skip to main content

Endometrial cancer — USMLE Step 2 CK MCQ

Instant feedback + full explanation. One question, done properly.

HardObstetrics & GynecologyEndometrial cancerUSMLE Step 2 CK

A 68-year-old Black woman with obesity and type 2 diabetes has two episodes of postmenopausal bleeding. Transvaginal ultrasonography performed during the initial evaluation shows an 8-mm endometrial thickness and no adnexal mass. What is the most appropriate next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Obtain endometrial tissue sampling for histopathologic evaluation

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

E is correct: postmenopausal bleeding requires prompt evaluation for endometrial cancer, and an 8-mm endometrium is not reassuring. Current ACOG guidance emphasizes tissue sampling in the initial evaluation of most patients, generally with transvaginal ultrasonography; the need is especially important because Black women have higher endometrial-cancer mortality and may have aggressive histology despite less striking sonographic findings. A evaluates the cervix and delays the uterine diagnosis. B is not a diagnostic strategy for endometrial cancer. C may define a focal lesion but does not provide histology. D treats before excluding malignancy.

Reference: ACOG 2026 guidance update: evaluation of postmenopausal bleeding. https://www.acog.org/news/news-releases/2026/04/acog-publishes-updated-guidance-evaluation-postmenopausal-bleeding