Skip to main content
Sign in Create a free account
Varsity Tutors
Sign in Sign up

Practice Test 12 - USMLE Step 3

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

  1. A patient receives a living-related kidney transplant. Immediately after the vascular anastomoses are completed and the kidney is reperfused, the allograft becomes swollen, cyanotic, and flaccid. Urine output, which was briefly present, ceases completely. This event is most likely caused by which of the following?
  2. A 63-year-old man with recurrent PE is on long-term warfarin, target INR 2.0–3.0, monitored monthly. He presents with 2 days of black tarry stools and dizziness. Risk factors include obesity and prior unprovoked VTE; no cancer. Vitals: BP 96/58, HR 118, SpO2 99% RA. Exam shows pallor. Labs: INR 2.7, Hgb 6.9 g/dL, platelets 240k, creatinine 1.0 mg/dL (eGFR 80 mL/min/1.73 m²). What is the most appropriate next step in management for this patient?
  3. In an oliguric patient with cirrhosis, which urinalysis finding best supports hepatorenal syndrome?
  4. Based on the King's College Criteria, which finding is the most specific indicator of a futile prognosis without transplantation?
  5. Which of the following is the most appropriate next step?
  6. What is the most accurate prognostic information to provide the family regarding the placement of a tracheostomy?
  7. A 55-year-old man with decompensated cirrhosis presents with progressive abdominal distension and dyspnea when supine. He has a history of heavy alcohol use and prior episodes of ascites. He denies fever or abdominal pain. Exam shows tense ascites and mild confusion without focal deficits. Vitals: BP 108/66 mm Hg. Labs: albumin 2.5 g/dL, INR 1.8, creatinine 1.2 mg/dL. Ultrasound confirms large-volume ascites. A therapeutic paracentesis is planned with removal of 7 L. What is the next best step in management for this patient?
  8. A 58-year-old woman with diabetic nephropathy and CKD stage G3b (eGFR 40 mL/min/1.73m²) is on maximally tolerated lisinopril and dapagliflozin. Her blood pressure is 125/78 mmHg. Despite these therapies, her urine albumin-to-creatinine ratio remains elevated at 500 mg/g. Her serum potassium is 5.1 mEq/L. Which medication would be the most appropriate addition to further reduce her risk of CKD progression?
  9. Which of the following orders is most important to include for this patient to prevent a common neurological complication?
  10. Which of the following is the most appropriate initial intervention to manage his CKD-mineral and bone disorder?
  11. In addition to her current medical therapy, which of the following interventions initiated prior to discharge is most likely to reduce her 30-day hospital readmission rate?
  12. A 65-year-old man is on postoperative day 4 from a coronary artery bypass grafting procedure. His indwelling urinary catheter was removed on postoperative day 2. He now complains of new-onset urinary frequency and dysuria. His temperature is 38.5°C (101.3°F).
  13. A 70-year-old woman taking apixaban 5 mg twice daily for a PE two months ago reports increased bruising and an episode of epistaxis that resolved with pressure. She is worried about these side effects. She is hemodynamically stable and her hemoglobin is at baseline. What is the most appropriate next step?
  14. A 65-year-old man is on postoperative day 1 following an elective right hemicolectomy. His past medical history is significant for hypertension, for which he takes oral amlodipine at home. He is currently receiving patient-controlled analgesia and is NPO. His nurse reports a blood pressure of 185/100 mmHg. The patient rates his pain as 3/10. He is afebrile with a heart rate of 95/min. In addition to ensuring adequate analgesia, which of the following is the most appropriate next step to manage his blood pressure?
  15. Which of the following represents the most effective model for coordinating this patient's care?
  16. Which of the following represents the most appropriate plan of care for this patient?
  17. Which of the following is the most appropriate recommendation regarding lung cancer screening for this patient?
  18. A 65-year-old woman with NYHA class II HFrEF (LVEF 35%) and no history of diabetes mellitus is evaluated for medication optimization. She is on maximally tolerated doses of sacubitril/valsartan, metoprolol succinate, and eplerenone. Her eGFR is 55 mL/min/1.73m². You plan to initiate dapagliflozin. Which of the following is the most important counseling point to provide?
  19. A 22-year-old G1P1 woman who underwent a cesarean section 5 days ago for failure to progress presents with a fever of 39.0°C (102.2°F), lower abdominal pain, and foul-smelling lochia. She was started on intravenous clindamycin and gentamicin. After 48 hours of therapy, her fever persists, and she still has significant uterine tenderness. Which of the following is the most appropriate next step?
  20. What is the most appropriate long-term management plan for this patient?

Practice tests