A 28 year-old-woman at 36 weeks’ gestation presents to the obstetrician for an antenatal appointment. Her pregnancy has been uncomplicated. Physical examination shows mild bilateral edema at the ankles. There is a 2/6 systolic murmur at the upper left sternal border. The lungs are clear to auscultation. Which of the following is the most likely explanation for this patient’s findings?

A) Antibodies against myocardium
B) Bicuspid aortic valve
C) Myxomatous degeneration
D) Functional murmur
E) Stenosis of the mitral valve

In this short clip, I talk about how to prepare for USMLE Step 3 in 2026.

A 50-year-old woman is evaluated in hospital.

Which of the following is the most likely location of the patient’s pathology?

A) Atrium
B) AV node
C) His-Purkinje system
D) SA node
E) Ventricle

An 8-year-old girl is brought to the physician by her mother. She has no remarkable past medical history. She’s had no recent illnesses.

Which of the following is the most likely explanation for this patient’s findings?

A) Gaucher syndrome
B) Legg-Calve-Perthes disease
C) Pseudofracture
D) Sickle cell disease
E) Transient synovitis

A 53-year-old man comes to the physician for a follow-up appointment. He takes no medications. The results of his bone scan are shown.

Which of the following is the most likely explanation for this patient’s findings?

A) Avascular necrosis
B) Osteopenia
C) Osteopetrosis
D) Primary hyperparathyroidism
E) Prostate cancer

A 24-year-old man comes to the physician for a 2-day history of dry cough and low-grade fever. He plays soccer avidly and had a tournament a few days ago. A chest x-ray is shown. Empiric treatment is initiated. Which of the following is the most likely pharmacotherapy and its most likely adverse effect?

A) Azithromycin; Gastrointestinal disturbance
B) Azithromycin; Photosensitivity
C) Doxycycline; Agranulocytosis
D) Doxycycline; Thyroid suppression
E) Levofloxacin; Disulfiram-like reaction
F) Levofloxacin; Photosensitivity

An 8-month-old boy is evaluated in hospital for a violaceous region that appears to be growing on the trunk. It was present as a faint mark since birth, but appears to have rapidly grown over the past month. Physical examination shows a 10×14-cm violaceous region on the trunk. Laboratory studies show:

Hemoglobin                                                    15 g/dL
Leukocytes                                                       8,000/μL
Platelets                                                            90,000/μL
Prothrombin time                                       13 seconds
Partial thromboplastin time                 30 seconds
Bleeding time                                                 9 minutes

Which of the following is the most likely explanation for this patient’s findings?

A) Cherry hemangioma
B) Kasabach-Merritt syndrome
C) Pyogenic granuloma
D) Stewart-Treves syndrome
E) Strawberry hemangioma

A 51-year-old man comes to the physician for a follow-up appointment. He has a 1-year history of increasing frequency of episodes in which he wakes up catching his breath in the middle of the night. Polysomnography performed last week showed 72 nocturnal awakenings within an 8-hour period. Blood pressure is 150/90. Which of the following is most likely to be seen in this patient?

A) Carotid chemoreceptor potassium channel closure
B) Decreased afferent glossopharyngeal firing
C) Decreased interomediolateral tract activation
D) Decreased rostral ventrolateral nucleus activation
E) Pulmonary vascular potassium channel opening

A 61-year-old woman comes to the physician for a follow-up appointment. She has no past medical history but inquires about how she can improve her overall health. She says she has heard saturated fats are bad for her blood vessels and heart. Which of the following is the most predominant mechanism behind the effect of saturated fat on cardiovascular health?

A) Decreased LDL receptor expression on adipocytes
B) Decreased LDL receptor expression on hepatocytes
C) Direct inhibition of sterol-regulatory element binding protein-2 (SREBP-2) transcription
D) Increased hepatic production of LDL
E) Increased plasma clearance of HDL

A 41-year-old woman comes to the physician for a 4-month history of increasing fatigue. She is an avid traveler and visited Honduras 6 months ago. Serum laboratory studies show:

Sodium                                             137 mEq/L
Potassium                                       5.6 mEq/L
Bicarbonate                                   22 mEq/L
Leukocytes                                     8,000/μL
Eosinophils                                    26%

Which of the following is the next best step in diagnosis?

A) ACTH stimulation test
B) Dexamethasone suppression test
C) Measure serum iron and ferritin
D) Stool nematode toxin test
E) Stool smear for ova and parasites