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USMLE STEP2 Exam
Step2 (Page 32 )

Updated On: 9-Feb-2026
Page 29 of 149
PDF with 738 Questions

On the first pelvic examination of an 18-yearold nulligravida, a soft, fluctuant mass is found in the superior aspect of the right labia majora. This is asymptomatic. She tells you it has been present for several years and seems to be enlarging slightly. There is no defect in the inguinal ring. Which of the following is the most likely diagnosis?

  1. vulvar varicosities
  2. inguinal hernia
  3. femoral hernia
  4. cyst of the canal of Nuck
  5. granuloma inguinale

Answer(s): D

Explanation:

The most likely diagnosis is a cyst of the canal of Nuck. These arise from inclusions of the peritoneum at the inferior insertion of the round ligament into the labia majora. They are analogous to a spermatic cord hydrocele and are typically found at the superior aspect of the labia majora. Vulvar varicosities usually involve most of the labia, occur in older and parous women, and have a classical "bag of worms" appearance. Given the physical findings, a hernia is unlikely. An ultrasound may be useful to distinguish a hernial sac from a cyst of the canal of Nuck. One-third of women with a cyst of the canal of Nuck may have a coexistent inguinal hernia.



Your patient has just had twins and wonders if there is any way to determine whether the twins are identical. You correctly tell her which of the following?

  1. Close examination of the placenta can often provide this answer.
  2. There is no way to tell unless one is a girl and one a boy.
  3. Only matching of human lymphocyte antigens could determine this with certainty.
  4. Identical twins occur only once in about 80 births of twins.
  5. It is unlikely because the birth weights differed by more than 200 g.

Answer(s): C

Explanation:

Different-sex twins must be dizygous. Prenatal ultrasound can detect monochorionic, monoamnionic twins, and these must be monozygous. For same-sex twins, careful examination of the amniotic membranes after birth can reveal monozygous twins if the placental membranes are monochorionic. Dichorionic membranes can occur with either monozygous or dizygous twins. Ultimately, assessment of DNA polymorphism is the best way to determine twin zygosity



An 11-year-old girl has her first menses. Both ovaries contain approximately how many oocytes?

  1. 7 million
  2. 1 million
  3. 500,000
  4. 50,000
  5. 5000

Answer(s): C

Explanation:

The maximum number of oocytes is 67 million at approximately 20 gestational weeks. At birth, the number of oocytes has decreased to about 1 million, and the number at puberty is 300,000500,000. Women at menopause still have a small number of oocytes, a number insufficient to produce an amount of estrogen to prevent vasomotor symptoms. By simple mathematics, women lose approximately 1000 oocytes per menstrual cycle: one by ovulation and the remainder by follicular atresia.



A healthy 29-year-old gravida 2 woman at 39 weeks has been in labor for 3 hours. She had a positive vaginal-anal culture for GBS at 37 weeks' gestation. Which one of the following statements is correct?

  1. Asymptomatic rectovaginal colonization is present in 60% of pregnant women.
  2. The transmission rate from mother to baby is approximately 25%.
  3. A rectovaginal culture should have been obtained at the first prenatal visit.
  4. Neonatal sepsis occurs in 1% of colonized mothers.
  5. Treatment with penicillin in labor is necessary only for heavy colonized mothers.

Answer(s): D

Explanation:

Approximately 20% of pregnant women have positive rectovaginal cultures. Vertical transmission rate from mother to baby is approximately 75%. A rectovaginal culture is not indicated at the first prenatal visit because the pregnant woman may subsequently convert from a negative to a positive culture. For this reason, all pregnant women should have a rectovaginal culture at 3637 gestational weeks. If the woman goes into preterm labor before a culture is obtained, she should be treated with penicillin (gentamicin if she is penicillin allergic). The rate of neonatal sepsis is 1% of colonized mothers, a serious infection that may cause pneumonia, meningitis, and death.



Which of the following statements is true regarding contraception?

  1. The vaginal contraceptive ring is changed weekly for 3 consecutive weeks, then removed for 1 week to allow for withdrawal bleeding.
  2. Because of effects on the cytochrome P450 system, Depo-Provera should not be used in patients taking antiepileptic drugs (e.g., phenytoin).
  3. Amenorrhea while using the levonorgestrel ntrauterine system (IUD) should raise concern immediately for ectopic pregnancy.
  4. A diaphragm should be inserted no more than 6 hours before intercourse and should remain in place about 6 hours after intercourse.
  5. Failure rate for tubal ligation over 10 years is less than 1 pregnancy per 1000 surgeries performed.

Answer(s): D

Explanation:

Diaphragms can be used successfully for contraception with proper patient education and motivation.
Proper fitting is most important for efficacy. The diaphragm should be coated with spermicide prior to insertion (within the dome and along the rim), and inserted no more than 6 hours before intercourse is planned. Conversely, the device should be left in place at least 6 hours but no more than 24 hours after intercourse. If multiple episodes of intercourse take place, additional spermicide should be used. The vaginal ring is designed to be worn for 3 consecutive weeks (i.e., one ring, not three rings changed weekly) and then removed for 1 week. Depo- Provera does not affect liver enzymes but actually increases the seizure threshold, making it a great choice for patients with seizure disorders. Amenorrhea is common (20- 60%) with patients using the levonorgestrel IUD, and is so effective in preventing pregnancy that this symptom should not raise alarm (as long as other pregnancy symptoms --e.g., nausea and breast tenderness--are not present). Over 10 years, tubal ligation failure rates approach 1 per 100 procedures






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