Federation of State Medical Boards (FSMB) &
National Board of Medical Examiners (NBME)
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
NBME CBSSA & NBME CBSE Comprehensive Basic
Science Self- Assessment and Examination
Course Title and Number: NBME CBSSA, NBME CBSE, and NBME USMLE Exam
Exam Title: NBME
Exam Date: Exam 2025- 2026
Instructor: ____ [Insert Instructor’s Name] _______
Student Name: ___ [Insert Student’s Name] _____
Student ID: ____ [Insert Student ID] _____________
Examination
Time: - ____ Hours: ___ Minutes
Instructions:
1. Read each question carefully.
2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you have completed the
Exam.
6. This test has a time limit, The test will save and submit automatically when the time
expires
7. This is Exam which will assess your knowledge on the course Learning Resources.
Good Luck……...!
, Click Here To <<ORDER NOW >> Follow Link
https://yourassignmenthandlers.kit.com/93b2309b47
!!!.ORDER NOW.!!! << TO GET INSTANT EXPERT HELP >> !!!.ORDER NOW.!!!
USMLE Step 3 NBME FSMB Exam Study Guide USMLE United State
Medical Licensing Examination Review Questions and Answers |
100% Pass Guaranteed | Graded A+ |
2025- 2026
NBME USMLE (United States Medical Licensing Examination)
USMLE Step 1, Step 2 CK (Clinical Knowledge), Step 2 CS (Clinica
Skills - discontinued), & Step 3
NBME CBSSA & NBME CBSE Comprehensive Basic Science Self-
Assessment and Examination
National Board of Medical Examiners (NBME)
Read All Instructions Carefully and Answer All the Questions Correctly Good
Luck: -
, CONTENTS
USMLE Step 3 Multiple Choice Test Question Formats...........................................2
Introduction to USMLE Step 3 Sample Test Questions............................................6
USMLE Step 3 Normal Laboratory Values................................................................7
Answer Form for USMLE Step 3 Sample Questions...............................................10
USMLE Step 3 Sample Test Questions...................................................................11
Answer Key for USMLE Step 3 Sample Questions..................................................79
, USMLE STEP 3 MULTIPLE-CHOICE TEST QUESTION FORMATS
The following are strategies for answering one-best-answer questions (eg, Single Items, Multiple
Item Sets, and Sequential Item Sets):
● Read each patient vignette and question carefully. It is important to understand what is being
asked.
● Try to generate an answer and then look for it in the option list.
● Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the
remaining options, select the one that is most correct.
● If unsure about an answer, it is better to guess since unanswered questions are automatically
counted as wrong answers.
Patient Scenario Formats
Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette
(paragraph) format, or in Chart/Tabular format. Questions written in Chart/Tabular format will
contain relevant patient information in list form, organized in clearly marked sections for ease of
review. Familiar medical abbreviations may be used within Chart/Tabular format questions.
Single-Item Questions
A single patient-centered scenario is associated with one question followed by four or more
response options. The response options for all questions are lettered (ie, A, B, C, D, E). You are
required to select the best answer to the question. Other options may be partially correct, but
there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice
question format on the examination.
Example Question 1
1. A 30-year-old man comes to the emergency department because of an acute episode of renal
colic. Medical history is remarkable for episodes of painful urination and passing of what he
calls "gravel in my urine." Urinalysis demonstrates microscopic hematuria with some crystalluria
and no casts. Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is
detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the
collecting system. The patient's pain is responsive to narcotic medication. In addition to
administering intravenous fluids, which of the following is the most appropriate next step?
A. Acidification of urine by drinking cranberry juice
B. Cystoscopic removal of the calculus
C. Cystoscopic ureteral lavage
D. Shock wave lithotripsy
E. Straining of the urine
(Answer: E)
2
, Multiple Item Sets
A single patient-centered scenario may be associated with two or three consecutive questions
about the information presented. Each question within these sets is associated with the patient
scenario and is independent of the other question(s) in the set. The questions within this type of
format are designed to be answered in any order. You are required to select the ONE BEST answer
to each question.
Example Questions 2 to 3
A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The
patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first
noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate
therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is
178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m 2. Today, vital signs are
temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm
Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of
0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli.
Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in
both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein.
2. Which of the following historical factors or physical examination findings is most strongly
associated with development of this patient's foot ulcer?
A. Diminished pedal pulses
B. Neurologic findings
C. The patient's weight
D. Proteinuria
E. Tobacco use
(Answer: B)
3. Which of the following is the most appropriate action at this time?
A. Begin aggressive debridement in the office
B. Begin intravenous antibiotic therapy
C. Refer the patient for transmetatarsal amputation
D. Schedule the patient for a third-degree skin graft
E. Switch the amoxicillin-clavulanate to oral ciprofloxacin
(Answer: B)
3
, Sequential Item Sets
A single patient-centered scenario may be associated with two or three consecutive questions
about the information presented. Each question is associated with the initial patient scenario but
is testing a different point. You are required to select the ONE BEST answer to each question.
Questions are designed to be answered in sequential order. You must click "Proceed to Next Item"
to view the next question in the set; once you click on this button, the next question will be
displayed, and you will not be able to add or change an answer to the previous question.
Example Questions 4 to 5
A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the
girl's physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical
shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for
approximately 45 seconds, after which she becomes relaxed and appears to fall asleep. Vital signs
at this time are temperature 40.0°C (104.0°F), pulse 120/min, and respirations 40/min. On physical
examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent
and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose
has a scant, clear discharge, and throat is mildly erythematous. Lungs are clear to auscultation
except for transmitted upper airway sounds. Heart has rapid rate with a grade 1/6 systolic murmur
at the left sternal border. Complete blood count, blood culture, lumbar puncture, and catheterized
urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal
suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional
history discloses that she was born at term, she had an uneventful neonatal course, she has
normal growth and development, and vaccinations are up-to-date. She has never had an episode
similar to this. Initial laboratory results are shown:
Blood
WBC 10,400/mm3
Neutrophils, segmented 25%
Neutrophils, bands 5%
Lymphocytes 65%
Monocytes 5%
Cerebrospinal fluid 0 RBC/mm3
Urinalysis Normal
Other laboratory studies are pending.
4. In addition to ampicillin for otitis media and acetaminophen, this child also should receive
which of the following?
A. Oral ethosuximide
B. Oral phenobarbital
C. Oral phenytoin
D. Rectal diazepam
E. No additional medications
(Answer E)
4
,5. Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that
she is doing well and she has had no recurrence of her symptoms. Examination of the ears
shows resolution of the otitis media. Which of the following is the most important diagnostic
step at this time?
A. Audiology testing
B. Cognitive testing
C. CT scan of the head
D. EEG
E. No additional testing
(Answer E)
5
, INTRODUCTION TO USMLE STEP 3 SAMPLE TEST QUESTIONS
The following pages include 137 sample test questions. Please note that reviewing the sample questions is
not a substitute for acquainting yourself with the test software. You should run the Step 3 tutorial and
practice test questions that are provided on the USMLE website well before your test date. The sample
materials on the USMLE website include additional item formats that do not appear in this booklet (eg,
items with associated audio findings). Note that the function of items such as pharmaceutical ads,
abstracts, and sequential item sets is unique in an examination interface. You should become familiar with
all test question/item formats as they will be used in the actual examination.
In addition, the computer-based case simulation (CCS) format you will see on an actual Step 3
examination is not represented in this booklet. You must become familiar with the CCS format by reading
information available in the USMLE Content Description and General Information booklet and by
practicing with sample CCS cases before you take the Step 3 examination; the information and the
practice materials are available on the USMLE Web site (www.usmle.org).
These sample questions are illustrative of the types of questions used in the Step 3 examination. Although
the questions exemplify content on the examination, they may not reflect the content coverage on
individual examinations. Questions are grouped together by the content appropriate for each
examination day in the same manner as in the actual computer-administered test blocks. In the actual
examination, the questions will be presented one at a time in a format designed for easy on-screen
reading, including use of a panel for the table of normal laboratory values (included here on pages 7–9)
and some pictorials. Photographs, charts, and x-rays referred to in this booklet are not of the same quality
as the pictorials used in the actual examination. In addition, you will have the capability to adjust the
brightness and contrast of pictorials on the computer screen.
To take the following sample test questions as they would be timed in the actual examination, you should
allow a maximum of 1 hour for each of the Foundations of Independent Practice (FIP) blocks, and a
maximum of 45 minutes for each of the Advanced Clinical Medicine (ACM) blocks, for a total of 3 hours
30 minutes. Please be aware that most examinees perceive the time pressure to be greater during an
actual examination. An answer sheet for recording answers for this practice is provided on page 10. An
answer key is provided on page 79. In the actual examination, answers will be selected on the screen; no
answer form will be provided.
6
, USMLE LABORATORY VALUES
Reference Range SI
Reference Range SI Reference Intervals
SERUM
General Chemistry:
Electrolytes
Sodium (Na+) 136–146 mEq/L 136–146 mmol/L
Potassium (K+) 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Chloride (Cl–) 95–105 mEq/L 95–105 mmol/L
–
Bicarbonate (HCO3 ) 22–28 mEq/L 22–28 mmol/L
Urea nitrogen 7–18 mg/dL 2.5–6.4 mmol/L
Creatinine 0.6–1.2 mg/dL 53–106 μmol/L
Glucose Fasting: 70–100 mg/dL 3.8–5.6 mmol/L
Random, non-fasting: <140 mg/dL <7.77 mmol/L
Calcium 8.4–10.2 mg/dL 2.1–2.6 mmol/L
Magnesium (Mg2+) 1.5–2.0 mg/dL 0.75–1.0 mmol/L
Phosphorus (inorganic) 3.0–4.5 mg/dL 1.0–1.5 mmol/L
Hepatic:
Alanine aminotransferase (ALT) 10–40 U/L 10–40 U/L
Aspartate aminotransferase (AST) 12–38 U/L 12–38 U/L
Alkaline phosphatase 25–100 U/L 25–100 U/L
Amylase 25–125 U/L 25–125 U/L
Bilirubin, Total // Direct 0.1–1.0 mg/dL // 0.0–0.3 mg/dL 2–17 μmol/L // 0–5 μmol/L
Proteins, total 6.0–7.8 g/dL 60–78 g/L
Albumin 3.5–5.5 g/dL 35–55 g/L
Globulin 2.3–3.5 g/dL 23–35 g/L
Lipids:
Cholesterol
Total Normal: <200 mg/dL <5.2 mmol/L
High: >240 mg/dL >6.2 mmol/L
HDL 40–60 mg/dL 1.0–1.6 mmol/L
LDL <160 mg/dL <4.2 mmol/L
Triglycerides Normal: <150 mg/dL <1.70 mmol/L
Borderline: 151–199 mg/dL 1.71–2.25 mmol/L
Iron Studies:
Ferritin Male: 20–250 ng/mL 20–250 μg/L
Female: 10–120 ng/mL 10–120 μg/L
Iron Male: 65–175 µg/dL 11.6–31.3 μmol/L
Female: 50–170 μg/dL 9.0–30.4 μmol/L
Total iron-binding capacity 250–400 µg/dL 44.8–71.6 μmol/L
Transferrin 200–360 mg/dL 2.0–3.6 g/L
7
Continued on Next Page
, USMLE LABORATORY VALUES (continued)
Reference Range SI Reference Intervals
Endocrine:
Follicle-stimulating hormone Male: 4–25 mIU/mL 4–25 IU/L
Female: premenopause 4–30 mIU/mL 4–30 IU/L
midcycle peak 10–90 mIU/mL 10–90 IU/L
postmenopause 40–250 mIU/mL 40–250 IU/L
Luteinizing hormone Male: 6–23 mIU/mL 6–23 IU/L
Female: follicular phase 5–30 mIU/mL 5–30 IU/L
midcycle 75–150 mIU/mL 75–150 IU/L
postmenopause 30–200 mIU/mL 30–200 IU/L
Growth hormone - arginine stimulation Fasting: <5 ng/mL <5 μg/L
Provocative stimuli: >7 ng/mL >7 μg/L
Prolactin (hPRL) Male: <17 ng/mL <17 μg/L
Female: <25 ng/mL <25 μg/L
Cortisol 0800 h: 5–23 μg/dL 138–635 nmol/L
1600 h: 3–15 μg/dL 82–413 nmol/L
2000 h: <50% of 0800 h Fraction of 0800 h: <0.50
TSH 0.4–4.0 μU/mL 0.4–4.0 mIU/L
Triiodothyronine (T3) (RIA) 100–200 ng/dL 1.5–3.1 nmol/L
Triiodothyronine (T3) resin uptake 25%–35% 0.25–0.35
Thyroxine (T4) 5–12 μg/dL 64–155 nmol/L
Free T4 0.9–1.7 ng/dL 12.0–21.9
pmol/L Thyroidal iodine (123I) uptake 8%–30% of administered dose/24 h 0.08–0.30/24 h
Intact PTH 10–60 pg/mL 10–60 ng/L
17-Hydroxycorticosteroids Male: 3.0–10.0 mg/24 h 8.2–27.6 μmol/24 h
Female: 2.0–8.0 mg/24 h 5.5–22.0 μmol/24 h
17-Ketosteroids, total Male: 8–20 mg/24 h 28–70 μmol/24 h
Female: 6–15 mg/24 h 21–52 μmol/24 h
Immunoglobulins:
IgA 76–390 mg/dL 0.76–3.90 g/L
IgE 0–380 IU/mL 0–380 kIU/L
IgG 650–1500 mg/dL 6.5–15.0 g/L
IgM 50–300 mg/dL 0.5–3.0 g/L
Other, serum:
Creatinine clearance Male: 97–137 mL/min 97–137 mL/min
Female: 88–128 mL/min 88–128 mL/min
Creatine kinase Male: 25–90 U/L 25–90 U/L
Female: 10–70 U/L 10–70 U/L
Lactate dehydrogenase 45–200 U/L 45–200 U/L
Osmolality 275–295 mOsmol/kg H2O 275–295 mOsmol/kg H2O
Uric acid 3.0–8.2 mg/dL 0.18–0.48 mmol/L
GASES, ARTERIAL BLOOD (ROOM AIR)
PO2 75–105 mm Hg 10.0–14.0 kPa
PCO2 33–45 mm Hg 4.4–5.9 kPa
pH 7.35–7.45 [H+] 36–44 nmol/L
CEREBROSPINAL FLUID
Cell count 0–5/mm3 0–5 × 106/L
Chloride 118–132 mEq/L 118–132 mmol/L
Gamma globulin 3%–12% total proteins 0.03–0.12
Glucose 40–70 mg/dL 2.2–3.9 mmol/L
Pressure 70–180 mm H2O 70–180 mm H2O
Proteins, total <40 mg/dL <0.40 g/L
8
Continued on Next Page
National Board of Medical Examiners (NBME)
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
NBME CBSSA & NBME CBSE Comprehensive Basic
Science Self- Assessment and Examination
Course Title and Number: NBME CBSSA, NBME CBSE, and NBME USMLE Exam
Exam Title: NBME
Exam Date: Exam 2025- 2026
Instructor: ____ [Insert Instructor’s Name] _______
Student Name: ___ [Insert Student’s Name] _____
Student ID: ____ [Insert Student ID] _____________
Examination
Time: - ____ Hours: ___ Minutes
Instructions:
1. Read each question carefully.
2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you have completed the
Exam.
6. This test has a time limit, The test will save and submit automatically when the time
expires
7. This is Exam which will assess your knowledge on the course Learning Resources.
Good Luck……...!
, Click Here To <<ORDER NOW >> Follow Link
https://yourassignmenthandlers.kit.com/93b2309b47
!!!.ORDER NOW.!!! << TO GET INSTANT EXPERT HELP >> !!!.ORDER NOW.!!!
USMLE Step 3 NBME FSMB Exam Study Guide USMLE United State
Medical Licensing Examination Review Questions and Answers |
100% Pass Guaranteed | Graded A+ |
2025- 2026
NBME USMLE (United States Medical Licensing Examination)
USMLE Step 1, Step 2 CK (Clinical Knowledge), Step 2 CS (Clinica
Skills - discontinued), & Step 3
NBME CBSSA & NBME CBSE Comprehensive Basic Science Self-
Assessment and Examination
National Board of Medical Examiners (NBME)
Read All Instructions Carefully and Answer All the Questions Correctly Good
Luck: -
, CONTENTS
USMLE Step 3 Multiple Choice Test Question Formats...........................................2
Introduction to USMLE Step 3 Sample Test Questions............................................6
USMLE Step 3 Normal Laboratory Values................................................................7
Answer Form for USMLE Step 3 Sample Questions...............................................10
USMLE Step 3 Sample Test Questions...................................................................11
Answer Key for USMLE Step 3 Sample Questions..................................................79
, USMLE STEP 3 MULTIPLE-CHOICE TEST QUESTION FORMATS
The following are strategies for answering one-best-answer questions (eg, Single Items, Multiple
Item Sets, and Sequential Item Sets):
● Read each patient vignette and question carefully. It is important to understand what is being
asked.
● Try to generate an answer and then look for it in the option list.
● Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the
remaining options, select the one that is most correct.
● If unsure about an answer, it is better to guess since unanswered questions are automatically
counted as wrong answers.
Patient Scenario Formats
Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette
(paragraph) format, or in Chart/Tabular format. Questions written in Chart/Tabular format will
contain relevant patient information in list form, organized in clearly marked sections for ease of
review. Familiar medical abbreviations may be used within Chart/Tabular format questions.
Single-Item Questions
A single patient-centered scenario is associated with one question followed by four or more
response options. The response options for all questions are lettered (ie, A, B, C, D, E). You are
required to select the best answer to the question. Other options may be partially correct, but
there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice
question format on the examination.
Example Question 1
1. A 30-year-old man comes to the emergency department because of an acute episode of renal
colic. Medical history is remarkable for episodes of painful urination and passing of what he
calls "gravel in my urine." Urinalysis demonstrates microscopic hematuria with some crystalluria
and no casts. Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is
detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the
collecting system. The patient's pain is responsive to narcotic medication. In addition to
administering intravenous fluids, which of the following is the most appropriate next step?
A. Acidification of urine by drinking cranberry juice
B. Cystoscopic removal of the calculus
C. Cystoscopic ureteral lavage
D. Shock wave lithotripsy
E. Straining of the urine
(Answer: E)
2
, Multiple Item Sets
A single patient-centered scenario may be associated with two or three consecutive questions
about the information presented. Each question within these sets is associated with the patient
scenario and is independent of the other question(s) in the set. The questions within this type of
format are designed to be answered in any order. You are required to select the ONE BEST answer
to each question.
Example Questions 2 to 3
A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The
patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first
noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate
therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is
178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m 2. Today, vital signs are
temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm
Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of
0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli.
Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in
both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein.
2. Which of the following historical factors or physical examination findings is most strongly
associated with development of this patient's foot ulcer?
A. Diminished pedal pulses
B. Neurologic findings
C. The patient's weight
D. Proteinuria
E. Tobacco use
(Answer: B)
3. Which of the following is the most appropriate action at this time?
A. Begin aggressive debridement in the office
B. Begin intravenous antibiotic therapy
C. Refer the patient for transmetatarsal amputation
D. Schedule the patient for a third-degree skin graft
E. Switch the amoxicillin-clavulanate to oral ciprofloxacin
(Answer: B)
3
, Sequential Item Sets
A single patient-centered scenario may be associated with two or three consecutive questions
about the information presented. Each question is associated with the initial patient scenario but
is testing a different point. You are required to select the ONE BEST answer to each question.
Questions are designed to be answered in sequential order. You must click "Proceed to Next Item"
to view the next question in the set; once you click on this button, the next question will be
displayed, and you will not be able to add or change an answer to the previous question.
Example Questions 4 to 5
A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the
girl's physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical
shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for
approximately 45 seconds, after which she becomes relaxed and appears to fall asleep. Vital signs
at this time are temperature 40.0°C (104.0°F), pulse 120/min, and respirations 40/min. On physical
examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent
and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose
has a scant, clear discharge, and throat is mildly erythematous. Lungs are clear to auscultation
except for transmitted upper airway sounds. Heart has rapid rate with a grade 1/6 systolic murmur
at the left sternal border. Complete blood count, blood culture, lumbar puncture, and catheterized
urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal
suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional
history discloses that she was born at term, she had an uneventful neonatal course, she has
normal growth and development, and vaccinations are up-to-date. She has never had an episode
similar to this. Initial laboratory results are shown:
Blood
WBC 10,400/mm3
Neutrophils, segmented 25%
Neutrophils, bands 5%
Lymphocytes 65%
Monocytes 5%
Cerebrospinal fluid 0 RBC/mm3
Urinalysis Normal
Other laboratory studies are pending.
4. In addition to ampicillin for otitis media and acetaminophen, this child also should receive
which of the following?
A. Oral ethosuximide
B. Oral phenobarbital
C. Oral phenytoin
D. Rectal diazepam
E. No additional medications
(Answer E)
4
,5. Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that
she is doing well and she has had no recurrence of her symptoms. Examination of the ears
shows resolution of the otitis media. Which of the following is the most important diagnostic
step at this time?
A. Audiology testing
B. Cognitive testing
C. CT scan of the head
D. EEG
E. No additional testing
(Answer E)
5
, INTRODUCTION TO USMLE STEP 3 SAMPLE TEST QUESTIONS
The following pages include 137 sample test questions. Please note that reviewing the sample questions is
not a substitute for acquainting yourself with the test software. You should run the Step 3 tutorial and
practice test questions that are provided on the USMLE website well before your test date. The sample
materials on the USMLE website include additional item formats that do not appear in this booklet (eg,
items with associated audio findings). Note that the function of items such as pharmaceutical ads,
abstracts, and sequential item sets is unique in an examination interface. You should become familiar with
all test question/item formats as they will be used in the actual examination.
In addition, the computer-based case simulation (CCS) format you will see on an actual Step 3
examination is not represented in this booklet. You must become familiar with the CCS format by reading
information available in the USMLE Content Description and General Information booklet and by
practicing with sample CCS cases before you take the Step 3 examination; the information and the
practice materials are available on the USMLE Web site (www.usmle.org).
These sample questions are illustrative of the types of questions used in the Step 3 examination. Although
the questions exemplify content on the examination, they may not reflect the content coverage on
individual examinations. Questions are grouped together by the content appropriate for each
examination day in the same manner as in the actual computer-administered test blocks. In the actual
examination, the questions will be presented one at a time in a format designed for easy on-screen
reading, including use of a panel for the table of normal laboratory values (included here on pages 7–9)
and some pictorials. Photographs, charts, and x-rays referred to in this booklet are not of the same quality
as the pictorials used in the actual examination. In addition, you will have the capability to adjust the
brightness and contrast of pictorials on the computer screen.
To take the following sample test questions as they would be timed in the actual examination, you should
allow a maximum of 1 hour for each of the Foundations of Independent Practice (FIP) blocks, and a
maximum of 45 minutes for each of the Advanced Clinical Medicine (ACM) blocks, for a total of 3 hours
30 minutes. Please be aware that most examinees perceive the time pressure to be greater during an
actual examination. An answer sheet for recording answers for this practice is provided on page 10. An
answer key is provided on page 79. In the actual examination, answers will be selected on the screen; no
answer form will be provided.
6
, USMLE LABORATORY VALUES
Reference Range SI
Reference Range SI Reference Intervals
SERUM
General Chemistry:
Electrolytes
Sodium (Na+) 136–146 mEq/L 136–146 mmol/L
Potassium (K+) 3.5–5.0 mEq/L 3.5–5.0 mmol/L
Chloride (Cl–) 95–105 mEq/L 95–105 mmol/L
–
Bicarbonate (HCO3 ) 22–28 mEq/L 22–28 mmol/L
Urea nitrogen 7–18 mg/dL 2.5–6.4 mmol/L
Creatinine 0.6–1.2 mg/dL 53–106 μmol/L
Glucose Fasting: 70–100 mg/dL 3.8–5.6 mmol/L
Random, non-fasting: <140 mg/dL <7.77 mmol/L
Calcium 8.4–10.2 mg/dL 2.1–2.6 mmol/L
Magnesium (Mg2+) 1.5–2.0 mg/dL 0.75–1.0 mmol/L
Phosphorus (inorganic) 3.0–4.5 mg/dL 1.0–1.5 mmol/L
Hepatic:
Alanine aminotransferase (ALT) 10–40 U/L 10–40 U/L
Aspartate aminotransferase (AST) 12–38 U/L 12–38 U/L
Alkaline phosphatase 25–100 U/L 25–100 U/L
Amylase 25–125 U/L 25–125 U/L
Bilirubin, Total // Direct 0.1–1.0 mg/dL // 0.0–0.3 mg/dL 2–17 μmol/L // 0–5 μmol/L
Proteins, total 6.0–7.8 g/dL 60–78 g/L
Albumin 3.5–5.5 g/dL 35–55 g/L
Globulin 2.3–3.5 g/dL 23–35 g/L
Lipids:
Cholesterol
Total Normal: <200 mg/dL <5.2 mmol/L
High: >240 mg/dL >6.2 mmol/L
HDL 40–60 mg/dL 1.0–1.6 mmol/L
LDL <160 mg/dL <4.2 mmol/L
Triglycerides Normal: <150 mg/dL <1.70 mmol/L
Borderline: 151–199 mg/dL 1.71–2.25 mmol/L
Iron Studies:
Ferritin Male: 20–250 ng/mL 20–250 μg/L
Female: 10–120 ng/mL 10–120 μg/L
Iron Male: 65–175 µg/dL 11.6–31.3 μmol/L
Female: 50–170 μg/dL 9.0–30.4 μmol/L
Total iron-binding capacity 250–400 µg/dL 44.8–71.6 μmol/L
Transferrin 200–360 mg/dL 2.0–3.6 g/L
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, USMLE LABORATORY VALUES (continued)
Reference Range SI Reference Intervals
Endocrine:
Follicle-stimulating hormone Male: 4–25 mIU/mL 4–25 IU/L
Female: premenopause 4–30 mIU/mL 4–30 IU/L
midcycle peak 10–90 mIU/mL 10–90 IU/L
postmenopause 40–250 mIU/mL 40–250 IU/L
Luteinizing hormone Male: 6–23 mIU/mL 6–23 IU/L
Female: follicular phase 5–30 mIU/mL 5–30 IU/L
midcycle 75–150 mIU/mL 75–150 IU/L
postmenopause 30–200 mIU/mL 30–200 IU/L
Growth hormone - arginine stimulation Fasting: <5 ng/mL <5 μg/L
Provocative stimuli: >7 ng/mL >7 μg/L
Prolactin (hPRL) Male: <17 ng/mL <17 μg/L
Female: <25 ng/mL <25 μg/L
Cortisol 0800 h: 5–23 μg/dL 138–635 nmol/L
1600 h: 3–15 μg/dL 82–413 nmol/L
2000 h: <50% of 0800 h Fraction of 0800 h: <0.50
TSH 0.4–4.0 μU/mL 0.4–4.0 mIU/L
Triiodothyronine (T3) (RIA) 100–200 ng/dL 1.5–3.1 nmol/L
Triiodothyronine (T3) resin uptake 25%–35% 0.25–0.35
Thyroxine (T4) 5–12 μg/dL 64–155 nmol/L
Free T4 0.9–1.7 ng/dL 12.0–21.9
pmol/L Thyroidal iodine (123I) uptake 8%–30% of administered dose/24 h 0.08–0.30/24 h
Intact PTH 10–60 pg/mL 10–60 ng/L
17-Hydroxycorticosteroids Male: 3.0–10.0 mg/24 h 8.2–27.6 μmol/24 h
Female: 2.0–8.0 mg/24 h 5.5–22.0 μmol/24 h
17-Ketosteroids, total Male: 8–20 mg/24 h 28–70 μmol/24 h
Female: 6–15 mg/24 h 21–52 μmol/24 h
Immunoglobulins:
IgA 76–390 mg/dL 0.76–3.90 g/L
IgE 0–380 IU/mL 0–380 kIU/L
IgG 650–1500 mg/dL 6.5–15.0 g/L
IgM 50–300 mg/dL 0.5–3.0 g/L
Other, serum:
Creatinine clearance Male: 97–137 mL/min 97–137 mL/min
Female: 88–128 mL/min 88–128 mL/min
Creatine kinase Male: 25–90 U/L 25–90 U/L
Female: 10–70 U/L 10–70 U/L
Lactate dehydrogenase 45–200 U/L 45–200 U/L
Osmolality 275–295 mOsmol/kg H2O 275–295 mOsmol/kg H2O
Uric acid 3.0–8.2 mg/dL 0.18–0.48 mmol/L
GASES, ARTERIAL BLOOD (ROOM AIR)
PO2 75–105 mm Hg 10.0–14.0 kPa
PCO2 33–45 mm Hg 4.4–5.9 kPa
pH 7.35–7.45 [H+] 36–44 nmol/L
CEREBROSPINAL FLUID
Cell count 0–5/mm3 0–5 × 106/L
Chloride 118–132 mEq/L 118–132 mmol/L
Gamma globulin 3%–12% total proteins 0.03–0.12
Glucose 40–70 mg/dL 2.2–3.9 mmol/L
Pressure 70–180 mm H2O 70–180 mm H2O
Proteins, total <40 mg/dL <0.40 g/L
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