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Practice Test 11 - USMLE Step 3

20 questions. Answer them in any order, then submit to see your score and every explanation.

  1. HPI/Breastfeeding: 26F G1P1, 10 days postpartum, reports nipple pain and infant "clicking" during feeds. Feeds every 2–3 hours but infant seems unsatisfied; 4 wet diapers/day. No fever. Exam: nipples cracked; breasts soft; infant has shallow latch. PMH: none. She wants to continue exclusive breastfeeding and avoid formula if possible. Interpregnancy: asks about lactational amenorrhea and spacing. What is the most appropriate next step in management for this patient?
  2. What is the most appropriate management of her antibiotic therapy?
  3. Robert, 66, BMI 34 with stable CAD asks lifestyle advice; smokes, BP 142/86, LDL 118 on statin. What lifestyle modification would most benefit him?
  4. Which of the following antithrombotic regimens is the most appropriate initial therapy for this patient?
  5. Which of the following is the most appropriate next action?
  6. Which of the following is the most important responsibility of the primary care physician in coordinating this patient's care?
  7. In addition to administering age-appropriate inactivated vaccines, which of the following is the most important recommendation regarding her vaccination status before starting therapy?
  8. Which of the following is the most appropriate next step in management?
  9. Based on this abstract, which of the following is the most appropriate conclusion?
  10. A 54-year-old man on in-center hemodialysis is undergoing dietary counseling. His most recent pre-dialysis laboratory results included a potassium of 6.4 mEq/L and a phosphorus of 6.1 mg/dL. He reports struggling with dietary restrictions. The patient should be advised that which of the following meals is most likely contributing to his electrolyte abnormalities?
  11. A 32-year-old man who works as a chef is diagnosed with acute hepatitis A infection at an urgent care center. He reports symptom onset two days ago. In addition to providing supportive care and counseling the patient on hygiene and transmission, which of the following actions is the physician legally required to take?
  12. A 42-year-old woman wants to donate a kidney to her brother. Her medical history is significant for well-controlled hypertension for the past 3 years, managed with amlodipine. Her blood pressure in the office is 125/78 mm Hg. Her BMI is 28. Laboratory evaluation reveals a serum creatinine of 0.8 mg/dL, an estimated GFR of 95 mL/min/1.73m², and a 24-hour urine collection shows protein excretion of 250 mg. Which of the following is the strongest contraindication to her serving as a living donor?
  13. In addition to counseling on dietary changes and oral hygiene, which of the following is the most important next step?
  14. Which of the following is the most appropriate advice regarding car seat safety for this child?
  15. In addition to a basic metabolic panel and lithium level, which of the following tests is most important to obtain as part of her routine annual monitoring?
  16. Which of the following is the most appropriate initial step in the evaluation of his current symptoms?
  17. Which of the following is the most appropriate change to his medication regimen?
  18. A 55-year-old woman with end-stage renal disease due to polycystic kidney disease had a radiocephalic arteriovenous fistula (AVF) created in her left forearm 10 weeks ago. She is scheduled to begin hemodialysis next week. On examination of the fistula, there is a weak, high-pitched bruit and no palpable thrill. The fistula is small and difficult to palpate. What is the most appropriate next step in her management?
  19. A 72-year-old man with CKD stage G4 (eGFR 26 mL/min/1.73m²), heart failure with reduced ejection fraction, and hypertension is seen for a routine clinic visit. His medications include lisinopril, carvedilol, and furosemide. A routine lab check reveals a serum potassium of 5.9 mEq/L. He is asymptomatic, and his ECG shows no acute changes. In addition to dietary counseling, what is the most appropriate long-term management strategy?
  20. A 57-year-old woman with compensated cirrhosis (Child-Pugh class A) due to autoimmune hepatitis presents with new-onset right knee pain and swelling consistent with an osteoarthritis flare. Her current medications for her liver disease are well-tolerated. Which of the following analgesic medications should be strictly avoided in this patient?

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