USMLE Step 2 Quiz: Reproductive Endocrinology Contraception And Gynecologic Oncology
20 questions · exam conditions
0:00
Reproductive Endocrinology Contraception And Gynecologic OncologyQuestion 1 of 20

A 29-year-old G0 with known endometriosis presents with worsening dysmenorrhea and deep dyspareunia despite continuous combined OCPs. She desires pregnancy in 1 year. History: laparoscopic diagnosis 3 years ago. Meds: continuous OCPs and NSAIDs. Exam: posterior uterine tenderness and nodularity of uterosacral ligaments. Pelvic ultrasound shows a 5-cm homogeneous left ovarian cyst consistent with endometrioma. What is the most appropriate management for this patient's condition?

Stop OCPs and manage with NSAIDs alone until attempting conception
Begin GnRH agonist therapy for 12 months without add-back therapy
Laparoscopic cystectomy with excision/ablation of endometriosis lesions
Total hysterectomy with bilateral salpingo-oophorectomy
Switch to cyclic OCPs to allow withdrawal bleeding and reduce pain
← Back to quizzes

USMLE Step 2 Quiz

USMLE Step 2 Quiz: Reproductive Endocrinology Contraception And Gynecologic Oncology

Practice Reproductive Endocrinology Contraception And Gynecologic Oncology in USMLE Step 2 with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Reproductive Endocrinology Contraception And Gynecologic Oncology, giving you a quick way to practice the rules, question types, and explanations that matter most for USMLE Step 2.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A 29-year-old G0 with known endometriosis presents with worsening dysmenorrhea and deep dyspareunia despite continuous combined OCPs. She desires pregnancy in 1 year. History: laparoscopic diagnosis 3 years ago. Meds: continuous OCPs and NSAIDs. Exam: posterior uterine tenderness and nodularity of uterosacral ligaments. Pelvic ultrasound shows a 5-cm homogeneous left ovarian cyst consistent with endometrioma. What is the most appropriate management for this patient's condition?

  1. Stop OCPs and manage with NSAIDs alone until attempting conception
  2. Begin GnRH agonist therapy for 12 months without add-back therapy
  3. Laparoscopic cystectomy with excision/ablation of endometriosis lesions (correct answer)
  4. Total hysterectomy with bilateral salpingo-oophorectomy
  5. Switch to cyclic OCPs to allow withdrawal bleeding and reduce pain
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on surgical management of endometriosis with future fertility desires. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the worsening symptoms despite medical therapy and presence of endometrioma guide the most appropriate clinical decision. The correct choice, laparoscopic cystectomy with excision/ablation of endometriosis lesions, aligns with ASRM guidelines and directly addresses pain relief while preserving fertility. A common mistake is selecting total hysterectomy with bilateral salpingo-oophorectomy, which fails because the patient desires pregnancy in the near future. Teaching strategies include reviewing current guidelines on endometriosis surgery, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 2

28yo with 4 months amenorrhea; progestin withdrawal bleeding occurs. Most likely diagnosis?

  1. Hypothalamic amenorrhea
  2. Polycystic ovary syndrome (correct answer)
  3. Intrauterine adhesions
  4. Premature ovarian failure
Explanation: Withdrawal bleeding after progestin means your endometrium has been primed by estrogen, so the problem is anovulation, not estrogen deficiency or outflow obstruction. In a young woman, PCOS is the most common cause of chronic anovulatory amenorrhea. Hypothalamic amenorrhea is the tempting wrong answer, but it causes low estrogen, so progestin typically produces no withdrawal bleed.

Question 3

Postmenopausal bleeding; biopsy grade 1 endometrioid cancer. Initial treatment?

  1. Complete surgical staging (correct answer)
  2. Progestin therapy alone
  3. Pelvic radiation alone
  4. Systemic chemotherapy alone
Explanation: Grade 1 endometrioid cancer is still invasive endometrial cancer, so initial management is complete surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation. Progestin therapy alone is the tempting option, but it is reserved for atypical hyperplasia or selected patients who want fertility preservation and cannot have surgery; it is not standard initial treatment for documented cancer.

Question 4

28yo with premature ovarian insufficiency. Best long-term therapy?

  1. Combined oral contraceptive
  2. Calcium and vitamin D only
  3. Hormone therapy until age 51 (correct answer)
  4. Long-term bisphosphonates
Explanation: Premature ovarian insufficiency means estrogen deficiency before the usual age of menopause, so hormone therapy until about age 51 replaces that loss and protects bone and cardiovascular health. The tempting wrong answer is combined oral contraceptive; it contains estrogen but is not the preferred long-term replacement for POI. Calcium/vitamin D or bisphosphonates alone fail to treat the underlying estrogen deficiency.

Question 5

BMI 34, unprotected sex 72h ago. Most effective emergency contraception?

  1. Ulipristal acetate 30 mg
  2. Levonorgestrel 1.5 mg tablet
  3. Copper intrauterine device (correct answer)
  4. Combined oral contraceptive
Explanation: The copper IUD is the most effective emergency contraception, works up to 120 hours after unprotected sex, and its efficacy is not reduced by obesity. With BMI 34, oral options are less reliable, so the IUD is preferred. Ulipristal acetate is the best oral choice but is still less effective than the IUD and loses potency at higher BMI.

Question 6

25yo, ASC-US cytology, high-risk HPV negative. Next step?

  1. Immediate colposcopy now
  2. Initiate HPV vaccination
  3. Repeat cytology in 1 year
  4. Routine cytology in 3 years (correct answer)
Explanation: An HPV-negative ASC-US result carries low risk, equivalent to a normal co-test, so you can return to routine screening in 3 years. The tempting wrong answer is repeat cytology in 1 year, but that applies to HPV-positive or unknown HPV status; with negative high-risk HPV, neither colposcopy nor early repeat is needed.

Question 7

A 45-year-old presents with postmenopausal bleeding and ultrasound shows a 5-cm complex adnexal mass without ascites. She is otherwise well. Exam: mobile adnexal mass. Labs: CA-125 normal. What is the most appropriate management for this patient's condition?

  1. Referral to gynecologic oncology for surgical evaluation given postmenopausal complex mass (correct answer)
  2. Reassure and repeat ultrasound in 12 months
  3. Start combined oral contraceptives to shrink the mass
  4. Treat with methotrexate for suspected ectopic pregnancy
  5. Order PET scan as the next diagnostic step
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on management of complex adnexal masses in postmenopausal women. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the postmenopausal status and complex adnexal mass guide the most appropriate clinical decision. The correct choice, referral to gynecologic oncology for surgical evaluation given postmenopausal complex mass, aligns with ACOG guidelines and directly addresses the malignancy risk. A common mistake is selecting reassure and repeat ultrasound in 12 months, which fails because it delays evaluation of a potentially malignant lesion. Teaching strategies include reviewing current guidelines on adnexal mass assessment, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 8

A 32-year-old G0 has irregular menses and infertility. She is a competitive runner with 10-lb weight loss, stress fracture history, and low libido. Meds: none. Exam: BMI 18, bradycardia. Labs: urine hCG negative, FSH low, LH low, estradiol low, prolactin normal, TSH normal. Pelvic ultrasound shows thin endometrium. What is the most likely diagnosis based on the clinical findings?

  1. Polycystic ovary syndrome
  2. Functional hypothalamic amenorrhea (correct answer)
  3. Primary ovarian insufficiency
  4. Hyperprolactinemia due to pituitary adenoma
  5. Late-onset congenital adrenal hyperplasia
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on diagnosis of amenorrhea in underweight athletes. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the low BMI, exercise history, and low gonadotropins guide the most appropriate clinical decision. The correct choice, functional hypothalamic amenorrhea, aligns with Endocrine Society guidelines and directly addresses the energy deficiency etiology. A common mistake is selecting polycystic ovary syndrome, which fails because it typically presents with hyperandrogenism and normal/high gonadotropins. Teaching strategies include reviewing current guidelines on amenorrhea classification, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 9

A 45-year-old presents with postmenopausal bleeding and pelvic mass. Ultrasound shows 8-cm complex adnexal mass and ascites. History: no prior cancers. Meds: none. Exam: nodular cul-de-sac. Labs: CA-125 elevated. What is the most appropriate management for this patient's condition?

  1. Image-guided biopsy of the adnexal mass before any surgery
  2. Laparoscopic cyst drainage and observation
  3. Referral for exploratory laparotomy with staging by gynecologic oncology (correct answer)
  4. Start oral progestin therapy and repeat ultrasound in 3 months
  5. Treat with antibiotics for presumed tubo-ovarian abscess
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on management of suspected ovarian malignancy in postmenopausal women. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the complex adnexal mass, ascites, and elevated CA-125 guide the most appropriate clinical decision. The correct choice, referral for exploratory laparotomy with staging by gynecologic oncology, aligns with NCCN guidelines and directly addresses the high malignancy risk. A common mistake is selecting image-guided biopsy, which fails because it risks tumor seeding in potential ovarian cancer. Teaching strategies include reviewing current guidelines on ovarian cancer staging, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 10

A 45-year-old with postmenopausal bleeding undergoes transvaginal ultrasound showing endometrial thickness 9 mm. History: obesity and chronic anovulation before menopause. Meds: none. Exam: normal cervix, no adnexal mass. Pregnancy test negative. Which diagnostic test is most indicated given the patient's symptoms?

  1. Endometrial biopsy (correct answer)
  2. Serum progesterone level
  3. Pap test with HPV cotesting
  4. Pelvic MRI as the next step
  5. Repeat ultrasound in 3 months
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on evaluation of thickened endometrium in postmenopausal bleeding. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the endometrial thickness of 9 mm and risk factors like obesity guide the most appropriate clinical decision. The correct choice, endometrial biopsy, aligns with ACOG guidelines and directly addresses the risk of hyperplasia or malignancy. A common mistake is selecting repeat ultrasound in 3 months, which fails because it delays necessary tissue diagnosis in a high-risk patient. Teaching strategies include reviewing current guidelines on endometrial sampling, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 11

A 45-year-old presents with postmenopausal bleeding. She is 6 years postmenopause. History: type 2 diabetes and obesity. Meds: metformin. Exam: normal cervix, small uterus. Transvaginal ultrasound shows endometrial thickness 3 mm and no adnexal mass. CBC normal. What is the most appropriate management for this patient's condition?

  1. Endometrial biopsy to rule out hyperplasia or malignancy
  2. Reassurance and outpatient follow-up if bleeding resolves (correct answer)
  3. Hysterosalpingogram to evaluate uterine cavity
  4. Start combined oral contraceptives for bleeding control
  5. Routine Pap test as the next diagnostic step
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on management of postmenopausal bleeding with thin endometrium. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the endometrial thickness of 3 mm on ultrasound guides the most appropriate clinical decision. The correct choice, reassurance and outpatient follow-up if bleeding resolves, aligns with ACOG guidelines and directly addresses the low risk of malignancy. A common mistake is selecting endometrial biopsy, which fails because biopsy is not indicated when thickness is below 4 mm in asymptomatic cases. Teaching strategies include reviewing current guidelines on endometrial evaluation, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 12

A 24-year-old G1P1 seeks long-term contraception. She has migraine with aura occurring monthly. No smoking. Meds: sumatriptan PRN. BP 118/72. Pelvic exam normal; pregnancy test negative. She wants a highly effective reversible method and lighter periods. Which contraceptive method is most suitable for this patient?

  1. Combined ethinyl estradiol/levonorgestrel oral contraceptive
  2. Copper intrauterine device
  3. Levonorgestrel-releasing intrauterine device (correct answer)
  4. Transdermal combined hormonal contraceptive patch
  5. Combined hormonal vaginal ring
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on contraceptive selection in patients with migraine with aura. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the patient's history of migraine with aura and desire for lighter periods guide the most appropriate clinical decision. The correct choice, levonorgestrel-releasing intrauterine device, aligns with US MEC guidelines and directly addresses the patient's need for a non-estrogen method that reduces menstrual flow. A common mistake is selecting combined ethinyl estradiol/levonorgestrel oral contraceptive, which fails because estrogen-containing methods are contraindicated in migraine with aura due to increased stroke risk. Teaching strategies include reviewing current guidelines on contraceptive safety, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 13

A 32-year-old G0 with infertility and irregular cycles has obesity and hirsutism. Meds: none. Exam: BMI 35, acanthosis nigricans. Labs: urine hCG negative, TSH normal, prolactin normal, total testosterone elevated, 17-hydroxyprogesterone normal. She is starting ovulation induction. What is the first-line treatment for this condition?

  1. Letrozole (correct answer)
  2. Combined oral contraceptives
  3. Gonadotropin injections as initial therapy
  4. Bromocriptine
  5. Bilateral oophorectomy
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on ovulation induction in polycystic ovary syndrome. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the clinical features of PCOS and desire for ovulation induction guide the most appropriate clinical decision. The correct choice, letrozole, aligns with ACOG recommendations and directly addresses first-line therapy for anovulatory infertility in PCOS. A common mistake is selecting combined oral contraceptives, which fails because they suppress ovulation rather than induce it. Teaching strategies include reviewing current guidelines on fertility treatments in PCOS, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 14

A 32-year-old G0 presents with infertility and irregular cycles. She reports milky nipple discharge and headaches. Meds: none. Exam: galactorrhea present; visual fields normal. Tests: urine hCG negative, prolactin 85 ng/mL, TSH normal, FSH/LH low-normal. Pelvic ultrasound normal. Which diagnostic test is most indicated given the patient's symptoms?

  1. MRI of the pituitary with contrast (correct answer)
  2. CT scan of the abdomen to evaluate adrenal mass
  3. Hysteroscopy to evaluate the endometrial cavity
  4. Serum CA-125 level
  5. Karyotype analysis for Turner syndrome
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on evaluation of hyperprolactinemia in infertility. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the elevated prolactin, galactorrhea, and headaches guide the most appropriate clinical decision. The correct choice, MRI of the pituitary with contrast, aligns with Endocrine Society guidelines and directly addresses the suspicion for pituitary adenoma. A common mistake is selecting serum CA-125 level, which fails because it is irrelevant to hyperprolactinemia without ovarian pathology. Teaching strategies include reviewing current guidelines on prolactin disorders, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 15

A 24-year-old seeks contraception. She has migraine with aura and a history of DVT 2 years ago after surgery; she is no longer anticoagulated. Meds: sumatriptan PRN. BP 120/76. Pregnancy test negative. She wants a reliable method and prefers to avoid heavier bleeding. Which contraceptive method is most suitable for this patient?

  1. Combined oral contraceptive pill
  2. Levonorgestrel-releasing intrauterine device (correct answer)
  3. Combined hormonal patch
  4. Combined hormonal vaginal ring
  5. Diethylstilbestrol for contraception
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on contraception in patients with thrombosis history and migraine with aura. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the prior DVT and migraine with aura guide the most appropriate clinical decision. The correct choice, levonorgestrel-releasing intrauterine device, aligns with US MEC guidelines and directly addresses the need for a progestin-only method that lightens bleeding. A common mistake is selecting combined oral contraceptive pill, which fails because estrogen is contraindicated due to thrombotic risk. Teaching strategies include reviewing current guidelines on high-risk contraception, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 16

A 24-year-old G2P2 requests contraception 6 weeks postpartum and breastfeeding. History: migraine with aura. Meds: prenatal vitamin. BP 112/70. Pregnancy test negative. She wants a method that will not affect milk supply and is highly effective. Which contraceptive method is most suitable for this patient?

  1. Combined oral contraceptive pill started today
  2. Levonorgestrel-releasing intrauterine device (correct answer)
  3. Transdermal combined hormonal contraceptive patch
  4. Combined hormonal vaginal ring
  5. Ethinyl estradiol emergency contraception as ongoing method
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on postpartum contraception in breastfeeding women with migraine with aura. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the history of migraine with aura and breastfeeding status guide the most appropriate clinical decision. The correct choice, levonorgestrel-releasing intrauterine device, aligns with US MEC guidelines and directly addresses the need for a progestin-only method safe for lactation. A common mistake is selecting combined oral contraceptive pill, which fails because estrogen is contraindicated in migraine with aura and may affect milk supply. Teaching strategies include reviewing current guidelines on postpartum contraception, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 17

A 45-year-old with postmenopausal bleeding has an endometrial biopsy showing endometrioid adenocarcinoma. Ultrasound earlier noted a 6-cm complex right adnexal mass. History: obesity. Meds: none. Exam: mobile uterus, right adnexal fullness. What is the most appropriate management for this patient's condition?

  1. Total hysterectomy with bilateral salpingo-oophorectomy and surgical staging (correct answer)
  2. High-dose combined oral contraceptives as definitive therapy
  3. Observation with repeat biopsy in 6 months
  4. Endometrial ablation to control bleeding
  5. Dilation and curettage only, without further surgery
Explanation: This question tests knowledge in reproductive endocrinology, contraception, and gynecologic oncology, specifically focusing on surgical management of endometrial cancer with adnexal involvement. Understanding the nuances in choosing appropriate diagnostic and management strategies is crucial in patient care. In this scenario, the biopsy-proven endometrioid adenocarcinoma and complex adnexal mass guide the most appropriate clinical decision. The correct choice, total hysterectomy with bilateral salpingo-oophorectomy and surgical staging, aligns with NCCN guidelines and directly addresses comprehensive oncologic treatment. A common mistake is selecting observation with repeat biopsy, which fails because it delays definitive therapy in confirmed malignancy. Teaching strategies include reviewing current guidelines on endometrial cancer staging, understanding the indications and contraindications of various treatments, and practicing with similar clinical scenarios to reinforce learning.

Question 18

A 32-year-old woman and her 34-year-old husband present to the clinic with an inability to conceive. They have been having regular, unprotected intercourse for the past 15 months. The woman reports regular menstrual cycles every 28-30 days. Her medical history is unremarkable. The husband has no significant medical history. Neither partner smokes tobacco or uses illicit drugs.

What is the most appropriate initial step in the evaluation of this couple's infertility?

  1. Hysterosalpingogram
  2. Mid-luteal phase progesterone level
  3. Semen analysis (correct answer)
  4. Trial of clomiphene citrate
Explanation: The initial evaluation of an infertile couple should include an assessment of ovulatory function, tubal and uterine anatomy, and male factors. Semen analysis is a simple, noninvasive, and cost-effective test that can identify male factor infertility, which accounts for up to 50% of cases. Given its high yield and low risk, it is a crucial first step. Hysterosalpingogram is more invasive and is typically performed after semen analysis. A mid-luteal phase progesterone level assesses ovulation, which is likely normal given the patient's regular cycles. Clomiphene citrate is a treatment, and therapy should not be initiated before a diagnosis is established.

Question 19

A 28-year-old woman presents to her primary care physician to discuss contraceptive options. Her medical history is significant for migraine headaches with aura, which occur approximately twice a month. She does not smoke. She desires a highly effective method of contraception.

Which of the following contraceptive methods is contraindicated in this patient?

  1. Copper intrauterine device (IUD)
  2. Combined oral contraceptive pills (correct answer)
  3. Levonorgestrel-releasing IUD
  4. Progestin-only pill
Explanation: Combined hormonal contraceptives (containing both estrogen and progestin) are contraindicated in women with migraine with aura due to an increased risk of ischemic stroke. The estrogen component is believed to be responsible for this risk. Progestin-only methods, such as the progestin-only pill and the levonorgestrel-releasing IUD, as well as non-hormonal methods like the copper IUD, are safe and appropriate alternatives for this patient.

Question 20

A 25-year-old woman undergoes her first routine cervical cancer screening. The cytology result from her Pap test is reported as atypical squamous cells of undetermined significance (ASC-US).

According to current screening guidelines, what is the most appropriate next step in management?

  1. Reflex human papillomavirus (HPV) testing (correct answer)
  2. Immediate colposcopy
  3. Repeat Pap smear in 1 year
  4. Loop electrosurgical excision procedure (LEEP)
Explanation: The preferred management for a Papanicolaou (Pap) test result of ASC-US in a woman aged 25 or older is reflex HPV testing from the same sample. If the HPV test is positive, the patient should be referred for colposcopy. If the HPV test is negative, she can return to routine screening. Repeating the Pap smear in one year is an alternative if HPV testing is not available or was not performed. Immediate colposcopy is indicated for higher-grade lesions (e.g., HSIL) or if the ASC-US result is positive for high-risk HPV. LEEP is a treatment modality, not an initial diagnostic step for ASC-US.