagious diseases;
elder and child abuse - ✔✔Conditions in which confidentiality must be overridden.
, ✔✔When treatment noncompliance represents a serious danger to public health (e.g.,
active TB) - ✔✔Involuntary commitment or isolation for medical treatment may be
undertaken for what reason?
✔✔Treat because the disease represents an immediate threat to the child's life. Then
seek a court order - ✔✔A 10-year-old child presents in status epilepticus, but her
parents refuse treatment on religious grounds.
✔✔A patient's family cannot require that a doctor withhold information from the patient -
✔✔A son asks that his mother not be told about her recently discovered cancer.
✔✔Emergent laparotomy to repair perforated viscus, likely stomach - ✔✔Patient
presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal
signs and AXR reveals free air under the diaphragm. Management?
✔✔Diverticulosis - ✔✔The most likely cause of acute lower GI bleed in patients > 40
years old.
✔✔HIDA scan - ✔✔Diagnostic modality used when ultrasound is equivocal for
cholecystitis.
✔✔Acute pancreatitis - ✔✔Sentinel loop on AXR.
✔✔Fat, female, fertile, forty, flatulent - ✔✔Risk factors for cholelithiasis.
✔✔Murphy's sign, seen in acute cholecystitis - ✔✔Inspiratory arrest during palpation of
the RUQ.
✔✔Campylobacter - ✔✔Identify key organisms causing diarrhea: ■ Most common
organism
✔✔Clostridium difficile - ✔✔Identify key organisms causing diarrhea: ■ Recent antibiotic
use
✔✔Giardia - ✔✔Identify key organisms causing diarrhea: ■ Camping
✔✔ETEC - ✔✔Identify key organisms causing diarrhea: ■ Traveler's diarrhea
✔✔S. aureus - ✔✔Identify key organisms causing diarrhea: ■ Church
picnics/mayonnaise
✔✔E. coli O157:H7 - ✔✔Identify key organisms causing diarrhea: ■ Uncooked
hamburgers
