USMLE Step 2 & 3 Internal Medicine
Board Review 2026-2027: 95 High-Yield
Practice Questions with Answers &
Explanations for Medical Students and
Resident Physicians
Description:
Master the 2026-2027 USMLE Step 2 CK, Step 3, and Internal Medicine board exams
with 95 clinically focused practice questions covering cardiology, pulmonology, infectious
disease, endocrinology, neurology, and more. Each question includes a detailed answer
explanation aligned with 2026 ACC/AHA/ADA guidelines.
Download the complete 2026-2027 examination paper now and boost your board scores.
, USMLE Step 2 & 3 Practice Exam 2026-2027
Section 1: Cardiology
Question 1
A 68-year-old patient presents with palpitations and lightheadedness. ECG demonstrates
absent P waves with a "sawtooth" baseline pattern at a rate of 300 beats per minute with
variable AV conduction. Which of the following is the most accurate description of this
finding?
A. Fibrillatory waves
B. Delta waves
C. Sawtooth flutter waves
D. Osborn waves
Answer: C
Explanation: Atrial flutter classically presents with "sawtooth" flutter waves (also called F
waves) best seen in leads II, III, and aVF. This pattern results from a reentrant circuit,
typically in the right atrium, with an atrial rate of 250–350 beats per minute.
Question 2
A 72-year-old diabetic patient with hypertension and proteinuria requires antihypertensive
therapy. Which medication class provides both blood pressure control and renal protection in
this clinical scenario?
A. Beta-blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Direct vasodilators
Answer: C
Explanation: ACE inhibitors (and ARBs) are first-line antihypertensives in diabetic patients
with proteinuria because they reduce intraglomerular pressure, decrease protein excretion,
and slow progression of diabetic nephropathy.
,Question 3
A 55-year-old man presents with hypotension, jugular venous distension, and muffled heart
sounds following a stab wound to the chest. This classic triad is most consistent with which
diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive pulmonary embolism
D. Aortic dissection
Answer: B
Explanation: Beck's triad—hypotension, distant (muffled) heart sounds, and jugular venous
distension—is the classic presentation of cardiac tamponade. Pulsus paradoxus (fall in
systolic BP >10 mmHg during inspiration) is an associated finding.
Question 4
Which of the following medications is associated with significant flushing and pruritus when
used for hypercholesterolemia treatment?
A. Atorvastatin
B. Ezetimibe
C. Niacin
D. PCSK9 inhibitor
Answer: C
Explanation: Niacin (nicotinic acid) causes prostaglandin-mediated flushing and pruritus,
which can be mitigated by aspirin pretreatment or using extended-release formulations. This
side effect often limits adherence.
Question 5
A 45-year-old patient with hypertrophic obstructive cardiomyopathy undergoes a Valsalva
maneuver during auscultation. How does this maneuver affect the patient's murmur?
A. The murmur decreases in intensity
B. The murmur increases in intensity
C. The murmur remains unchanged
D. The murmur changes from systolic to diastolic
, Answer: B
Explanation: In hypertrophic obstructive cardiomyopathy, decreased preload (as occurs with
Valsalva maneuver, standing, or nitroglycerin) increases the outflow tract gradient and
intensifies the systolic ejection murmur. Increased preload (squatting) decreases murmur
intensity.
Question 6
A 28-year-old patient with no prior cardiac history presents with acute-onset palpitations and
dizziness. ECG shows atrial fibrillation with a ventricular rate of 160 beats per minute. The
patient is hemodynamically stable. What is the most appropriate initial management?
A. Immediate synchronized cardioversion
B. Rate control with beta-blocker or calcium channel blocker
C. Direct current cardioversion without sedation
D. Immediate heparin bolus followed by electrical cardioversion
Answer: B
Explanation: In hemodynamically stable patients with atrial fibrillation, initial management
focuses on rate control using beta-blockers (metoprolol, esmolol) or nondihydropyridine
calcium channel blockers (diltiazem, verapamil). Cardioversion is indicated for unstable
patients (hypotension, chest pain, heart failure).
Question 7
A 62-year-old patient with a history of inferior wall myocardial infarction 3 weeks ago
presents with fever, pleuritic chest pain, and a pericardial friction rub. ESR is 85 mm/hr. This
presentation is most consistent with which diagnosis?
A. Recurrent myocardial infarction
B. Dressler's syndrome
C. Pericarditis from viral etiology
D. Pulmonary embolism
Answer: B
Explanation: Dressler's syndrome (post-myocardial infarction pericarditis) is an autoimmune
phenomenon occurring 2–4 weeks post-MI, characterized by fever, pericarditis, elevated
Board Review 2026-2027: 95 High-Yield
Practice Questions with Answers &
Explanations for Medical Students and
Resident Physicians
Description:
Master the 2026-2027 USMLE Step 2 CK, Step 3, and Internal Medicine board exams
with 95 clinically focused practice questions covering cardiology, pulmonology, infectious
disease, endocrinology, neurology, and more. Each question includes a detailed answer
explanation aligned with 2026 ACC/AHA/ADA guidelines.
Download the complete 2026-2027 examination paper now and boost your board scores.
, USMLE Step 2 & 3 Practice Exam 2026-2027
Section 1: Cardiology
Question 1
A 68-year-old patient presents with palpitations and lightheadedness. ECG demonstrates
absent P waves with a "sawtooth" baseline pattern at a rate of 300 beats per minute with
variable AV conduction. Which of the following is the most accurate description of this
finding?
A. Fibrillatory waves
B. Delta waves
C. Sawtooth flutter waves
D. Osborn waves
Answer: C
Explanation: Atrial flutter classically presents with "sawtooth" flutter waves (also called F
waves) best seen in leads II, III, and aVF. This pattern results from a reentrant circuit,
typically in the right atrium, with an atrial rate of 250–350 beats per minute.
Question 2
A 72-year-old diabetic patient with hypertension and proteinuria requires antihypertensive
therapy. Which medication class provides both blood pressure control and renal protection in
this clinical scenario?
A. Beta-blockers
B. Thiazide diuretics
C. ACE inhibitors
D. Direct vasodilators
Answer: C
Explanation: ACE inhibitors (and ARBs) are first-line antihypertensives in diabetic patients
with proteinuria because they reduce intraglomerular pressure, decrease protein excretion,
and slow progression of diabetic nephropathy.
,Question 3
A 55-year-old man presents with hypotension, jugular venous distension, and muffled heart
sounds following a stab wound to the chest. This classic triad is most consistent with which
diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive pulmonary embolism
D. Aortic dissection
Answer: B
Explanation: Beck's triad—hypotension, distant (muffled) heart sounds, and jugular venous
distension—is the classic presentation of cardiac tamponade. Pulsus paradoxus (fall in
systolic BP >10 mmHg during inspiration) is an associated finding.
Question 4
Which of the following medications is associated with significant flushing and pruritus when
used for hypercholesterolemia treatment?
A. Atorvastatin
B. Ezetimibe
C. Niacin
D. PCSK9 inhibitor
Answer: C
Explanation: Niacin (nicotinic acid) causes prostaglandin-mediated flushing and pruritus,
which can be mitigated by aspirin pretreatment or using extended-release formulations. This
side effect often limits adherence.
Question 5
A 45-year-old patient with hypertrophic obstructive cardiomyopathy undergoes a Valsalva
maneuver during auscultation. How does this maneuver affect the patient's murmur?
A. The murmur decreases in intensity
B. The murmur increases in intensity
C. The murmur remains unchanged
D. The murmur changes from systolic to diastolic
, Answer: B
Explanation: In hypertrophic obstructive cardiomyopathy, decreased preload (as occurs with
Valsalva maneuver, standing, or nitroglycerin) increases the outflow tract gradient and
intensifies the systolic ejection murmur. Increased preload (squatting) decreases murmur
intensity.
Question 6
A 28-year-old patient with no prior cardiac history presents with acute-onset palpitations and
dizziness. ECG shows atrial fibrillation with a ventricular rate of 160 beats per minute. The
patient is hemodynamically stable. What is the most appropriate initial management?
A. Immediate synchronized cardioversion
B. Rate control with beta-blocker or calcium channel blocker
C. Direct current cardioversion without sedation
D. Immediate heparin bolus followed by electrical cardioversion
Answer: B
Explanation: In hemodynamically stable patients with atrial fibrillation, initial management
focuses on rate control using beta-blockers (metoprolol, esmolol) or nondihydropyridine
calcium channel blockers (diltiazem, verapamil). Cardioversion is indicated for unstable
patients (hypotension, chest pain, heart failure).
Question 7
A 62-year-old patient with a history of inferior wall myocardial infarction 3 weeks ago
presents with fever, pleuritic chest pain, and a pericardial friction rub. ESR is 85 mm/hr. This
presentation is most consistent with which diagnosis?
A. Recurrent myocardial infarction
B. Dressler's syndrome
C. Pericarditis from viral etiology
D. Pulmonary embolism
Answer: B
Explanation: Dressler's syndrome (post-myocardial infarction pericarditis) is an autoimmune
phenomenon occurring 2–4 weeks post-MI, characterized by fever, pericarditis, elevated
