Anyone who hopes to practice medicine in the United States must pass the United States Medical Licensing Examination, or USMLE. (The only exceptions are graduates of osteopathy programs, who can pass either the USMLE or the COMLEX.) The test is actually a battery of three separate tests, known as Step 1, Step 2, and Step 3, and a candidate must pass all three steps in order to qualify for medical licensure.
Wishing to be able to help you in preparing for your USMLE step 3 exam, in this practice, along with more information about formatting USMLE questions, we also present 27 free USMLE step 3 questions and answers for the Step 3 of the United States Medical Licensing Examination.
USMLE Step 3 Test Question Formats
- Read each question carefully. It is important to understand what is being asked.
- Try to generate an answer and then look for it in the option list.
- Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the remaining options, select the one that is most correct.
- If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
A single patient-centered vignette is associated with one question followed by four or more response options. The response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial materials. You are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination.
Example Question 1
1. A 30-year-old man comes to the emergency department because of an acute episode of renal colic. Medical history is remarkable for episodes of painful urination and passing of what he calls “gravel in my urine.” Urinalysis demonstrates microscopic hematuria with some crystalluria and no casts. Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the collecting system. The patient’s pain is responsive to narcotic medication. In addition to administering intravenous fluids, which of the following is the most appropriate next step?
A. Acidification of urine by drinking cranberry juice
B. Cystoscopic removal of the calculus
C. Cystoscopic ureteral lavage
D. Shock wave lithotripsy
E. Straining of the urine
Multiple Item Sets
A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question within these sets is associated with the patient vignette and is independent of the other question(s) in the set. The items within this type of format are designed to be answered in any order. You are required to select the ONE BEST answer to each question.
Example Questions 2 to 3
A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is 178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m2. Today, vital signs are temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of 0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli. Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein.
2. Which of the following historical factors or physical examination findings is most strongly associated with development of this patient’s foot ulcer?
A. Diminished pedal pulses
B. Neurologic findings
C. The patient’s weight
E. Tobacco use
3. Which of the following is the most appropriate action at this time?
A. Begin aggressive debridement in the office
B. Begin intravenous antibiotic therapy
C. Refer the patient for transmetatarsal amputation
D. Schedule the patient for a third-degree skin graft
E. Switch the amoxicillin-clavulanate to oral ciprofloxacin
Sequential Item Sets
A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is associated with the initial patient vignette but is testing a different point. You are required to select the ONE BEST answer to each question. Questions are designed to be answered in sequential order. You must click “Proceed to Next Item” to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item.
Example Questions 4 to 5
A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the girl’s physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for approximately 45 seconds, after which she becomes relaxed and appears to fall asleep. Vital signs at this time are temperature 40.0°C (104.0°F), pulse 120/min, and respirations 40/min. On physical examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose has a scant, clear discharge, and throat is mildly erythematous. Lungs are clear to auscultation except for transmitted upper airway sounds. Heart has rapid rate with a grade 1/6 systolic murmur at the left sternal border. Complete blood count, blood culture, lumbar puncture, and catheterized urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional history discloses that she was born at term, she had an uneventful neonatal course, she has normal growth and development, and vaccinations are up-to-date. She has never had an episode similar to this. Initial laboratory results are shown:
Neutrophils, segmented 25%
Neutrophils, bands 5%
Cerebrospinal fluid 0 RBC/mm3
Other laboratory studies are pending.
4. In addition to ampicillin for otitis media and acetaminophen, this child also should receive which of the following?
A. Oral ethosuximide
B. Oral phenobarbital
C. Oral phenytoin
D. Rectal diazepam
E. No additional medications
5. Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that she is doing well and she has had no recurrence of her symptoms. Examination of the ears shows resolution of the otitis media. Which of the following is the most important diagnostic step at this time?
A. Audiology testing
B. Cognitive testing
C. CT scan of the head
E. No additional testing
Pharmaceutical Advertisement (Drug Ad) Format
The drug ad item format includes a rich stimulus presented in a manner commonly encountered by a physician, eg, as a printed advertisement in a medical journal. Examinees must interpret the presented material in order to answer questions on various topics, including:
- Decisions about care of an individual patient
- Development and approval of drugs and dietary supplements
- Medical ethics
The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, eg, as an abstract that accompanies a research report in a medical journal. Examinees must interpret the abstract in order to answer questions on various topics, including:
- Decisions about care of an individual patient
- Use of diagnostic studies
Primum Computer-based Case Simulations (CCS)
You will manage one case at a time. Free-text entry of patient orders is the primary means for interacting with the format. Buttons and check boxes are used for ordering a physical examination, advancing the clock, changing the patient’s location, reviewing previously displayed information, and obtaining updates on the patient. At the beginning of each case, you will see the clinical setting, simulated case time, and introductory patient information. Photographs and sounds will not be provided. Normal or reference laboratory values will be provided with each report; some tests will be accompanied by a clinical interpretation. To manage patients using the Primum CCS software, it is essential that you complete the Primum tutorial and sample cases provided. A brief description of the interface is provided in the Primum Tutorial.
Free USMLE step 3 questions and answers
Take our 27 free USMLE step 3 questions and answers in this practice test is one of great way to help you review your knowledge, skill and strength for the Step 3 of USMLE.
To respond to the free USMLE Step 3 questions: Click the button corresponding to the best answer for each question. And right after you click the “Submit” button at the bottom of this page.
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This practice test with 27 USMLE step 3 questions and answers is not timed and all are free, so you may take it as many times as you wish.