USMLE STEP 3 COMPLETE BOARD
PREP 2026–2027 Featuring Practice
Questions, CCS Simulations, High-Yield
Review & Success Strategies
1. A 55-year-old male with a history of hypertension presents with acute onset
of severe headache, nausea, and photophobia. His blood pressure is 190/110
mmHg. Which finding on physical examination is most concerning for
subarachnoid hemorrhage?
A. Papilledema
B. Nuchal rigidity
C. Retinal hemorrhages
D. Focal neurological deficit
E. Nuchal rigidity
2. A 32-year-old female presents with fatigue, weight gain, and cold
intolerance. Laboratory studies reveal TSH 15.0 µIU/mL and free T4 0.4
ng/dL. Which of the following is the most appropriate initial treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 50 mcg daily
C. Levothyroxine 100 mcg daily
D. Liothyronine 25 mcg daily
E. Levothyroxine 50 mcg daily
3. A 68-year-old male with a history of COPD presents with increasing
dyspnea and purulent sputum. Chest X-ray shows hyperinflation and no
infiltrates. Which of the following is the most appropriate initial antibiotic
for an acute exacerbation?
A. Azithromycin
B. Doxycycline
C. Amoxicillin-clavulanate
D. Levofloxacin
E. Amoxicillin-clavulanate
,4. A 45-year-old female presents with palpitations, weight loss, and heat
intolerance. Thyroid examination reveals a diffuse, nontender goiter. Which
laboratory finding is most consistent with Graves' disease?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, elevated free T4
D. Elevated TSH, elevated free T4
E. Low TSH, elevated free T4
5. A 70-year-old male with a history of diabetes presents with a non-healing
ulcer on the plantar surface of his right foot. Which finding indicates the
need for vascular intervention?
A. ABI of 0.8
B. ABI of 0.5
C. Toe-brachial index of 0.7
D. Transcutaneous oxygen tension of 50 mmHg
E. ABI of 0.5
6. A 25-year-old female presents with acute pelvic pain and vaginal discharge.
She is sexually active with multiple partners. Which diagnostic test should
be performed first?
A. Urinalysis
B. Pelvic ultrasound
C. Nucleic acid amplification test for Chlamydia and Gonorrhea
D. CT scan of the pelvis
E. Nucleic acid amplification test for Chlamydia and Gonorrhea
7. A 60-year-old male presents with hematuria and flank pain. CT scan reveals
a 3 cm renal mass. Which of the following is the most appropriate next step?
A. CT-guided biopsy
B. Partial nephrectomy
C. Radical nephrectomy
D. Observation with repeat imaging
E. Partial nephrectomy
8. A 52-year-old female presents with worsening dyspnea on exertion and
peripheral edema. Echocardiogram reveals severe aortic stenosis with a
valve area of 0.8 cm². Which symptom is most concerning for poor
prognosis?
, A. Dyspnea on exertion
B. Syncope
C. Angina
D. Peripheral edema
E. Syncope
9. A 28-year-old male presents with acute scrotal pain and swelling. On
examination, the testis is tender and elevated. Which is the most likely
diagnosis?
A. Testicular torsion
B. Epididymitis
C. Hydrocele
D. Varicocele
E. Testicular torsion
10.A 65-year-old female presents with a 2-week history of progressive
confusion and unsteady gait. Lumbar puncture reveals elevated protein and
normal glucose. Which diagnosis is most likely?
A. Viral meningitis
B. Bacterial meningitis
C. Normal pressure hydrocephalus
D. Subdural hematoma
E. Normal pressure hydrocephalus
11.A 48-year-old male with a history of alcohol abuse presents with jaundice
and abdominal distension. Liver biopsy shows steatosis, inflammation, and
Mallory bodies. Which diagnosis is most likely?
A. Alcoholic hepatitis
B. Cirrhosis
C. Nonalcoholic fatty liver disease
D. Primary biliary cholangitis
E. Alcoholic hepatitis
12.A 30-year-old female presents with palpitations, anxiety, and weight loss.
She has a thyroid bruit and exophthalmos. Which medication is most
appropriate for symptom control?
A. Methimazole
B. Propylthiouracil
C. Propranolol
, D. Radioactive iodine
E. Propranolol
13.A 75-year-old male presents with acute onset of left-sided weakness and
facial droop. His symptoms started 2 hours ago. CT scan shows no
hemorrhage. Which of the following is the most appropriate treatment?
A. Aspirin
B. Clopidogrel
C. Alteplase (tPA)
D. Heparin
E. Alteplase (tPA)
14.A 40-year-old female presents with fatigue, joint pain, and a malar rash.
Laboratory studies reveal positive ANA and anti-dsDNA antibodies. Which
is the most likely diagnosis?
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Scleroderma
D. Sjögren's syndrome
E. Systemic lupus erythematosus
15.A 55-year-old male with a history of hypertension presents with acute onset
of severe chest pain radiating to the back. Blood pressure is 200/110 mmHg
in the right arm and 140/90 mmHg in the left arm. Which diagnosis is most
likely?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Aortic dissection
16.A 32-year-old female presents with menorrhagia and easy bruising.
Laboratory studies reveal platelet count of 45,000/µL. Which medication is
most likely to be the cause?
A. Aspirin
B. Ibuprofen
C. Quinine
D. Heparin
E. Quinine
PREP 2026–2027 Featuring Practice
Questions, CCS Simulations, High-Yield
Review & Success Strategies
1. A 55-year-old male with a history of hypertension presents with acute onset
of severe headache, nausea, and photophobia. His blood pressure is 190/110
mmHg. Which finding on physical examination is most concerning for
subarachnoid hemorrhage?
A. Papilledema
B. Nuchal rigidity
C. Retinal hemorrhages
D. Focal neurological deficit
E. Nuchal rigidity
2. A 32-year-old female presents with fatigue, weight gain, and cold
intolerance. Laboratory studies reveal TSH 15.0 µIU/mL and free T4 0.4
ng/dL. Which of the following is the most appropriate initial treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 50 mcg daily
C. Levothyroxine 100 mcg daily
D. Liothyronine 25 mcg daily
E. Levothyroxine 50 mcg daily
3. A 68-year-old male with a history of COPD presents with increasing
dyspnea and purulent sputum. Chest X-ray shows hyperinflation and no
infiltrates. Which of the following is the most appropriate initial antibiotic
for an acute exacerbation?
A. Azithromycin
B. Doxycycline
C. Amoxicillin-clavulanate
D. Levofloxacin
E. Amoxicillin-clavulanate
,4. A 45-year-old female presents with palpitations, weight loss, and heat
intolerance. Thyroid examination reveals a diffuse, nontender goiter. Which
laboratory finding is most consistent with Graves' disease?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Normal TSH, elevated free T4
D. Elevated TSH, elevated free T4
E. Low TSH, elevated free T4
5. A 70-year-old male with a history of diabetes presents with a non-healing
ulcer on the plantar surface of his right foot. Which finding indicates the
need for vascular intervention?
A. ABI of 0.8
B. ABI of 0.5
C. Toe-brachial index of 0.7
D. Transcutaneous oxygen tension of 50 mmHg
E. ABI of 0.5
6. A 25-year-old female presents with acute pelvic pain and vaginal discharge.
She is sexually active with multiple partners. Which diagnostic test should
be performed first?
A. Urinalysis
B. Pelvic ultrasound
C. Nucleic acid amplification test for Chlamydia and Gonorrhea
D. CT scan of the pelvis
E. Nucleic acid amplification test for Chlamydia and Gonorrhea
7. A 60-year-old male presents with hematuria and flank pain. CT scan reveals
a 3 cm renal mass. Which of the following is the most appropriate next step?
A. CT-guided biopsy
B. Partial nephrectomy
C. Radical nephrectomy
D. Observation with repeat imaging
E. Partial nephrectomy
8. A 52-year-old female presents with worsening dyspnea on exertion and
peripheral edema. Echocardiogram reveals severe aortic stenosis with a
valve area of 0.8 cm². Which symptom is most concerning for poor
prognosis?
, A. Dyspnea on exertion
B. Syncope
C. Angina
D. Peripheral edema
E. Syncope
9. A 28-year-old male presents with acute scrotal pain and swelling. On
examination, the testis is tender and elevated. Which is the most likely
diagnosis?
A. Testicular torsion
B. Epididymitis
C. Hydrocele
D. Varicocele
E. Testicular torsion
10.A 65-year-old female presents with a 2-week history of progressive
confusion and unsteady gait. Lumbar puncture reveals elevated protein and
normal glucose. Which diagnosis is most likely?
A. Viral meningitis
B. Bacterial meningitis
C. Normal pressure hydrocephalus
D. Subdural hematoma
E. Normal pressure hydrocephalus
11.A 48-year-old male with a history of alcohol abuse presents with jaundice
and abdominal distension. Liver biopsy shows steatosis, inflammation, and
Mallory bodies. Which diagnosis is most likely?
A. Alcoholic hepatitis
B. Cirrhosis
C. Nonalcoholic fatty liver disease
D. Primary biliary cholangitis
E. Alcoholic hepatitis
12.A 30-year-old female presents with palpitations, anxiety, and weight loss.
She has a thyroid bruit and exophthalmos. Which medication is most
appropriate for symptom control?
A. Methimazole
B. Propylthiouracil
C. Propranolol
, D. Radioactive iodine
E. Propranolol
13.A 75-year-old male presents with acute onset of left-sided weakness and
facial droop. His symptoms started 2 hours ago. CT scan shows no
hemorrhage. Which of the following is the most appropriate treatment?
A. Aspirin
B. Clopidogrel
C. Alteplase (tPA)
D. Heparin
E. Alteplase (tPA)
14.A 40-year-old female presents with fatigue, joint pain, and a malar rash.
Laboratory studies reveal positive ANA and anti-dsDNA antibodies. Which
is the most likely diagnosis?
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Scleroderma
D. Sjögren's syndrome
E. Systemic lupus erythematosus
15.A 55-year-old male with a history of hypertension presents with acute onset
of severe chest pain radiating to the back. Blood pressure is 200/110 mmHg
in the right arm and 140/90 mmHg in the left arm. Which diagnosis is most
likely?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Aortic dissection
16.A 32-year-old female presents with menorrhagia and easy bruising.
Laboratory studies reveal platelet count of 45,000/µL. Which medication is
most likely to be the cause?
A. Aspirin
B. Ibuprofen
C. Quinine
D. Heparin
E. Quinine
