Practice Test 1 - USMLE Step 3
20 questions. Answer them in any order, then submit to see your score and every explanation.
- Patient takes warfarin after unprovoked PE 9 months ago. Elective surgery in 5 days. Plan?
- A 65-year-old man with alcoholic cirrhosis underwent a TIPS procedure four weeks ago for refractory ascites. His ascites has resolved, but his family brings him to the clinic for worsening confusion and daytime sleepiness. On examination, he is disoriented to time and place and has prominent asterixis. He is taking lactulose twice daily. What is the most likely cause of his neurologic decline?
- A 55-year-old man with HFrEF complains of persistent daytime sleepiness. His partner notes that he snores loudly and has episodes where he stops breathing during sleep. His BMI is 34 kg/m². What is the most appropriate next step in the management of this patient's symptoms?
- A 33-year-old G1P1 is seen at her 3-month postpartum visit. She reports that she and her partner have attempted to resume intercourse, but she experiences significant pain and vaginal dryness. She is exclusively breastfeeding. Her pelvic examination is normal, with a well-healed second-degree perineal laceration and no signs of infection. The vaginal mucosa appears pale and thin.
- Which of the following is the most critical document for the physician to prepare to ensure the child's safety at school?
- A 64-year-old man with HFrEF and moderate osteoarthritis of the knees calls your office. He reports a flare of knee pain and asks if he can take over-the-counter ibuprofen for a few days. He is otherwise stable on his heart failure regimen. What is the most appropriate advice?
- History & Lifestyle: 50-year-old man here for routine check-up. • Smokes 1 pack/day x 25 years. • Works desk job; no regular exercise. • BMI 29; waist circumference increased. • Diet high in saturated fat. • No known diabetes. Family History: Brother had MI at 52; father had stroke at 60. Preventive Care Review: No lipid testing in >10 years; no statin therapy. BP today 132/84. He asks what screening is needed to reduce cardiovascular risk. Exam is normal. Clinician counsels on smoking cessation, weight loss, and physical activity. Guidelines support primary prevention risk stratification using standard labs. What is the next best step in preventive care for this patient?
- A 45-year-old man is in the ICU on postoperative day 3 following an emergency laparotomy for a perforated duodenal ulcer. He remains intubated and sedated. He has been NPO with maintenance IV fluids. His abdomen is distended with absent bowel sounds. His hemodynamic status is stable on low-dose vasopressors.
- What is the most appropriate discharge plan to coordinate this patient's care?
- Which of the following is the most appropriate primary management strategy for this patient?
- Which of the following is the most appropriate approach to conducting the clinical interview?
- Which of the following is the most likely diagnosis?
- Which of the following is the most appropriate management regarding screening for an abdominal aortic aneurysm?
- A 68-year-old asymptomatic man with a long history of smoking undergoes an abdominal ultrasound for evaluation of gallstones. The study incidentally identifies a fusiform infrarenal abdominal aortic aneurysm measuring 4.2 cm in maximal diameter. His blood pressure is 138/84 mmHg. Which of the following is the most appropriate surveillance recommendation for this finding?
- Which of the following is the most appropriate modification to his antithrombotic regimen?
- A 77-year-old woman with HFpEF is hospitalized for a non-ST elevation myocardial infarction and undergoes successful percutaneous coronary intervention. She is discharged on dual antiplatelet therapy, a high-intensity statin, metoprolol succinate, and lisinopril. Which of the following aspects of her longitudinal care is most critical for her secondary prevention?
- A 62-year-old man sustained major trauma and developed a PE. Due to an associated intracranial hemorrhage, a retrievable IVC filter was placed. It is now 3 months later, his intracranial hemorrhage has resolved, and he is considered neurologically stable. Which of the following is the most appropriate management plan?
- Which of the following is the most appropriate next step in her management?
- A 56-year-old woman has CKD stage 3b for 5 years from hypertension; she limits sodium and takes lisinopril 20 mg daily and amlodipine 10 mg daily. She develops chronic knee pain from osteoarthritis and asks about analgesics. BP is 124/76 mm Hg. Exam shows knee crepitus. Labs: creatinine 1.9 mg/dL, eGFR 37 mL/min/1.73 m², K 4.6 mEq/L. What is the next best step in managing this patient's CKD?
- Which of the following is the most appropriate initial advice for the mother?