USMLE STEP 3 – FULL PRACTICE EXAM (100
QUESTIONS) LATEST UPDATED 2026 2027 REAL
EXAM WITH COMPLETE QUESTIONS &
CORRECT 100% VERIFIED ANSWERS PLUS
RATIONALES WITH ALREADY GRADED A+
{BRAND NEW}
1. A 58-year-old man with hypertension presents with crushing chest pain for 45
minutes. ECG shows ST elevations in leads II, III, and aVF. Blood pressure is
80/50 mm Hg. What is the most appropriate next step?
A. IV nitroglycerin
B. IV fluids
C. Morphine
D. Beta-blocker
Answer: B
Rationale: Inferior MI can involve the right ventricle; hypotension should be treated with
IV fluids before nitrates.
2. A 72-year-old woman is admitted for pneumonia. On day 4 she develops acute
confusion and agitation at night. What is the most likely diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Psychosis
,Answer: B
Rationale: Acute onset fluctuating mental status in hospitalized patients is delirium.
3. A 34-year-old woman presents with sudden onset pelvic pain and hypotension.
Pregnancy test is positive. What is the next step?
A. Transvaginal ultrasound
B. Methotrexate
C. Laparoscopy
D. CT abdomen
Answer: C
Rationale: Hemodynamically unstable suspected ectopic pregnancy requires immediate
surgical intervention.
4. A patient with cirrhosis presents with hematemesis. Initial management?
A. Endoscopy
B. Octreotide
C. IV fluids and airway protection
D. Propranolol
Answer: C
Rationale: Stabilization with airway protection and IV access is the first priority in upper
GI bleeding.
5. A 60-year-old man with COPD presents with worsening dyspnea and purulent
sputum. ABG shows pH 7.28, PaCO₂ 60. Best next step?
A. Intubation
B. Noninvasive ventilation
C. Oxygen only
D. Antibiotics only
Answer: B
Rationale: COPD exacerbation with respiratory acidosis is best treated initially with
BiPAP.
, 6. A hospitalized patient develops sudden chest pain and hypotension. ECG
shows electrical alternans. Diagnosis?
A. MI
B. Pulmonary embolism
C. Cardiac tamponade
D. Tension pneumothorax
Answer: C
Rationale: Electrical alternans is characteristic of pericardial tamponade.
7. A 29-year-old woman with SLE presents with pleuritic chest pain and
shortness of breath. CT confirms pulmonary embolism. Best long-term therapy?
A. Aspirin
B. Warfarin
C. LMWH for life
D. Clopidogrel
Answer: B
Rationale: PE requires long-term anticoagulation, typically warfarin or DOACs.
8. A patient with diabetes presents with confusion and glucose of 35 mg/dL. He is
unconscious. Best immediate treatment?
A. Oral glucose
B. Insulin
C. IV dextrose
D. Glucagon IM
Answer: C
Rationale: Unconscious hypoglycemia requires IV dextrose.
9. A 75-year-old man with BPH presents with acute urinary retention. Next step?
A. Alpha blockers
B. PSA testing
C. Foley catheter placement
D. TURP
QUESTIONS) LATEST UPDATED 2026 2027 REAL
EXAM WITH COMPLETE QUESTIONS &
CORRECT 100% VERIFIED ANSWERS PLUS
RATIONALES WITH ALREADY GRADED A+
{BRAND NEW}
1. A 58-year-old man with hypertension presents with crushing chest pain for 45
minutes. ECG shows ST elevations in leads II, III, and aVF. Blood pressure is
80/50 mm Hg. What is the most appropriate next step?
A. IV nitroglycerin
B. IV fluids
C. Morphine
D. Beta-blocker
Answer: B
Rationale: Inferior MI can involve the right ventricle; hypotension should be treated with
IV fluids before nitrates.
2. A 72-year-old woman is admitted for pneumonia. On day 4 she develops acute
confusion and agitation at night. What is the most likely diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Psychosis
,Answer: B
Rationale: Acute onset fluctuating mental status in hospitalized patients is delirium.
3. A 34-year-old woman presents with sudden onset pelvic pain and hypotension.
Pregnancy test is positive. What is the next step?
A. Transvaginal ultrasound
B. Methotrexate
C. Laparoscopy
D. CT abdomen
Answer: C
Rationale: Hemodynamically unstable suspected ectopic pregnancy requires immediate
surgical intervention.
4. A patient with cirrhosis presents with hematemesis. Initial management?
A. Endoscopy
B. Octreotide
C. IV fluids and airway protection
D. Propranolol
Answer: C
Rationale: Stabilization with airway protection and IV access is the first priority in upper
GI bleeding.
5. A 60-year-old man with COPD presents with worsening dyspnea and purulent
sputum. ABG shows pH 7.28, PaCO₂ 60. Best next step?
A. Intubation
B. Noninvasive ventilation
C. Oxygen only
D. Antibiotics only
Answer: B
Rationale: COPD exacerbation with respiratory acidosis is best treated initially with
BiPAP.
, 6. A hospitalized patient develops sudden chest pain and hypotension. ECG
shows electrical alternans. Diagnosis?
A. MI
B. Pulmonary embolism
C. Cardiac tamponade
D. Tension pneumothorax
Answer: C
Rationale: Electrical alternans is characteristic of pericardial tamponade.
7. A 29-year-old woman with SLE presents with pleuritic chest pain and
shortness of breath. CT confirms pulmonary embolism. Best long-term therapy?
A. Aspirin
B. Warfarin
C. LMWH for life
D. Clopidogrel
Answer: B
Rationale: PE requires long-term anticoagulation, typically warfarin or DOACs.
8. A patient with diabetes presents with confusion and glucose of 35 mg/dL. He is
unconscious. Best immediate treatment?
A. Oral glucose
B. Insulin
C. IV dextrose
D. Glucagon IM
Answer: C
Rationale: Unconscious hypoglycemia requires IV dextrose.
9. A 75-year-old man with BPH presents with acute urinary retention. Next step?
A. Alpha blockers
B. PSA testing
C. Foley catheter placement
D. TURP
