Practice Test 10 - USMLE Step 3
20 questions. Answer them in any order, then submit to see your score and every explanation.
- HPI/Interpregnancy: 33F G2P2, 3 months postpartum, not breastfeeding, requests counseling after prior preterm birth at 34 weeks due to preeclampsia. BP today 146/92. She is not on antihypertensives. Wants another pregnancy within 6 months. Labs pending. What counseling should be provided to this patient regarding interpregnancy care?
- HPI/Contraception: 27F G1P1, 3 weeks postpartum, exclusively breastfeeding, requests contraception. PMH: migraine with aura. No smoking. Wants to avoid pregnancy for at least 18 months. Vitals normal. She asks about "the pill." What counseling should be provided to this patient regarding interpregnancy care?
- Which of the following is the most appropriate intervention to reduce this patient's risk of a primary stroke?
- Which of the following is the most appropriate next step in this patient's management?
- HPI/PP Visit: 32F G2P2 at 6-week postpartum check. Reports persistent sadness, guilt, poor sleep even when infant sleeps, low appetite, and difficulty bonding for 3 weeks. Denies mania. Passive thoughts of "family better off," no plan; partner supportive. PMH: depression in college; no current meds. Breastfeeding. Vitals normal; exam unremarkable. She asks if this is "normal baby blues." Interpregnancy: wants to delay pregnancy 2–3 years; open to contraception. Which of the following best describes the condition affecting the patient?
- Elena, 64, stable CAD, overweight, sedentary, LDL 80 on statin; angina only climbing 2 flights. What lifestyle modification would most benefit her?
- A 26-year-old G1P1 is diagnosed with postpartum depression at her 8-week visit after scoring 18 on the Edinburgh Postnatal Depression Scale. She is exclusively breastfeeding her infant and is adamant about continuing. After discussing risks and benefits, she agrees to begin pharmacotherapy in conjunction with psychotherapy. She has no other medical or psychiatric history.
- In addition to being a highly effective contraceptive, which method offers the most substantial reduction in the risk of ovarian cancer?
- Which of the following interventions is most likely to improve her long-term functional outcome?
- Which of the following is the most important element of a coordinated discharge plan to prevent relapse and ensure continuity of care?
- Surveillance ultrasound shows a new 8-mm liver nodule in a cirrhotic liver. What is the next best step?
- In addition to continued glucose monitoring, which of the following is the most appropriate adjustment to her insulin regimen to prevent recurrence?
- A 29-year-old woman is seen for a well-woman visit one year after her first pregnancy, which was complicated by preeclampsia with severe features requiring delivery at 34 weeks. She currently has no symptoms, and her blood pressure is 115/75 mm Hg. In addition to routine health maintenance, which of the following is the most important counseling point for this patient?
- 30 min after delivery, fundus is firm but bleeding soaks a pad every 15 min. Next step?
- What is the most appropriate initial diagnostic step?
- A 70-year-old man with chronic kidney disease stage G4 (eGFR 22 mL/min/1.73m²) reports generalized fatigue and muscle weakness. His laboratory results show a serum bicarbonate level of 18 mEq/L. Physical examination is otherwise unremarkable.
- Which of the following is the most appropriate initial management for this infant?
- Peritoneal dialysis patient receiving ceftazidime; Gram stain of effluent shows gram-positive cocci. Add which drug?
- Which of the following is the most critical step to perform before administering the first injection of extended-release naltrexone?
- According to the USPSTF, which of the following is the most appropriate action regarding screening for intimate partner violence (IPV)?