Massachusetts United States Medical
Licensing Examination Step 3 Questions
And Correct Answers (Verified Answers)
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1. A 58-year-old man with hypertension presents with sudden onset left
flank pain radiating to the groin, nausea, and gross hematuria. Vital
signs show BP 158/92 mmHg and HR 88 bpm. Noncontrast CT of the
abdomen reveals a 6 mm stone in the proximal ureter. What is the
most appropriate next step?
A. Intravenous pyelogram
B. Immediate ureteroscopy
C. Medical expulsive therapy with alpha-blocker
D. Percutaneous nephrolithotomy
Administering an alpha-blocker facilitates passage of ureteral stones
≤10 mm and is appropriate initial management in stable patients.
2. A 25-year-old woman presents with fever, dysuria, and urinary
urgency. Urinalysis shows positive nitrites and leukocyte esterase. She
has no allergy history. What is the best initial antibiotic choice?
A. Amoxicillin
B. Ciprofloxacin
C. Trimethoprim alone
D. Trimethoprim–sulfamethoxazole
Trimethoprim–sulfamethoxazole is a first-line agent for
uncomplicated UTI in patients without allergies or contraindications.
3. A 45-year-old man with chronic hepatitis C presents with fatigue. Labs
show AST 78, ALT 85, and platelets 95,000/mm³. FibroScan suggests
advanced fibrosis. What’s the next best step?
, A. Repeat liver enzymes in 3 months
B. Evaluate for hepatocellular carcinoma surveillance
C. Begin prednisone therapy
D. Immediate liver transplant
Advanced fibrosis from hepatitis C warrants hepatocellular
carcinoma surveillance with imaging every 6 months.
4. A 68-year-old man presents with progressive shortness of breath on
exertion and a chronic productive cough. He has a 50-pack-year
smoking history. Exam reveals diffuse wheezes and decreased breath
sounds. Spirometry shows FEV₁/FVC <0.7 with no significant
reversibility. What is the likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Pulmonary fibrosis
D. Bronchiectasis
COPD is characterized by persistent airflow limitation (FEV₁/FVC <0.7)
without significant reversibility.
5. A 30-year-old woman at 28 weeks gestation presents with severe right
upper quadrant pain, nausea, and vomiting. Labs show elevated AST
and ALT, low platelets, and hemolysis. What is the most likely
diagnosis?
A. Acute fatty liver of pregnancy
B. HELLP syndrome
C. Intrahepatic cholestasis of pregnancy
D. Hyperemesis gravidarum
HELLP syndrome presents with hemolysis, elevated liver enzymes,
and low platelets in the third trimester.
6. A 60-year-old man with chronic atrial fibrillation on warfarin presents
with acute left arm weakness and slurred speech. CT of the head
shows no hemorrhage. What is the next best step?
A. Endarterectomy
B. Thrombolytic therapy
C. Immediate anticoagulant reversal
D. Observe and repeat imaging
, In acute ischemic stroke within the treatment window, thrombolytic
therapy is indicated if no hemorrhage.
7. A 50-year-old woman presents with polyuria, polydipsia, and fatigue.
Labs show glucose 322 mg/dL, bicarbonate 18 mEq/L, and positive
serum ketones. What is the initial treatment?
A. Oral hypoglycemic agents
B. Subcutaneous insulin only
C. Intravenous fluids and insulin
D. Dapagliflozin
DKA requires prompt IV fluids and insulin to correct dehydration and
hyperglycemia.
8. A 23-year-old man presents with testicular pain and swelling. The
cremasteric reflex is absent on the affected side. What is the most
likely diagnosis?
A. Epididymitis
B. Testicular torsion
C. Inguinal hernia
D. Hydrocele
Absence of the cremasteric reflex is a key sign of testicular torsion.
9. A 40-year-old woman has a screening mammogram showing a
suspicious mass. Biopsy reveals invasive ductal carcinoma, estrogen
receptor–positive. What is the most appropriate adjuvant therapy?
A. Chemotherapy only
B. Hormonal therapy with tamoxifen
C. Radiotherapy only
D. No adjuvant therapy
ER-positive breast cancer benefits from hormonal therapy to reduce
recurrence risk.
10. A 55-year-old man presents with dysphagia for solids that
progressively worsened over 6 months. Barium swallow shows
corkscrew esophagus. What is the diagnosis?
A. Achalasia
B. Diffuse esophageal spasm
C. Esophageal cancer
D. Zenker diverticulum
Licensing Examination Step 3 Questions
And Correct Answers (Verified Answers)
Plus Rationale 2026 Q&A| Instant
Download Pdf
1. A 58-year-old man with hypertension presents with sudden onset left
flank pain radiating to the groin, nausea, and gross hematuria. Vital
signs show BP 158/92 mmHg and HR 88 bpm. Noncontrast CT of the
abdomen reveals a 6 mm stone in the proximal ureter. What is the
most appropriate next step?
A. Intravenous pyelogram
B. Immediate ureteroscopy
C. Medical expulsive therapy with alpha-blocker
D. Percutaneous nephrolithotomy
Administering an alpha-blocker facilitates passage of ureteral stones
≤10 mm and is appropriate initial management in stable patients.
2. A 25-year-old woman presents with fever, dysuria, and urinary
urgency. Urinalysis shows positive nitrites and leukocyte esterase. She
has no allergy history. What is the best initial antibiotic choice?
A. Amoxicillin
B. Ciprofloxacin
C. Trimethoprim alone
D. Trimethoprim–sulfamethoxazole
Trimethoprim–sulfamethoxazole is a first-line agent for
uncomplicated UTI in patients without allergies or contraindications.
3. A 45-year-old man with chronic hepatitis C presents with fatigue. Labs
show AST 78, ALT 85, and platelets 95,000/mm³. FibroScan suggests
advanced fibrosis. What’s the next best step?
, A. Repeat liver enzymes in 3 months
B. Evaluate for hepatocellular carcinoma surveillance
C. Begin prednisone therapy
D. Immediate liver transplant
Advanced fibrosis from hepatitis C warrants hepatocellular
carcinoma surveillance with imaging every 6 months.
4. A 68-year-old man presents with progressive shortness of breath on
exertion and a chronic productive cough. He has a 50-pack-year
smoking history. Exam reveals diffuse wheezes and decreased breath
sounds. Spirometry shows FEV₁/FVC <0.7 with no significant
reversibility. What is the likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease
C. Pulmonary fibrosis
D. Bronchiectasis
COPD is characterized by persistent airflow limitation (FEV₁/FVC <0.7)
without significant reversibility.
5. A 30-year-old woman at 28 weeks gestation presents with severe right
upper quadrant pain, nausea, and vomiting. Labs show elevated AST
and ALT, low platelets, and hemolysis. What is the most likely
diagnosis?
A. Acute fatty liver of pregnancy
B. HELLP syndrome
C. Intrahepatic cholestasis of pregnancy
D. Hyperemesis gravidarum
HELLP syndrome presents with hemolysis, elevated liver enzymes,
and low platelets in the third trimester.
6. A 60-year-old man with chronic atrial fibrillation on warfarin presents
with acute left arm weakness and slurred speech. CT of the head
shows no hemorrhage. What is the next best step?
A. Endarterectomy
B. Thrombolytic therapy
C. Immediate anticoagulant reversal
D. Observe and repeat imaging
, In acute ischemic stroke within the treatment window, thrombolytic
therapy is indicated if no hemorrhage.
7. A 50-year-old woman presents with polyuria, polydipsia, and fatigue.
Labs show glucose 322 mg/dL, bicarbonate 18 mEq/L, and positive
serum ketones. What is the initial treatment?
A. Oral hypoglycemic agents
B. Subcutaneous insulin only
C. Intravenous fluids and insulin
D. Dapagliflozin
DKA requires prompt IV fluids and insulin to correct dehydration and
hyperglycemia.
8. A 23-year-old man presents with testicular pain and swelling. The
cremasteric reflex is absent on the affected side. What is the most
likely diagnosis?
A. Epididymitis
B. Testicular torsion
C. Inguinal hernia
D. Hydrocele
Absence of the cremasteric reflex is a key sign of testicular torsion.
9. A 40-year-old woman has a screening mammogram showing a
suspicious mass. Biopsy reveals invasive ductal carcinoma, estrogen
receptor–positive. What is the most appropriate adjuvant therapy?
A. Chemotherapy only
B. Hormonal therapy with tamoxifen
C. Radiotherapy only
D. No adjuvant therapy
ER-positive breast cancer benefits from hormonal therapy to reduce
recurrence risk.
10. A 55-year-old man presents with dysphagia for solids that
progressively worsened over 6 months. Barium swallow shows
corkscrew esophagus. What is the diagnosis?
A. Achalasia
B. Diffuse esophageal spasm
C. Esophageal cancer
D. Zenker diverticulum
