Page 1 of 155
“UWorld Step 3 QUESTIONS & ANSWERS EXAM
2026 ”LATEST EXAM 2026 – 2027 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
UWorld Step 3
67 yr woman + 4 wks of upper abdominal pain. Also describes epigastric
fullness and mild nausea that occur mostly after eating and sometimes at
night. Pt has no vomiting, wt loss, dysphagia, acid reflux, or black or bloody
stools. Has hx of HT, hyperlipidemia, migraines, and mild intermittent asthma.
Meds include lisinopril and atorvastatin. Father died of colon cancer at age 75.
On PE, abdomen is soft and nontender. No jaundice or palpable masses. Her
hgb is 13.2. Last colonoscopy 3 yrs ago was nml. Best next step in
management of this pt?
Upper GI endoscopy
Dyspepsia
- >/= 1 of the following: postprandial fullness, epigastric pain or burning, early satiety
- pts age >55 or with alarm features (unintentional wt loss, persistent vomiting or
hematemesis, unexplained iron def anemia) should undergo endoscopy)
Subacute thyroiditis is characterized by fever and painful, diffusely enlarged
thyroid, often associated with thyroxicosis. IT is due to acute inflammation of
thyroid and release of stored thyroid hormone, leading to suppressed TSH and
does what to radioactive iodine uptake?
decreases radioactive iodine uptake
Subacute thyroiditis is a self-limited condition. Hyperthyroid phase may last a
few wks, followed by transient hypothyroid phase and eventual return to
euthyroid state. Tx...
, Page 2 of 155
NSAIDs, beta blockers
- glucocorticoids in severe or refractory cases
In pts with signs and symptoms of recurrence of C diff (>/= 3 loose stools in 24
hrs, abdominal cramping, leukocytosis), repeat testing is indicated and
positive results indicate active infection. Management of first recurrence
includes...
oral vanc in prolonged pulsed and tapered regimen, or fidaxomicin
Diabetic neuropathy should be suspected in pts with diabetes who have
symmetric sensory changes in feet that consist of injury to nerve fibers
controlling pain, temp, vibratory, and proprioception sense. What is an easy
and inexpensive way to assess for the loss of vibratory sense in pts with
diabetic neuropathy?
Tuning fork test
Anemia of chronic dz (anemia of chronic inflammation) is a common
complication of inflammatory conditions such as RA. Management generally
involves treating underlying condition and ruling out concurrent causes of
anemia. What improves anemia of chronic disease in pts with RA?
Anti-TNF-alpha agents
Acute rhinosinusitis most commonly due to viral pathogens and usually
resolves within 10 days. Pts with persistent symptoms >/= 10 days, severe
symptoms, or deterioration after several days of improvement often have
acute bacterial rhinosinusitis, which is usually treated empirically with...
5-7 days of amoxicillin-clavulanate
Preferred method of hydration in severe malnutrition
Oral rehydration
First-line tx of tinea capitis
oral griseofulvin or oral terbinafine
Untreated Chlamydia trachomatis infection during pregnancy associated with
what obstetric complications...
PPROM, preterm labor, postpartum endometritis
- neonatal complications: blindness, pna
- first-line tx = azithromycin
Threshold for blood transfusion in most stable pts with upper GI bleeding is ...
hgb <7 g/dL
Diagnosis of 21-hydroxylase def confirmed by...
excessive levels of 17-hydroxyprogesterone
- aldosterone and cortisol low
HIV-positive women in resource-rich countries are advised to feed their infants
with...
formula instead of breast milk
Children with urticarial reactions to egg protein can receive what flu vaccine?
inactivated IM influenza vaccine
32 yo man comes to ED after episode of choking in rest. He was drinking and
dining with friends at local rest, when he accidentally choked on fish bone.
Initially felt sharp painful sensation, but this subsided to vague discomfort
after drinking four glasses of water. Denies having any difficulty in breathing,
, Page 3 of 155
and only has slight difficulty in swallowing his saliva. Mild discomfort and can
still feel fish bone lodged in back of his throat. On quick exam of upper
oropharynx, you don't see any evidence of fishbone. Most appropriate next
step in management of pt?
Perform urgent endoscopy to remove fishbone
- most pts with hx of foreign body ingestion are asymptomatic and have negative
radiograph --> no further tx
- *in all symptomatic pts or pts with hx of sharp object ingestion (fish or chicken
bone, toothpicks, needles, pins) --> urgent endoscopy to prevent esophageal
perforation
Failure to detect difference between groups when it exists is referred to as...
type II error
- probability of type II errors (beta) related to power of study (1-beta)
- power increased with larger sample sizes
- smaller study would be less effective in detecting differences between groups,
increasing chance of type II error
Cat-scratch dz generally presents with cutaneous lesion and regional LAD
following cat scratch or bite. What can reduce the length and severity of
symptoms?
Azithromycin
- regional LAD follows within 1-2 wks
- mild cases in healthy pts often self-resolve within 1-4 mos
Although cases of reversible dementia are rare (<1%), clinicians must rule out
reversible causes prior to making diagnosis of specific dementia syndrome.
Initial lab workup should include...
TSH, CBC, CMP, vit B12 levels
First-line pharm for dementia-related cognitive impairment
Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
- NMDA receptor antagonist, memantine, is another med shown to be modestly
beneficial for symptomatic management of mod to severe dementia
When are kids expected to begin walking?
Typically 12 months but range = 9-16 months
- close f/u until 16 mos
42 yo C woman + "patchy hair loss" for past 6 wks. Other med probz include
hypothyroidism, GERD, bipolar. Smoked 1 pck of cigz daily for past 15 yrs.
Drinks 1-2 ounces of alcohol daily and is a vegetarian. Mother had thyroid
disease, bipolar, and breast cancer. Pt meds include lanoprazole, L-
thyroxinne, and valproic acid. On PE, vitals wnl. Scalp exam reveals several
well-demarcated circular areas of complete hair loss. Fingernail pitting also
present. Most likely cause of hair loss?
Alopecia areata
- well-demarcated, non-scarred, round patches of hair loss
- exclamation point hairs
- may have autoimmune condition history
, Page 4 of 155
Suggestive of benign etiology in pulm nodule...
popcorn calcification (hamartoma) or concentric, central, or diffuse homogenous
calcification on radiographic imaging
biliary colic presents with episodes of constant epigastric or RUQ discomfort
that can radiate to back and right shoulder with associated nausea, vomiting,
and diaphoresis. What is initially preferred for diagnosis?
Transabdominal US
- pts with typical biliary colic symptoms and confirmed gallstones usually given acute
pain management and undergo prophylactic therapy with elective cholecystectomy
Management of retrosternal goiter with compressive symptoms is...
surgical
In pts with CF, pulm exacerbations are typically due to P aeruginosa or S
aureus. Empiric therapy should include meth-resistant S aureus coverage
(vanc) and 2 drugs against P aeruginosa, including...
cefepime and amikacin
Cataplexy is sudden loss of tone triggered by strong emotions and is a
common symptom of narcolepsy. Stimulant meds may mildly improve
symptoms but are often insufficient, especially if there is a significant safety
risk. Other meds for CP include...
SNRI, SSRI, TCAs, sodium oxybate
Infants with macrocephaly (HC >97th percentile) who have open anterior
fontanelle and rapidly expanding head circumference should have what to
evaluate for pathologic intracranial processes?
head US
Isolated elevation of alkaline phosphatase can be seen in ...
infiltrative liver disease (granulomatous disease, infection, certain meds)
- additional evidence of granulomatous disease = bilateral hilar adenopathy in
sarcoidosis
Classic triad of cough, pleuritic chest pain, and hemoptysis. Chest imaging
typically reveals nodules with surrounding ground-glass opacities ("halo
sign") or cavitations with air-fluid levels ("air crescent sign").
Pulmonary aspergillosis
- dx confirmed by serum fungal biomarkers (galactomannan and beta-D-glucan
assay) and sputum sampling for fungal staining and cx
- tx = voriconazole
Preferred treatment in pts with alopecia areata...
topical or intralesional corticosteroids
- after steroid injection, new hair growth is usually seen in next 4-6 weeks
- most pts have normal hair growth within next one to two years even without tx
Prolactinoma is a common cause of amenorrhea and infertility in women.
Other endocrine effects include galactorrhea in women, gynecomastia in men,
and symptoms of hypogonadism in both sexes. Long-term suppression of sex
hormone production by prolactinoma in women can lead to...
osteoporosis
Pts with sore throat, pharyngeal edema, and tonsillar exudates has...
“UWorld Step 3 QUESTIONS & ANSWERS EXAM
2026 ”LATEST EXAM 2026 – 2027 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
UWorld Step 3
67 yr woman + 4 wks of upper abdominal pain. Also describes epigastric
fullness and mild nausea that occur mostly after eating and sometimes at
night. Pt has no vomiting, wt loss, dysphagia, acid reflux, or black or bloody
stools. Has hx of HT, hyperlipidemia, migraines, and mild intermittent asthma.
Meds include lisinopril and atorvastatin. Father died of colon cancer at age 75.
On PE, abdomen is soft and nontender. No jaundice or palpable masses. Her
hgb is 13.2. Last colonoscopy 3 yrs ago was nml. Best next step in
management of this pt?
Upper GI endoscopy
Dyspepsia
- >/= 1 of the following: postprandial fullness, epigastric pain or burning, early satiety
- pts age >55 or with alarm features (unintentional wt loss, persistent vomiting or
hematemesis, unexplained iron def anemia) should undergo endoscopy)
Subacute thyroiditis is characterized by fever and painful, diffusely enlarged
thyroid, often associated with thyroxicosis. IT is due to acute inflammation of
thyroid and release of stored thyroid hormone, leading to suppressed TSH and
does what to radioactive iodine uptake?
decreases radioactive iodine uptake
Subacute thyroiditis is a self-limited condition. Hyperthyroid phase may last a
few wks, followed by transient hypothyroid phase and eventual return to
euthyroid state. Tx...
, Page 2 of 155
NSAIDs, beta blockers
- glucocorticoids in severe or refractory cases
In pts with signs and symptoms of recurrence of C diff (>/= 3 loose stools in 24
hrs, abdominal cramping, leukocytosis), repeat testing is indicated and
positive results indicate active infection. Management of first recurrence
includes...
oral vanc in prolonged pulsed and tapered regimen, or fidaxomicin
Diabetic neuropathy should be suspected in pts with diabetes who have
symmetric sensory changes in feet that consist of injury to nerve fibers
controlling pain, temp, vibratory, and proprioception sense. What is an easy
and inexpensive way to assess for the loss of vibratory sense in pts with
diabetic neuropathy?
Tuning fork test
Anemia of chronic dz (anemia of chronic inflammation) is a common
complication of inflammatory conditions such as RA. Management generally
involves treating underlying condition and ruling out concurrent causes of
anemia. What improves anemia of chronic disease in pts with RA?
Anti-TNF-alpha agents
Acute rhinosinusitis most commonly due to viral pathogens and usually
resolves within 10 days. Pts with persistent symptoms >/= 10 days, severe
symptoms, or deterioration after several days of improvement often have
acute bacterial rhinosinusitis, which is usually treated empirically with...
5-7 days of amoxicillin-clavulanate
Preferred method of hydration in severe malnutrition
Oral rehydration
First-line tx of tinea capitis
oral griseofulvin or oral terbinafine
Untreated Chlamydia trachomatis infection during pregnancy associated with
what obstetric complications...
PPROM, preterm labor, postpartum endometritis
- neonatal complications: blindness, pna
- first-line tx = azithromycin
Threshold for blood transfusion in most stable pts with upper GI bleeding is ...
hgb <7 g/dL
Diagnosis of 21-hydroxylase def confirmed by...
excessive levels of 17-hydroxyprogesterone
- aldosterone and cortisol low
HIV-positive women in resource-rich countries are advised to feed their infants
with...
formula instead of breast milk
Children with urticarial reactions to egg protein can receive what flu vaccine?
inactivated IM influenza vaccine
32 yo man comes to ED after episode of choking in rest. He was drinking and
dining with friends at local rest, when he accidentally choked on fish bone.
Initially felt sharp painful sensation, but this subsided to vague discomfort
after drinking four glasses of water. Denies having any difficulty in breathing,
, Page 3 of 155
and only has slight difficulty in swallowing his saliva. Mild discomfort and can
still feel fish bone lodged in back of his throat. On quick exam of upper
oropharynx, you don't see any evidence of fishbone. Most appropriate next
step in management of pt?
Perform urgent endoscopy to remove fishbone
- most pts with hx of foreign body ingestion are asymptomatic and have negative
radiograph --> no further tx
- *in all symptomatic pts or pts with hx of sharp object ingestion (fish or chicken
bone, toothpicks, needles, pins) --> urgent endoscopy to prevent esophageal
perforation
Failure to detect difference between groups when it exists is referred to as...
type II error
- probability of type II errors (beta) related to power of study (1-beta)
- power increased with larger sample sizes
- smaller study would be less effective in detecting differences between groups,
increasing chance of type II error
Cat-scratch dz generally presents with cutaneous lesion and regional LAD
following cat scratch or bite. What can reduce the length and severity of
symptoms?
Azithromycin
- regional LAD follows within 1-2 wks
- mild cases in healthy pts often self-resolve within 1-4 mos
Although cases of reversible dementia are rare (<1%), clinicians must rule out
reversible causes prior to making diagnosis of specific dementia syndrome.
Initial lab workup should include...
TSH, CBC, CMP, vit B12 levels
First-line pharm for dementia-related cognitive impairment
Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
- NMDA receptor antagonist, memantine, is another med shown to be modestly
beneficial for symptomatic management of mod to severe dementia
When are kids expected to begin walking?
Typically 12 months but range = 9-16 months
- close f/u until 16 mos
42 yo C woman + "patchy hair loss" for past 6 wks. Other med probz include
hypothyroidism, GERD, bipolar. Smoked 1 pck of cigz daily for past 15 yrs.
Drinks 1-2 ounces of alcohol daily and is a vegetarian. Mother had thyroid
disease, bipolar, and breast cancer. Pt meds include lanoprazole, L-
thyroxinne, and valproic acid. On PE, vitals wnl. Scalp exam reveals several
well-demarcated circular areas of complete hair loss. Fingernail pitting also
present. Most likely cause of hair loss?
Alopecia areata
- well-demarcated, non-scarred, round patches of hair loss
- exclamation point hairs
- may have autoimmune condition history
, Page 4 of 155
Suggestive of benign etiology in pulm nodule...
popcorn calcification (hamartoma) or concentric, central, or diffuse homogenous
calcification on radiographic imaging
biliary colic presents with episodes of constant epigastric or RUQ discomfort
that can radiate to back and right shoulder with associated nausea, vomiting,
and diaphoresis. What is initially preferred for diagnosis?
Transabdominal US
- pts with typical biliary colic symptoms and confirmed gallstones usually given acute
pain management and undergo prophylactic therapy with elective cholecystectomy
Management of retrosternal goiter with compressive symptoms is...
surgical
In pts with CF, pulm exacerbations are typically due to P aeruginosa or S
aureus. Empiric therapy should include meth-resistant S aureus coverage
(vanc) and 2 drugs against P aeruginosa, including...
cefepime and amikacin
Cataplexy is sudden loss of tone triggered by strong emotions and is a
common symptom of narcolepsy. Stimulant meds may mildly improve
symptoms but are often insufficient, especially if there is a significant safety
risk. Other meds for CP include...
SNRI, SSRI, TCAs, sodium oxybate
Infants with macrocephaly (HC >97th percentile) who have open anterior
fontanelle and rapidly expanding head circumference should have what to
evaluate for pathologic intracranial processes?
head US
Isolated elevation of alkaline phosphatase can be seen in ...
infiltrative liver disease (granulomatous disease, infection, certain meds)
- additional evidence of granulomatous disease = bilateral hilar adenopathy in
sarcoidosis
Classic triad of cough, pleuritic chest pain, and hemoptysis. Chest imaging
typically reveals nodules with surrounding ground-glass opacities ("halo
sign") or cavitations with air-fluid levels ("air crescent sign").
Pulmonary aspergillosis
- dx confirmed by serum fungal biomarkers (galactomannan and beta-D-glucan
assay) and sputum sampling for fungal staining and cx
- tx = voriconazole
Preferred treatment in pts with alopecia areata...
topical or intralesional corticosteroids
- after steroid injection, new hair growth is usually seen in next 4-6 weeks
- most pts have normal hair growth within next one to two years even without tx
Prolactinoma is a common cause of amenorrhea and infertility in women.
Other endocrine effects include galactorrhea in women, gynecomastia in men,
and symptoms of hypogonadism in both sexes. Long-term suppression of sex
hormone production by prolactinoma in women can lead to...
osteoporosis
Pts with sore throat, pharyngeal edema, and tonsillar exudates has...
