USMLE STEP 3 MOCK EXAM 100 QUESTIONS
AND CORRECT DETAILED ANSWERS FOR
GUARANTEED SUCCESS / NEWEST 2025/2026
GRADED A+||BRAND NEW VERSION!!
1. A 62-year-old man with type 2 diabetes presents with fever, flank pain, and
hypotension. CT scan shows gas in the renal parenchyma. Best next step?
A. Oral ciprofloxacin
B. IV fluids and ceftriaxone
C. Percutaneous drainage only
D. Immediate nephrectomy and IV antibiotics
E. Observation
Emphysematous pyelonephritis is life-threatening and requires urgent surgical
management.
2. A 55-year-old woman with atrial fibrillation on warfarin presents with sudden
severe headache and vomiting. INR is 4.5. Next best step?
A. Vitamin K orally
B. Fresh frozen plasma only
C. Prothrombin complex concentrate + IV vitamin K
D. Platelet transfusion
E. Observation
Suspected intracranial hemorrhage with supratherapeutic INR requires rapid
reversal.
,3. A postoperative patient develops sudden dyspnea, hypotension, and elevated
JVP. ECG shows electrical alternans. Best next step?
A. IV fluids
B. CT angiography
C. Emergent pericardiocentesis
D. Thrombolysis
E. Amiodarone
Findings indicate acute cardiac tamponade.
4. A 29-year-old pregnant woman (32 weeks) presents with BP 170/110,
headache, and visual changes. Next step?
A. Oral labetalol
B. Magnesium sulfate only
C. IV antihypertensives and immediate delivery
D. Bed rest
E. Observe until 37 weeks
Severe preeclampsia requires stabilization and delivery.
5. A patient with COPD exacerbation has pH 7.28, PaCO₂ 60, PaO₂ 55. Best initial
management?
A. Intubation
B. BiPAP
C. Diuretics
D. High-flow oxygen only
E. Chest tube
Noninvasive ventilation improves outcomes in acute hypercapnic respiratory
failure.
,6. A hospitalized patient develops watery diarrhea after antibiotics. Best
diagnostic test?
A. Stool culture
B. Ova and parasites
C. C. difficile toxin PCR
D. Colonoscopy
E. Abdominal CT
Antibiotic-associated diarrhea suggests C. difficile infection.
7. A 70-year-old man presents with painless jaundice and weight loss. CT shows
pancreatic head mass. Best next step?
A. ERCP with stenting only
B. Biopsy before any treatment
C. Surgical resection evaluation (Whipple)
D. Chemotherapy
E. Radiation
Resectable pancreatic cancer should proceed to surgery.
8. A patient with cirrhosis presents with confusion and asterixis. Ammonia is
elevated. First-line therapy?
A. Rifaximin
B. Protein restriction
C. Lactulose
D. Neomycin
E. IV glucose
Lactulose reduces ammonia absorption.
, 9. A trauma patient has BP 80/50, HR 130, flat neck veins, trachea deviated
right. Diagnosis?
A. Cardiac tamponade
B. Pulmonary embolism
C. Tension pneumothorax
D. Hemothorax
E. Neurogenic shock
Classic signs of tension pneumothorax.
10. Best immediate management for the patient in Question 9?
A. Chest X-ray
B. Intubation
C. Needle decompression
D. CT scan
E. Thoracentesis
Life-saving intervention precedes imaging.
11. A patient presents with fever, neck stiffness, and altered mental status. Next
step?
A. CT head
B. Lumbar puncture
C. Empiric IV antibiotics immediately
D. EEG
E. Steroids only
Do not delay antibiotics in suspected bacterial meningitis.
12. A diabetic patient presents with abdominal pain and vomiting. Labs show
glucose 600 mg/dL, ketones positive, pH 7.1. First step?
AND CORRECT DETAILED ANSWERS FOR
GUARANTEED SUCCESS / NEWEST 2025/2026
GRADED A+||BRAND NEW VERSION!!
1. A 62-year-old man with type 2 diabetes presents with fever, flank pain, and
hypotension. CT scan shows gas in the renal parenchyma. Best next step?
A. Oral ciprofloxacin
B. IV fluids and ceftriaxone
C. Percutaneous drainage only
D. Immediate nephrectomy and IV antibiotics
E. Observation
Emphysematous pyelonephritis is life-threatening and requires urgent surgical
management.
2. A 55-year-old woman with atrial fibrillation on warfarin presents with sudden
severe headache and vomiting. INR is 4.5. Next best step?
A. Vitamin K orally
B. Fresh frozen plasma only
C. Prothrombin complex concentrate + IV vitamin K
D. Platelet transfusion
E. Observation
Suspected intracranial hemorrhage with supratherapeutic INR requires rapid
reversal.
,3. A postoperative patient develops sudden dyspnea, hypotension, and elevated
JVP. ECG shows electrical alternans. Best next step?
A. IV fluids
B. CT angiography
C. Emergent pericardiocentesis
D. Thrombolysis
E. Amiodarone
Findings indicate acute cardiac tamponade.
4. A 29-year-old pregnant woman (32 weeks) presents with BP 170/110,
headache, and visual changes. Next step?
A. Oral labetalol
B. Magnesium sulfate only
C. IV antihypertensives and immediate delivery
D. Bed rest
E. Observe until 37 weeks
Severe preeclampsia requires stabilization and delivery.
5. A patient with COPD exacerbation has pH 7.28, PaCO₂ 60, PaO₂ 55. Best initial
management?
A. Intubation
B. BiPAP
C. Diuretics
D. High-flow oxygen only
E. Chest tube
Noninvasive ventilation improves outcomes in acute hypercapnic respiratory
failure.
,6. A hospitalized patient develops watery diarrhea after antibiotics. Best
diagnostic test?
A. Stool culture
B. Ova and parasites
C. C. difficile toxin PCR
D. Colonoscopy
E. Abdominal CT
Antibiotic-associated diarrhea suggests C. difficile infection.
7. A 70-year-old man presents with painless jaundice and weight loss. CT shows
pancreatic head mass. Best next step?
A. ERCP with stenting only
B. Biopsy before any treatment
C. Surgical resection evaluation (Whipple)
D. Chemotherapy
E. Radiation
Resectable pancreatic cancer should proceed to surgery.
8. A patient with cirrhosis presents with confusion and asterixis. Ammonia is
elevated. First-line therapy?
A. Rifaximin
B. Protein restriction
C. Lactulose
D. Neomycin
E. IV glucose
Lactulose reduces ammonia absorption.
, 9. A trauma patient has BP 80/50, HR 130, flat neck veins, trachea deviated
right. Diagnosis?
A. Cardiac tamponade
B. Pulmonary embolism
C. Tension pneumothorax
D. Hemothorax
E. Neurogenic shock
Classic signs of tension pneumothorax.
10. Best immediate management for the patient in Question 9?
A. Chest X-ray
B. Intubation
C. Needle decompression
D. CT scan
E. Thoracentesis
Life-saving intervention precedes imaging.
11. A patient presents with fever, neck stiffness, and altered mental status. Next
step?
A. CT head
B. Lumbar puncture
C. Empiric IV antibiotics immediately
D. EEG
E. Steroids only
Do not delay antibiotics in suspected bacterial meningitis.
12. A diabetic patient presents with abdominal pain and vomiting. Labs show
glucose 600 mg/dL, ketones positive, pH 7.1. First step?
