USMLE Step 3 2026 ACTUAL TEST
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PART 1 (Questions 1–25)
Q1.
A 67-year-old man with hypertension presents with sudden right-sided weakness and slurred
speech for 1 hour. CT head is negative for hemorrhage. What is the next best step?
A. Aspirin
B. IV alteplase (tPA)
C. Heparin infusion
D. MRI brain
E. Clopidogrel
Answer: B
Explanation: Acute ischemic stroke within 3–4.5 hours and no hemorrhage → IV thrombolysis is
indicated if eligible.
Q2.
A 24-year-old woman has dysuria and frequency. Urinalysis shows nitrites and leukocytes. No
fever or flank pain. Best treatment?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Ceftriaxone
E. Vancomycin
Answer: C
Explanation: Uncomplicated cystitis → nitrofurantoin first-line.
,Q3.
A patient has chest pain, ST elevation in II, III, aVF. Which artery is most likely occluded?
A. LAD
B. Left circumflex
C. Right coronary artery
D. Left main
E. Posterior descending (LAD branch only)
Answer: C
Explanation: Inferior MI = RCA in most patients.
Q4.
A 55-year-old smoker has chronic cough and barrel chest. Best initial diagnosis test?
A. CT chest
B. Spirometry
C. Bronchoscopy
D. Chest X-ray
E. ABG
Answer: B
Explanation: COPD diagnosis requires spirometry (FEV1/FVC < 0.7).
Q5.
A child presents with barking cough and inspiratory stridor. Best treatment?
A. Antibiotics
B. Oxygen only
C. Dexamethasone + nebulized epinephrine
D. Heliox
E. Intubation immediately
Answer: C
Explanation: Croup treatment depends on severity; steroids + epinephrine if stridor at rest.
, Q6.
A diabetic patient has foot ulcer with foul-smelling discharge and gas in tissues. Likely
organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Clostridium perfringens
D. E. coli
E. Pseudomonas
Answer: C
Explanation: Gas gangrene → Clostridium species.
Q7.
A woman presents with fatigue, weight gain, cold intolerance. Labs: high TSH, low T4.
Diagnosis?
A. Graves disease
B. Thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
E. Hashimoto thyroid cancer
Answer: C
Explanation: High TSH + low T4 = primary hypothyroidism.
Q8.
A patient on heparin develops low platelets and thrombosis. Diagnosis?
A. DIC
B. ITP
C. TTP
D. HIT (Heparin-induced thrombocytopenia)
E. Aplastic anemia
BANK | Real Questions + Detailed
Solutions | Pass Guaranteed
PART 1 (Questions 1–25)
Q1.
A 67-year-old man with hypertension presents with sudden right-sided weakness and slurred
speech for 1 hour. CT head is negative for hemorrhage. What is the next best step?
A. Aspirin
B. IV alteplase (tPA)
C. Heparin infusion
D. MRI brain
E. Clopidogrel
Answer: B
Explanation: Acute ischemic stroke within 3–4.5 hours and no hemorrhage → IV thrombolysis is
indicated if eligible.
Q2.
A 24-year-old woman has dysuria and frequency. Urinalysis shows nitrites and leukocytes. No
fever or flank pain. Best treatment?
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Ceftriaxone
E. Vancomycin
Answer: C
Explanation: Uncomplicated cystitis → nitrofurantoin first-line.
,Q3.
A patient has chest pain, ST elevation in II, III, aVF. Which artery is most likely occluded?
A. LAD
B. Left circumflex
C. Right coronary artery
D. Left main
E. Posterior descending (LAD branch only)
Answer: C
Explanation: Inferior MI = RCA in most patients.
Q4.
A 55-year-old smoker has chronic cough and barrel chest. Best initial diagnosis test?
A. CT chest
B. Spirometry
C. Bronchoscopy
D. Chest X-ray
E. ABG
Answer: B
Explanation: COPD diagnosis requires spirometry (FEV1/FVC < 0.7).
Q5.
A child presents with barking cough and inspiratory stridor. Best treatment?
A. Antibiotics
B. Oxygen only
C. Dexamethasone + nebulized epinephrine
D. Heliox
E. Intubation immediately
Answer: C
Explanation: Croup treatment depends on severity; steroids + epinephrine if stridor at rest.
, Q6.
A diabetic patient has foot ulcer with foul-smelling discharge and gas in tissues. Likely
organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Clostridium perfringens
D. E. coli
E. Pseudomonas
Answer: C
Explanation: Gas gangrene → Clostridium species.
Q7.
A woman presents with fatigue, weight gain, cold intolerance. Labs: high TSH, low T4.
Diagnosis?
A. Graves disease
B. Thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
E. Hashimoto thyroid cancer
Answer: C
Explanation: High TSH + low T4 = primary hypothyroidism.
Q8.
A patient on heparin develops low platelets and thrombosis. Diagnosis?
A. DIC
B. ITP
C. TTP
D. HIT (Heparin-induced thrombocytopenia)
E. Aplastic anemia
