First Aid USMLE Step 3 Questions
A 30 year old high school guidance counselor presents to her
dermatologist for irritation of her hands. She states that she
washed her hands under hot water about 20 times a day and
uses a variety of alcohol-based hand sanitizer products to
avoid picking up germs. What is the best treatment for her
disorder? - Correct Answer ✔ ✔ SSRIs and CBT.
A 15 year old boy presents to the pediatrician. He states that
he has been exercising more and eating less so that he can
make the school wrestling team. His growth curve has
dropped from the 50th to the 15th percentile for weight.
Which psychiatric diagnosis should be considered? - Correct
,Answer ✔ ✔ Anorexia nervosa. Eating disorders are less
common in males than in females but do occur.
A patient with a history of asthma that was previously
controlled with once-monthly albuterol states that he has
been using his albuterol inhaler four to five times a week. He
denies any nighttime symptoms. How would you adjust his
treatment regimen? - Correct Answer ✔ ✔ Add a low
dose ICS, as the patient how has mild persistent asthma.
You order PFTs for a patient with worsening shortness of
breath with of the following values would be consistent with a
diagnosis of COPD?
(A) Low FEV1, low FVC, low FEV1/FVC, high TLC, low DLCO
,(B) Low FEV1, low FVC, high FEV1/FVC, low TLC, low DLCO -
Correct Answer ✔ ✔ The answer is A. Choice B describes
a restrictive pattern.
A 33 year old man presents with cough, night sweats, and
pleuritic chest pain. CXR shows a left pleural effusion. PPD
demonstrates 16 mm of induration. Thoracocentesis reveals a
glucose level of 50 mg/dL, LDH 340 U/L, pleural fluid protein
4.6 g/dL, and serum protein 3.0 mg/dL. A spectrum of cultures
for AFB is (-). What is the next step? - Correct Answer ✔ ✔
This patient has an exudative pleural effusion with
suspected TB. He will need a pleural biopsy to confirm the
diagnosis of TB despite having a (-) sputum culture.
, A 64 year old man with COPD comes to the ED with sudden
onset shortness of breath that requires high levels of
supplemental O2. PE reveals decreased breath sounds on the
left side and tracheal deviation to the right along with
hypotension. What is your next step? - Correct Answer ✔
✔ Needle decompression for presumed left-sided tension
pneumothroax.
A 72 year old patient who was admitted to the hospital for a
hemorrhagic stroke develops shortness of breath. Imaging
reveals a pulmonary embolus and a left lower extremity DVT.
How do you proceed? - Correct Answer ✔ ✔ Place an
inferior vena cava (IVC) filter. This patient is not a candidate
for anticoagulation as she currently has a hemorrhagic stroke.
Futrue PE's should be prevented with an IVC filter.
A 30 year old high school guidance counselor presents to her
dermatologist for irritation of her hands. She states that she
washed her hands under hot water about 20 times a day and
uses a variety of alcohol-based hand sanitizer products to
avoid picking up germs. What is the best treatment for her
disorder? - Correct Answer ✔ ✔ SSRIs and CBT.
A 15 year old boy presents to the pediatrician. He states that
he has been exercising more and eating less so that he can
make the school wrestling team. His growth curve has
dropped from the 50th to the 15th percentile for weight.
Which psychiatric diagnosis should be considered? - Correct
,Answer ✔ ✔ Anorexia nervosa. Eating disorders are less
common in males than in females but do occur.
A patient with a history of asthma that was previously
controlled with once-monthly albuterol states that he has
been using his albuterol inhaler four to five times a week. He
denies any nighttime symptoms. How would you adjust his
treatment regimen? - Correct Answer ✔ ✔ Add a low
dose ICS, as the patient how has mild persistent asthma.
You order PFTs for a patient with worsening shortness of
breath with of the following values would be consistent with a
diagnosis of COPD?
(A) Low FEV1, low FVC, low FEV1/FVC, high TLC, low DLCO
,(B) Low FEV1, low FVC, high FEV1/FVC, low TLC, low DLCO -
Correct Answer ✔ ✔ The answer is A. Choice B describes
a restrictive pattern.
A 33 year old man presents with cough, night sweats, and
pleuritic chest pain. CXR shows a left pleural effusion. PPD
demonstrates 16 mm of induration. Thoracocentesis reveals a
glucose level of 50 mg/dL, LDH 340 U/L, pleural fluid protein
4.6 g/dL, and serum protein 3.0 mg/dL. A spectrum of cultures
for AFB is (-). What is the next step? - Correct Answer ✔ ✔
This patient has an exudative pleural effusion with
suspected TB. He will need a pleural biopsy to confirm the
diagnosis of TB despite having a (-) sputum culture.
, A 64 year old man with COPD comes to the ED with sudden
onset shortness of breath that requires high levels of
supplemental O2. PE reveals decreased breath sounds on the
left side and tracheal deviation to the right along with
hypotension. What is your next step? - Correct Answer ✔
✔ Needle decompression for presumed left-sided tension
pneumothroax.
A 72 year old patient who was admitted to the hospital for a
hemorrhagic stroke develops shortness of breath. Imaging
reveals a pulmonary embolus and a left lower extremity DVT.
How do you proceed? - Correct Answer ✔ ✔ Place an
inferior vena cava (IVC) filter. This patient is not a candidate
for anticoagulation as she currently has a hemorrhagic stroke.
Futrue PE's should be prevented with an IVC filter.
