The United States Medical Licensing Examination® (USMLE®) Step 3 is a key byway for early residents, who typically take the exam during the first year of the graduate medical education training.

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When juxtaposed with the USMLE Step 1 and Step 2 exams, Step 3 is a more comprehensive exam and tests more in-depth clinical knowledge and decision-making. Because Step 3 covers the core disciplines, it is recommended that you take this exam while your knowledge of these core areas is still fresh. This is especially true for those in more specialized residencies.

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 five of our most popular Step 3 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

Think you can answer these popular questions? Find out now. 

  1. What is the best way to address this patient’s high blood pressure?

    1. A 56-year-old woman comes to the clinic for follow-up of her hypertension and diabetes. She has been on ramipril (minimum dose), metformin and glimepiride. The patient has no symptoms. There has been no protein in the urine in the past. She stopped smoking six months ago. She is meticulous about her diet and ingests almost no salt or saturated fats. She exercises with a stationary bike for 30 minutes, four times a week.
  2. What’s next for teen with a newly enlarged heart?

    1. A 17-year-old boy who is hospitalized for depression on the general psychiatric unit complains of severe chest pain. The pain is worse on inspiration and has been present for about two weeks. His past medical history is significant for depression with multiple suicide gestures for the past five years and seasonal allergies. His only medication is fluoxetine. He tells you that he is not sexually active and denies illicit drug use. Review of systems is significant for a recent bronchitis.
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  3. What’s causing patient’s right lower quadrant pain?

    1. 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.
  4. What are the next steps to manage leg pain?

    1. A 79-year-old man with a medical history of colon cancer presents to the emergency department because of right leg pain below the knee for the past four hours. He has never had pain like this before and rates the pain as nine out of 10 in intensity below the knee. The patient denies shortness of breath. Physical examination is significant for absent dorsalis pedis and posterior tibial pulses in the right lower extremity.
  5. What procedure can help diagnose woman with double vision?

    1. A 36-year-old woman comes to the office complaining of double vision. She says that for the last few weeks she has been feeling “weak all over,” especially at the end of the day. This is also when she thinks her double vision is most noticeable. She reports that she experienced similar symptoms one year ago that persisted for several weeks.

Related Coverage

Kaplan USMLE Step 3 prep: Abdominal pain drives these 4 stumpers

Balancing rotations, Step 3 prep

Finding time to study for Step 3 in the midst of a busy year of residency training can be tough. Get advice on how to do it from three physicians who have done so successfully.

The AMA selected Kaplan as a preferred provider to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. AMA members can save 30% on access to additional study resources, such as Kaplan’s Qbank and High-yield courses. Learn more

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