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Practice Test 2 - USMLE Step 3

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

  1. A 34-year-old G2P2 woman at her 6-week postpartum visit reports leaking urine when she coughs, sneezes, or lifts her baby. She did not have this issue before her recent vaginal delivery of a 4200-g infant. A pelvic exam is normal, and a urinalysis is negative. What is the most appropriate initial recommendation?
  2. Which of the following is the most appropriate next step in management?
  3. Which of the following is the most appropriate initial pharmacologic treatment for this patient's condition?
  4. In discussing prognosis with the family, which factor is the most critical determinant of his high mortality risk?
  5. Which of the following is the most appropriate next step in the management of her hyperlipidemia?
  6. In addition to continuing individual therapy, which of the following interventions has the most robust evidence for improving outcomes in this patient?
  7. HPI/PP Course: 35F G3P3, 2 weeks postpartum after cesarean delivery, presents with unilateral leg swelling and calf pain. No chest pain. PMH: obesity and smoker; no thrombophilia history. Exam: left calf tender, 3 cm larger than right. Vitals stable. She is breastfeeding and asks about safety of medications and future pregnancy timing. Which complication is the patient most at risk for?
  8. This change in mental status is most concerning for which of the following underlying processes, significantly worsening his prognosis?
  9. A 65-year-old man was admitted with an acute pulmonary embolism and started on enoxaparin 1 mg/kg twice daily and warfarin 5 mg daily. It is now hospital day 5. The patient is clinically stable, and his morning INR result is 1.7. What is the most appropriate management step?
  10. A 65-year-old woman with a history of CKD stage G3a (baseline eGFR ~55 mL/min/1.73m²) presents with a 2-week history of nausea and poor oral intake. Her medications include valsartan and atorvastatin. Laboratory studies today show a BUN of 80 mg/dL and a serum creatinine of 2.5 mg/dL (eGFR 22 mL/min/1.73m²). Her blood pressure is 110/70 mmHg. Urinalysis is bland. A renal ultrasound shows normal-sized kidneys without hydronephrosis.
  11. A 72-year-old man with a 40-pack-year smoking history and type 2 diabetes presents with a 6-month history of cramping pain in his right calf that occurs after walking two blocks and is relieved by 5 minutes of rest. His ankle-brachial index is 0.65 on the right and 0.95 on the left. He is currently taking metformin and low-dose aspirin. In addition to counseling on smoking cessation and recommending a supervised exercise program, which of the following is the most appropriate addition to his medical regimen?
  12. What is the most appropriate management for this patient at this time?
  13. A 75-year-old woman with a history of hypertension and diabetes presents for follow-up of her heart failure with preserved ejection fraction (HFpEF, LVEF 55%). She reports persistent dyspnea on exertion. Her blood pressure is 135/82 mmHg, and she has trace pedal edema. Current medications include lisinopril, amlodipine, and a low dose of furosemide. Which of the following interventions is most likely to improve her heart failure-related outcomes?
  14. What is the most important responsibility of the ward physician regarding his amiodarone therapy?
  15. What is the most appropriate recommendation regarding future cervical cancer screening for this patient?
  16. Which of the following is the most appropriate immediate action?
  17. In addition to optimal medical therapy with an antiplatelet, statin, and antihypertensive, which of the following interventions is most appropriate?
  18. A 45-year-old woman is evaluated after completing 3 months of apixaban for a first-time unprovoked pulmonary embolism. She feels well and has no complaints. Her medical history is otherwise unremarkable, and she is calculated to have a low risk of bleeding. Which of the following is the most appropriate recommendation?
  19. Screening: sensitivity 90%, specificity 95%, prevalence 1%, 10,000. Fraction of positives that are false?
  20. A 58-year-old man underwent a low anterior resection with a diverting loop ileostomy for rectal cancer. His postoperative course was complicated by a small, contained anastomotic leak diagnosed on POD 7, which was successfully managed non-operatively with bowel rest and IV antibiotics. He is now 4 weeks post-surgery, feeling well, and tolerating a diet. He is being seen to discuss the next steps in his care.

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