Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 3 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled four cases from Kaplan Medical involving senior patients. Each question comes with an expert explanation of the answer. You can check out all posts in this series.

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Kaplan USMLE Step 3 prep: 4 stumpers involving senior patients

Think you can answer these questions involving women’s health? Find out now.

  1. What to do next in difficult delivery?

    A 34-year-old G1P0 woman at 39 weeks presents for rupture of membranes. The patient felt a gush of fluid one-hour ago, denies vaginal bleeding and is feeling contractions every three to four minutes. She feels the baby moving. The patient's prenatal course has been complicated by gestational diabetes for which she is following a special diet but no medication. She progressed to fully dilated and began pushing 90 minutes ago. The fetal head was delivered 30 seconds ago, and anterior shoulder has not been able to be delivered. The nurses are applying suprapubic pressure. What is the next step in the management of this patient?

  2. How to manage pregnant woman’s lab result?

    A 24-year-old G2P1 woman with intrauterine pregnancy at 17 weeks presents for routine prenatal visit. The patient denies contractions, vaginal bleeding, or leakage of fluid. The patient states that she feels the baby moving. On physical exam the patient's fundal height is 15 cm and a fetal heartbeat is heard. Routine labs are done and the maternal serum alpha-fetoprotein returns low. Which is the next step in the management of this patient?

  3. Woman with abdominal and pelvic pain

    A 27-year-old woman comes to the clinic because of abdominal and pelvic pain. She has experienced pain for two weeks each month for the past six years. She describes the pain as being most severe during each menstrual period; the pain is sometimes associated with nausea. She also tells you that she and her husband have been unable to conceive for the past two years.

    She has no significant past medical history. Her last menstrual period was eight days ago. General physical and pelvic examinations are normal. A hysterosalpingogram performed as an outpatient demonstrates a normal uterus with normal fallopian tubes and spillage into the peritoneum. What is the best next step in management?

  4. What is the woman’s electrolyte abnormality?

    An 82-year-old woman with a history of Alzheimer dementia is brought to the emergency department by her family. Her home health attendant found her collapsed on the floor of her apartment. The patient gradually becomes more alert and conversant after administration of intravenous normal saline for two days. Attempts to feed her orally are unsuccessful, as she has evidence of defective swallowing. The decision is made to place a percutaneous gastrostomy tube to ensure proper nutrition and protect against aspiration. Which is the most likely electrolyte abnormality in this patient?

  5. Rash, weight loss and fatigue

    A 52-year-old woman presents to her physician with a rash that involves her face, back, arms and hands. She denies any recent insect or tick bites, or exposure to poison ivy. Her past medical history is notable for hypertension and diabetes, and she takes hydrochlorothiazide, lisinopril and glyburide. She has been taking these medications for the past three years. She denies smoking, consuming alcohol or using illicit substances.

    Review of systems reveals that she has experienced fatigue and weight loss for about five months. She has also noticed difficulty rising out of a chair. The patient is started on high-dose steroids. What would be the next step in management?

  6. 22-year-old with right lower quadrant pain

    A 22-year-old college student comes to the emergency department with severe right lower quadrant pain. She says the pain started about six hours ago and has progressively worsened. She has no significant medical problems and her only medication is oral contraceptive pills. She is sexually active with one partner, her boyfriend. Her last menstrual period was two weeks ago. Which is the most likely etiology of this patient's symptoms?

  7. What’s next to treat a 58-year-old’s chest pain?

    A 58-year-old woman comes to the emergency department with chest pain that has been going on for the past 30 minutes. The pain truly frightened her because she has a history of coronary artery disease and underwent coronary angiography with angioplasty and stent placement the previous year. The pain is on the left side of her sternum. It does not alter in quality or intensity when she moves in bed to change position or with breathing. Her current medications are aspirin, metoprolol, lisinopril, clopidogrel and atorvastatin. What is the most appropriate management of this patient?

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USMLE Step 3: Tips for balancing rotations with exam prep

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.

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