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Practice Test 6 - USMLE Step 3

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

  1. A primary care clinic implemented a new workflow to improve the rate of depression screening. A run chart is created, plotting the percentage of eligible patients screened each month. The pre-intervention median screening rate was 30%. In the 10 months following the intervention, the monthly screening rates were: 45%, 48%, 42%, 55%, 51%, 49%, 53%, 58%, 56%, 60%. How should this data be interpreted?
  2. A 60-year-old man with no prior medical care presents to the emergency department with confusion and lethargy. Laboratory studies reveal a BUN of 190 mg/dL and serum creatinine of 16.5 mg/dL. He is diagnosed with end-stage renal disease and scheduled for his first hemodialysis session. Near the end of the 2.5-hour session, he becomes agitated, complains of a severe headache, and then experiences a generalized tonic-clonic seizure. This patient's acute neurologic deterioration is best explained by which of the following mechanisms?
  3. A 34-year-old G2P2 with a history of chronic hypertension presents for a routine visit 3 months postpartum. Her last pregnancy was complicated by preeclampsia with severe features. Her blood pressure is well-controlled at 135/85 mm Hg on lisinopril. She states she would like to become pregnant again in the next 1-2 years. She is currently using condoms for contraception.
  4. What is the most appropriate response?
  5. In coordinating this patient's transition from the emergency department to outpatient care, which of the following is the most critical element to communicate to the primary care physician?
  6. What is the most appropriate action by the ward physician regarding this finding?
  7. Which of the following is the most appropriate long-term medical therapy for this condition?
  8. History & Lifestyle: 50-year-old man for preventive visit. • Smokes 1 pack/day; sedentary; BMI 32. • No history of diabetes; last glucose unknown. Family History: Mother with type 2 diabetes; father MI at 57. Preventive Care Review: BP 136/88. No labs in years. He asks about diabetes screening. No symptoms of hyperglycemia. Based on the vignette, which screening test is recommended for this patient?
  9. Which of the following is the most appropriate immediate action to address this medication discrepancy?
  10. Which of the following is the most appropriate next step in her outpatient management?
  11. Paul, 73, 2 weeks post-PCI, on aspirin+clopidogrel, reports black stools and dizziness; BP 96/60. Based on symptoms, what is next best step?
  12. Which of the following is the most appropriate long-term management strategy to discontinue her benzodiazepine use?
  13. Which of the following represents the most effective evidence-based approach for this patient's long-term recovery?
  14. Which of the following is the most appropriate perioperative management plan for this patient's buprenorphine therapy?
  15. Which of the following is the most likely diagnosis?
  16. Which of the following actions by her current physician is most likely to result in a successful transition to adult care?
  17. A 42-year-old woman is undergoing an elective laparoscopic cholecystectomy. Shortly after the induction of anesthesia, her blood pressure rises to 220/130 mmHg and her heart rate to 140/min. The procedure is aborted. After she is stabilized, she mentions having had episodic headaches, sweating, and palpitations for the past year. Which of the following is the most appropriate initial step in her diagnostic workup?
  18. A 35-year-old woman is 4 weeks post-deceased donor kidney transplant. She presents to the clinic with a 3-day history of low-grade fever, malaise, and tenderness over the graft site in her right iliac fossa. Her urine output has decreased over the past 24 hours. Laboratory studies show her serum creatinine has risen from a baseline of 1.2 mg/dL to 2.8 mg/dL. Her tacrolimus level is within the therapeutic range. What is the most likely diagnosis?
  19. Which of the following is the most appropriate next step in management?
  20. What is the most appropriate next step in this patient's care?

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