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Practice Test 5 - USMLE Step 3

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

  1. A 38-year-old woman is seen for a 3-month follow-up visit after being diagnosed with a PE provoked by a 14-hour flight. She has been taking apixaban, and her symptoms have completely resolved. She is concerned and asks if she needs another CT scan to see if the clot has dissolved. What is the most appropriate response?
  2. A 62-year-old man on maintenance hemodialysis three times weekly has a hemoglobin of 9.8 g/dL despite a stable dose of epoetin alfa for the past 3 months. His blood pressure is well-controlled. Further laboratory studies are ordered to evaluate for iron deficiency. Which of the following sets of results would be most consistent with absolute iron deficiency requiring intravenous iron supplementation in this patient?
  3. After 6 months of apixaban for PE, her breast cancer still requires chemotherapy. Best plan?
  4. A 34-year-old woman presents with newly diagnosed hypertension. Her blood pressure is 170/105 mmHg. She has no family history of hypertension, a BMI of 22 kg/m², and does not use tobacco. On examination, a faint bruit is audible just to the right of the umbilicus. Initial laboratory studies, including serum electrolytes and creatinine, are within normal limits. Which of the following is the most appropriate next diagnostic test?
  5. A 29-year-old G2P1 presents for interpregnancy counseling. Her first pregnancy resulted in a spontaneous preterm birth at 32 weeks' gestation. She has no history of uterine surgery or cervical procedures. She has no other significant medical history and wishes to conceive again in the next year. She asks what can be done to reduce her risk of another preterm birth.
  6. A 55-year-old woman with autosomal dominant polycystic kidney disease has a progressively declining eGFR, which is now 19 mL/min/1.73m². She is currently asymptomatic and is being managed in a nephrology clinic. She is interested in in-center hemodialysis as her future renal replacement therapy.
  7. Dialysis patient with tunneled catheter has fever and S. aureus bacteremia. Best next step?
  8. Stable HFrEF on furosemide 40 mg daily. Weight up 3 lb in 2 days, no dyspnea. Best advice?
  9. What is the most likely reason for the persistently elevated serology?
  10. Measles R0=15, vaccine fully protective. Minimum coverage for herd immunity?
  11. History & Lifestyle: 25-year-old woman at wellness visit. • Sexually active; condoms inconsistent. • Not pregnant. • No prior hepatitis C screening; no injection drug use. Family History: Noncontributory. Preventive Care Review: Up to date on Pap; wants recommended infectious disease screening based on age cohort. Based on the vignette, which screening test is recommended for this patient?
  12. Which of the following best predicts the patient's long-term morbidity and mortality after surviving this critical illness?
  13. Two days after knee surgery, a 45-year-old woman on prophylactic LMWH develops sudden dyspnea and syncope; BP 82/50, HR 128; bedside echo shows RV dilation. Which intervention is most critical at this stage of care?​
  14. A 30-year-old G1P1 who is 4 weeks postpartum and exclusively breastfeeding presents with a 2-day history of right breast pain, swelling, and redness. She also reports fever and chills. Her temperature is 38.8°C (101.8°F). Examination reveals a 5-cm, indurated, erythematous, and tender area in the upper outer quadrant of the right breast. There is no palpable fluctuance.
  15. A 59-year-old man has CKD stage 3b for 5 years from diabetes; he limits sodium and takes losartan 100 mg daily, empagliflozin 10 mg daily, metformin 500 mg twice daily, and atorvastatin 40 mg nightly. He reports no symptoms. BP is 118/66 mm Hg. Exam is normal. Labs: creatinine 2.1 mg/dL, eGFR 33 mL/min/1.73 m², K 4.8 mEq/L, HCO3 24 mEq/L. Urine albumin-to-creatinine ratio is 120 mg/g. What complication is this patient at highest risk for?
  16. In addition to routine care and counseling, which of the following is the most appropriate next step in management?
  17. An 82-year-old woman with dementia undergoes a hip hemiarthroplasty for a femoral neck fracture. On postoperative day 2, she becomes acutely agitated, disoriented to time and place, and is attempting to pull out her IV lines. Her vital signs are stable, oxygen saturation is 98% on room air, and a recent metabolic panel is unremarkable. Non-pharmacologic interventions like reorientation have failed.
  18. In addition to non-pharmacologic interventions, which of the following is the most appropriate next step in the pharmacologic management of this patient's agitation?
  19. What is the most appropriate next step in this patient's management?
  20. What is the most appropriate screening test for this patient to assess her long-term risk of developing type 2 diabetes?

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