Archer USMLE Step 3 Question Bank – Answer Key

Archer Question Bank - Answer Key:

Archer has received overwhelming requests to release the answers for our recently posted Blog questions. Thousands of students have felt that these questions are highly useful in their Step 3 preparation and have requested us to release a dedicated question bank with separate navigation since they find it difficult to follow the questions on the blog. We are in the process of releasing such dedicated question bank. We will notify you when this is released. In the mean time, please use this Answer Key for the sample USMLE Step 3 high-yield questions posted on the blog. For some of the questions, you can find explanations under the questions. Full explanations will be released once our question bank is released. You can also find explanations for the concepts in the questions inArcher USMLE step 3 Theory Lectures which are currently regarded as best high-yield and standard preparatory course for USMLE Step 3. 

Archer USMLE Step 3 Question bank – ANSWER KEY

1. C

2. B

3. B

4. C

5. B

6. B

7. B

8. D

9. D

10. c

11. A

12. E

13. A

14. C

15. C

16. A

17. C

18. C

19. E

20. A

21. A

22. D

23. D

24. E

25. D

26. A

27. E

28. A

29. A

30. B

31. B

32. C

33. E

34. B

35. E

36. D

37. C

38. B, D

39. D

40. D

41. B

42. D

43.E

44. C

45. B

46. B

47. D

48. B

49. C

50.D

51.C

52.C

53.C

54.C

55.D

56.E

57.E

58.A

59.C

60. D

61. D

62. D

63. D

64.C

65.A

66.C

67.E

68.D

69.B

70.C

71.C

72.B

73.F

74.D

75.B

76.D

77.F

78.B

79.D

80.A

81.B

82.C

83.C

84.E

85.C

86.B

87.C

88.C

89.D

90.A

91.A

92.E

93.E

94.D

95.D, B

96.D

97.C

98.C

99.D

100.C

101.

102.

103.

104.

105.

Question of the Week # 12

Question of the Week # 108

Archer

Question of the Week # 88

Q88). A 75 year old woman is sent from the nursing home for evaluation of fever and altered mental status. The patient’s past medical history is significant for moderate Alzheimer’s dementia. On examination, she is confused. Her vitals reveal Temperature of 102F, Blood pressure 80/60 and a HR of 102/min. Chest and cardiovascular examination is benign. On abdominal examination, the patient moans upon palpation of right upper quadrant. Cholecystitis is suspected and ultrasound is obtained that reveals very distended gall bladder with pericholecystic fluid, a normal caliber common bile duct and a gall stone in the cystic duct. The patient is started on IV Normal saline and broad spectrum antibiotics. Her blood pressure despite initial hydration is still 80/40. She is started on Norepinephrine drip. The next most important step in managing this patient ?

A. Urgent Cholecystectomy

B. Endoscopic Retrograde Cholangiopancreatography

C. Percutaneous Cholecystostomy

D. 2D echocardiogram

E. Exploratory Laporotomy

 

What predicts USMLE Step 3 performance?

As per this Study, the following variables predict USMLE step 3 performance :

1. Knowledge of clinical
science as measured on USMLE Step 2
exam
2. Having higher Step 2 Scores
3.The nature of the
residency training
4. Having a higher GPA
5. Residency training in a
broad-based specialty

Step 1 score did not predict Step 3 performance.

Question of the Week # 170

170) A 41 year old woman is evaluated in the office for 20lb weight loss over the last three months. She has a history of Hodgkin’s disease involving mediastinal and cervical lymph nodes and was treated with chemotherapy and Involved field radiation therapy at the age of 12.  She is born in the USA and never traveled outside United States. Her recent tuberculin skin test was 2mm about 1 month ago. Recent mammogram was normal. She denies any night sweats or pruritus. She reports chronic cough over the last 6 months associated with intermittent mild hemoptysis. On physical examination, there is no peripheral lymphadenopathy. A Chest X-ray is shown below:



 

 

 

 

 

 

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

A)     Tuberculosis

B)      Long term sequel of Hodgkin’s therapy

C)      Recurrent Hodgkin’s disease

D)     Radiation fibrosis

E)      Radiation Pneumonitis

Question of the Week # 171

171)  A 54 year old woman presents with complaints of abdominal pain in the right upper quadrant that started 4 hours ago and is persistent. She denies any fever, nausea or vomiting.

On physical examination, there is mild tenderness in right upper quadrant. Her liver function tests reveal an AST (SGOT) 160U/L ( N= 5 to 40U/L) , ALT (SGPT) 240U/L( N= 8 to 55U/L)  , Alkaline phosphatase 110 U/L ( 40 TO 130U/L) , Total Bilirubin 1.2mg%.  An ultrasound of the gall bladder does not reveal any gall stones or pericholecystic fluid and shows a common bile duct diameter of 9mm (normal 6mm). The most appropriate next step in managing this patient:

A)     Hepatitis Serology

B)      Laparoscopic Cholecystectomy

C)      HIDA scan

D)     Endoscopic Retrograde Cholangiopancreatography (ERCP)

E)      Magnetic Resonance CholangiOpancreatography ( MRCP)

Question of the Week # 172

172)  A 44 year old obese woman presents with complaints of abdominal pain in the right upper quadrant that started 4 hours ago and is persistent. She has mild nausea. On physical examination, there is tenderness in right upper quadrant which increases with deep breath. Her liver function tests are normal; WBC count is 24,000/µl with neutrophilic predominance. Amylase and Lipase are with in normal limits. An ultrasound of the gall bladder reveals gall stones but there is no pericholecystic fluid or any other sonographic evidence of acute cholecystitis. Sonographic murphy’s sign is absent. The most appropriate next step in managing this patient:

A)     Percutaneous Cholecystostomy

B)      Laparoscopic Cholecystectomy

C)      HIDA scan

D)     Endoscopic Retrograde Cholangiopancreatography (ERCP)

E)     Magnetic Resonance CholangiOpancreatography ( MRCP)

 

Archer USMLE Step 3 Question Bank - Answer Key

Archer has received overwhelming requests to release the answers for our recently posted Blog questions. Thousands of students have felt that these questions are highly useful in their Step 3 preparation and have requested us to release a dedicated question bank with separate navigation since they find it difficult to follow the questions on the blog. We are in the process of releasing such dedicated question bank. We will notify you when this is released. In the mean time, please use this Answer Key for the sample USMLE Step 3 high-yield questions posted on the blog. For some of the questions, you can find explanations under the questions. Full explanations will be released once our question bank is released. You can also find explanations for the concepts in the questions in Archer USMLE step 3 Theory Lectures which are currently regarded as best high-yield and standard preparatory course for USMLE Step 3. 

Archer USMLE Step 3 Question bank - ANSWER KEY

1. C

2. B

3. B

4. C

5. B

6. B

7. B

8. D

9. D

10. c

11. A

12. E

13. A

14. C

15. C

16. A

17. C

18. C

19. E

20. A

21. A

22. D

23. D

24. E

25. D

26. A

27. E

28. A

29. A

30. B

31. B

32. C

33. E

34. B

35. E

36. D

37. C

38. B, D

39. D

40. D

41. B

42. D

43.E

44. C

45. B

46. B

47. D

48. B

49. C

50.D

51.C

52.C

53.C

54.C

55.D

56.E

57.E

58.A

59.C

60. D

61. D

62. D

63. D

64.C

65.A

66.C

67.E

68.D

69.B

70.C

71.C

72.B

73.F

74.D

75.B

76.D

77.F

78.B

79.D

80.A

81.B

82.C

83.C

84.E

85.C

86.B

87.C

88.C

89.D

90.A

91.A

92.E

93.E

94.D

95.D, B

96.D

97.C

98.C

99.D

100.C

101.

102.

103.

104.

105.

Question of the Week # 167

167)  A 77 year old woman is brought by her son for evaluation in your office for excessive forgetfulness.  Her son discovered that the patient has become increasingly forgetful over the last two years. She has difficulty managing her finances. She lives alone, drives her own car and prepares her own meals. As per her son, several recent new dents were noted on her mother’s car. She is dressed well and is comfortable. Visual acuity on examination is 20/40 in both eyes. She has seen her ophthalmologist recently and was prescribed corrective glasses which correct her vision to normal. She is compliant with using her glasses during driving. Rest of the physical including sensory and motor functions are grossly normal. She scores 25/30 on Mini-Mental Status examination.

The most appropriate recommendation regarding her driving at this time:

A)     Limit driving to day-time only

B)      Unrestricted driving

C)      Complete cessation of driving

D)     Referral to Driving Rehabilitation Service

E)     Start therapy for Alzheimer’s

Question of the Week # 166

166) A 42 year old woman with history of lupus nephritis presents with complaints of pain in her right thigh. Pain increases on walking and standing. Her kidney disease is under control on Prednisone maintenance for past one year. She denies any recent trauma. On physical examination, she is noted to have a right sided limp on walking. Her Hip X-ray is shown below:



The most likely etiology for the condition shown above:

A)           Renal insufficiency

B)            Secondary Hyperparathyroidism

C)            Systemic Lupus Erythematosus

D)           Vitamin D deficiency

E)            Prednisone therapy

Question of the Week # 168

168) A 70 year old woman with history of Hypertension, Diabetes mellitus, severe osteoarthritis and Macular degeneration is seen during a follow-up visit. He was seen a month ago in your office for evaluation of his driving capacity. At that time, he was noted to have significant impairment of vision and motor skills. His visual impairment persisted despite corrective glasses. He also uses cane to walk and has persistent deficits of left sided weakness and hemi spatial inattention secondary to a stroke 8 months ago. He was subsequently referred to driving rehabilitation specialist and was deemed unsafe to drive. During his visit 2 weeks ago, he has been counseled and was instructed to stop driving. While talking him about his transportation, he tells you that he drove himself to the clinic today.

Your most appropriate response at this time:

a) “When do you think it’s an appropriate time for a person to stop driving?”

b)  Let’s talk about some of your concerns regarding retiring from driving

c) I am wondering, is there someone whom you trust, and who would tell you when they thought it was unsafe for you to continue driving?

d) “You are a threat to others while driving on the road”

e) “I have a duty to protect you and so, I will have to report you to DMV”

f) “Let me refer you to Driving Rehabilitation so that they can help you with adaptive devices”

Question of the Week # 169

169) A 77 year old woman is brought by her son for evaluation in your office for excessive forgetfulness.  Her son discovered that the patient has become increasingly forgetful over the last two years. She has difficulty managing her finances. She lives alone, drives her own car and prepares her own meals. As per son, several recent new dents were noted on her mother’s car. She is dressed well and is comfortable. Visual acuity on examination is 20/100 in both eyes and is partially corrected with glasses. She also has a fixed visual field deficit that is persistent for past one year due to a cerebrovascular accident. Rest of the physical including sensory and motor functions are grossly normal. She scores 25/30 on Mini-Mental Status examination.

The most appropriate recommendation regarding her driving at this time:

A)           Limit driving to day-time only

B)            Unrestricted driving

C)            Complete cessation of driving

D)           On-Road performance based driving test

E)            Adaptive devices for safe driving

Question of the Week # 165

165) A 42 year old woman with history of lupus nephritis presents with complaints of pain in her right thigh. Pain increases on walking and standing. Her kidney disease is under control on Prednisone maintenance for past one year. She denies any recent trauma. On physical examination, she is noted to have a right sided limp on walking. Her Hip X-ray is shown below:



 

 

 

 

 

 

 

 

The most likely diagnosis is:

A)     Osteosarcoma

B)      Osteonecrosis

C)      Lupus arthritis

D)     Osteoarthritis

E)      Osteoporosis

Question of the Week # 164

164) A 64 year old man is seen in the Emergency room for sharp sub sternal chest pain that started few hours ago. The pain increases on coughing and deep breathing. His history is significant for Acute Myocardial Infarction about 6 weeks ago. At that time, he was treated with percutaneous coronary intervention and stent placement. On physical examination, temperature is 100F, Heart rate 88/min, and Blood pressure 110/70 mm Hg. Pulsus paradoxus is 8mm Hg and lungs are clear to auscultation. A chest X-ray reveals enlargement of cardiac shadow. The most appropriate treatment for this patient’s presentation:

A) Pericardiocentesis

B) Oral Ibuprofen

C) Oral Prednisone

D) Metoprolol

E) Cardiac catheterization to evaluate stent re-occlusion

Question of the Week # 161

161) A 42 year old man is evaluated in your office for pain in his left hand. He has a chronic history of biciptal tendinopathy in his left upper extremity and Gastro-esophageal Reflux disease. He denies any history of recent trauma. He reports sudden onset of pain in his left hand that is associated with burning sensation. On physical examination, the left hand is swollen, pal, cool and tender to touch. Radial and ulnar pulses are intact. The image of his hands is shown below:



The cornerstone of the treatment modalities in this condition:

A)  Encouraging normal use of the limb

B)  Immobilization in plaster cast

C) Surgical decompression

D) Arterial Bypass surgery

E) prevention of exposure to cold temperatures

Question of the Week # 163

163) A 62 year old man with past medical history significant for Congestive Heart Failure presents with progressively increasing shortness of breath over the past 2 months. He denies any chest pain on exertion or at rest. He was recently started on furosemide for management of peripheral edema and is compliant with low salt diet. An Echocardiogram obtained 3 months ago revealed an Ejection Fraction of 32% (Normal = above 55%) at which time he was started on Enalapril. On physical examination, there is trace ankle edema. There are no lung crackles on auscultation. Rest of the examination is normal. An EKG reveal changes of left ventricular hypertrophy with normal QRS duration. The most important intervention at this time that would most improve his survival is

A) Start Losartan

B) Start Carvedilol

C) Start Isosorbide and Hydralazine

D) Add Digoxin

E) Biventricular Pacing

Question of the Week # 161

161) A 42 year old man is evaluated in your office for pain in his left hand. He has a chronic history of biciptal tendinopathy in his left upper extremity and Gastro-esophageal Reflux disease. He denies any history of recent trauma. He reports sudden onset of pain in his left hand that is associated with burning sensation. On physical examination, the left hand is swollen, pal, cool and tender to touch. Radial and ulnar pulses are intact. The image of his hands is shown below:



 

 

 

 

 

 

Most likely diagnosis of this patient’s presentation

A)     Scleroderma

B)      Raynaud’s phenomenon

C)      Complex regional pain syndrome

D)     Acute arterial occlusion

E)      Carpal Tunnel Syndrome

F)      Compartment Syndrome

Question of the Week # 162

162) A 42 year old man is evaluated in your office for pain in his left hand. He has a chronic history of biciptal tendinopathy in his left upper extremity and Gastro-esophageal Reflux disease. He denies any history of recent trauma. He reports sudden onset of pain in his left hand that is associated with burning sensation. On physical examination, the left hand is swollen, pal, cool and tender to touch. Radial and ulnar pulses are intact. The image of his hands is shown below:



 

 

 

 

 

 

 

The cornerstone of the treatment modalities in this condition:

A)  Encouraging normal use of the limb

B)  Immobilization in plaster cast

C) Surgical decompression

D) Arterial Bypass surgery

E)     Prevention of exposure to cold temperatures