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USMLE STEP2 Exam Questions
Step2 (Page 28 )

Updated On: 24-Feb-2026
Page 28 of 149
PDF with 738 Questions

At a follow-up routine prenatal visit, the uterine fundus of a healthy 23-year-old pregnant woman is palpated halfway between her symphysis pubis and umbilicus. Which of the following is the most appropriate test to order at this stage of her pregnancy?

  1. serum human immunodeficiency virus (HIV) titer
  2. glucose tolerance test
  3. amniocentesis
  4. maternal serum alpha-fetoprotein (MSAFP)
  5. cervical culture for group B Streptococcus (GBS)

Answer(s): D

Explanation:

The fundal height corresponds to 16 gestational weeks. Between 15 and 20 weeks, screening for open neural tube defects should be offered. In addition to MSAFP, the American College of Obstetricians and Gynecologists recommends hCG and unconjugated estriol to screen for Down syndrome and trisomy 18 as well. This triad of tests is called a triple screen or triple marker screen. Reported sensitivity of the triple screen is between 57 and 67% and the false positive rate is 5%. An abnormal result must be evaluated further by ultrasonography to identify the presence or absence of open neural tube defects or abdominal wall defects (increased MSAFP) or trisomy disorder (decreased MSAFP and unconjugated estriol, increased hCG). In skilled hands, an ultrasound reduces the risk of such an anomaly by 95%. If the diagnosis is still uncertain, the woman should be offered amniocentesis for measurement of alpha- fetoprotein
(AFP) and acetylcholinesterase activity (increased in neural tube defects) and karyotype of fetal skin cells.
Although testing for HIV can be done any time, it is most appropriate at the first prenatal visit, because earlier onset of prophylaxis with acquired immune deficiency syndrome (AIDS) drugs reduces the risk of transmission to the fetus significantly. Routine culture for GBS is not recommended because of the high recurrence rate after treatment and the low attack rate to the fetus. Amniocentesis is not a screening procedure and is reserved for those women with a specific indication, such as elevated MSAFP, low MSAFP (risk of Down syndrome), advanced maternal age, and others. A glucose tolerance test may be appropriate if there is a clinical indication for diabetes mellitus: previous macrosomic infant or stillbirth, strong family history of diabetes mellitus, persistent glycosuria, previous gestational diabetes, or elevated random serum glucose concentration.



A 58-year-old woman with stage II epithelial ovarian cancer undergoes successful surgical debulking followed by chemotherapy with carboplatin and radiation therapy. Subsequently, she develops nonpitting edema of both legs and pain and numbness in her legs. Which of the following is the most likely cause of her pain and numbness?

  1. nerve damage caused by the pelvic lymphadenectomy
  2. lymphedema
  3. carboplatin therapy
  4. radiation therapy
  5. recurrent ovarian cancer

Answer(s): C

Explanation:

The nonpitting edema of her legs is likely the result of lymphedema. This may cause discomfort or pain in her legs, but not hypesthesia. The most likely cause of the peripheral neuropathy is the carboplatin. Toxicity at doses higher than 100 mg/m2 limit its use and also limit the ability to study various doses alone and in combination with other chemotherapeutic agents, such as paclitaxel (Taxol), which may also cause peripheral neuropathy. Nonetheless, the combination of tumor debulking, pelvic and paraaortic lymph node dissection, combination paclitaxel and carboplatin, and radiation offers the longest disease-free interval.



A13-year-old girl had growth of breast buds at 11 years, followed by the appearance of pubic hair between the ages of 11 1/2 and 12 years. Which pubertal event is most likely to occur next?

  1. beginning of accelerated growth
  2. menarche
  3. Tanner stage 5 breast development
  4. maximal growth rate
  5. Tanner stage 5 pubic hair

Answer(s): D

Explanation:

The mean age of onset of any pubertal event is approximately 11 years, beginning with the appearance of breast buds. Pubic hair appears approximately 6 months later, and this is followed by the peak height velocity (greatest rate of linear growth per unit time). Six to 12 months later, menstrual bleeding begins.
Increased rate of growth begins early in the pubertal process. The sequence of pubertal events and the approximate age of appearance of each event is sufficiently predictable that significant variation in age of onset or sequence should lead to an evaluation of a cause of abnormal puberty.



An 18-year-old nullipara has suddenly stopped menstruating. She recently lost 8.6 kg when she started long-distance running. The laboratory test most consistent with her cause of secondary amenorrhea is which of the following?

  1. a serum prolactin level of 86 ng/mL normal <20)
  2. a serum LH level of 48 mIU/mL (normal 635)
  3. a serum estradiol level of 128 pg/mL (normal 40300)
  4. a serum FSH level of 3 mIU/mL (normal 518)
  5. a serum testosterone level of 156 ng/dL (normal 40110)

Answer(s): D

Explanation:

Women with amenorrhea owing to weight loss and stress have decreased hypothalamic secretion of GnRH, and secondarily decreased serum levels of FSH and LH. As a consequence, serum estradiol levels will be low. While women with weight loss amenorrhea may have mild hirsutism, it is probably the result of a decreased estrogen secretion and decreased estrogen: androgen ratio, rather than an increase in serum testosterone levels.



A 22-year-old woman with cystic fibrosis is engaged to be married and asks you about childbearing.
How should you advise her?

  1. An amniocentesis should be done to detect fetal cystic fibrosis.
  2. Pregnancy is contraindicated because maternal mortality is significantly increased.
  3. Her children have a 25% chance of having cystic fibrosis.
  4. Pregnancy and delivery are usually successful with special care and precautions.
  5. She should use nasal oxygen throughout pregnancy to minimize fetal hypoxemia.

Answer(s): D

Explanation:

With improved care, women with cystic fibrosis now survive into the reproductive age and are capable of carrying a pregnancy successfully. No special precautions such as prolonged hospitalization, oxygen supplementation, bed rest, or others are necessary. Likewise, there is no need for routine cesarean section or other labor modifications, except ensuring adequate hydration and normal serum electrolytes. An amniocentesis is unnecessary. There is no constituent of amniotic fluid that is diagnostic of cystic fibrosis.
Also, the fetus is at risk for cystic fibrosis only if the father is a carrier. If not, the fetus will be a carrier only.
Chorionic villus biopsy can be done to determine whether the fetus has cystic fibrosis if the father carries one of the 150+ alleles for cystic fibrosis or the couple had a previously affected child. It is becoming the standard of care to screen routinely pregnant women for the cystic fibrosis gene.
Currently, routine screening will identify approximately 80% of carriers of the cystic fibrosis gene.






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