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Practice Test 7 - USMLE Step 3

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

  1. Which preventive care screening is most indicated for this patient based on his anatomy and risk factors?
  2. In addition to continuing his current medical therapy, which of the following is the most appropriate next step to guide long-term secondary prevention?
  3. Olga, 68, stable CAD, HTN, smoker, wants diet advice; LDL 92 on statin, A1c 6.1. What lifestyle modification would most benefit her?
  4. What is the most appropriate recommendation regarding the duration of his pharmacotherapy?
  5. A 78-year-old woman with a known history of atrial fibrillation for which she takes no anticoagulation is brought to the emergency department for a 3-hour history of sudden, severe pain in her right leg. On examination, the leg is cool and pale from the mid-shin down. She has profound weakness of dorsiflexion and plantar flexion of the foot, and sensation is diminished to light touch. Popliteal, dorsalis pedis, and posterior tibial pulses are absent on the right. After initiating an intravenous heparin infusion, which of the following is the most critical and time-sensitive next step in management?
  6. You are reviewing a pharmaceutical advertisement for a new combined oral contraceptive (COC). A 35-year-old G2P2 who is 3 weeks postpartum, exclusively formula-feeding, and smokes one pack of cigarettes per day asks for a prescription for this new pill. She has no other medical problems.
  7. A federally qualified health center notes that its patient population has a significantly higher rate of uncontrolled type 2 diabetes compared to regional benchmarks. A needs assessment reveals that many patients struggle with food insecurity and live in neighborhoods without access to affordable fresh fruits and vegetables. Which of the following interventions is most likely to address this health disparity at a population level?
  8. A 72-year-old obese man with type 2 diabetes is on postoperative day 7 after an exploratory laparotomy for a perforated diverticulum. While coughing, he feels a sudden 'popping' sensation in his abdomen, followed by a large gush of serosanguinous fluid from his midline incision. The nurse calls you to the bedside.
  9. Which biologic agent would be the most appropriate choice for this patient?
  10. A 28-year-old man is 12 hours postoperative from an intramedullary nail fixation of a right tibial shaft fracture. He is using a patient-controlled analgesia (PCA) pump with morphine. The nurse calls to report that his pain is progressively worsening and is not relieved by additional PCA doses. On examination, the patient's lower leg is tense and exquisitely tender. He reports numbness between his first and second toes. Pain is dramatically increased with passive dorsiflexion of the toes.
  11. Which of the following is the most important counseling point for this patient regarding his future health?
  12. A 29-year-old G2P2 woman presents for a postpartum visit 4 months after an uncomplicated vaginal delivery. She missed her scheduled 6-week appointment due to childcare issues. She feels well overall and is using condoms for contraception. Her pregnancy was notable for a blood pressure of 135/85 mm Hg at 38 weeks, which resolved after delivery. She is not breastfeeding. In addition to a general physical and pelvic examination, which of the following is the most important assessment to perform at this visit?
  13. A 68-year-old woman on rivaroxaban for unprovoked PE (18 months ago) presents for routine follow-up. Risk factors include obesity and prior DVT; no malignancy. She reports progressive fatigue and exertional dyspnea but no chest pain. She denies overt bleeding. Vitals: HR 92, BP 122/74, SpO2 97% RA. Labs: Hgb 8.9 g/dL (baseline 12.9), MCV 72 fL, platelets 310k, creatinine 1.1 mg/dL (eGFR 60 mL/min/1.73 m²), INR 1.2. Stool guaiac is positive. What is the most appropriate next step in management for this patient?
  14. A 28-year-old healthy woman presents with a six-month history of intermittent abdominal cramping, bloating, and loose stools, often worse with stress. She denies weight loss, rectal bleeding, or nocturnal symptoms. Physical examination is normal. A complete blood count, celiac serologies, and C-reactive protein are all within normal limits. Which of the following management strategies best demonstrates appropriate resource stewardship?
  15. Which of the following is the most appropriate next step in managing his ADHD?
  16. Which of the following is the most appropriate next step?
  17. A 67-year-old man with stable NYHA Class II HFrEF is seen for a routine annual visit in October. His medications are optimized. He has no new complaints. In addition to managing his heart failure medications, which of the following preventive health interventions is most important to administer or prescribe at this visit?
  18. A 52-year-old man on maintenance hemodialysis has persistent hyperphosphatemia, with a pre-dialysis phosphorus level of 7.5 mg/dL. He has received extensive dietary counseling. He is currently taking calcium acetate 1334 mg (2 tablets) with each meal. His serum calcium is 9.2 mg/dL.
  19. Which of the following is the most appropriate recommendation for pneumococcal vaccination for this patient?
  20. A 68-year-old woman with cirrhosis (Child-Pugh class B) needs an elective inguinal hernia repair. Her preoperative labs show a platelet count of 65,000/mcL and an INR of 1.7. The surgeon is concerned about her bleeding risk and consults you. Which of the following is the most accurate statement to guide perioperative management?

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