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USMLE STEP3 Exam
Step3 (Page 15 )

Updated On: 1-Feb-2026
Page 15 of 162
PDF with 804 Questions

A 54-year-old woman is triaged in the emergency room for nausea and vomiting. Upon examination, she appears somewhat disheveled and anxious, smelling of alcohol. Her sclerae are injected, and she has moderate tenderness to palpation over her upper abdomen, without rebound or guarding. Although she initially denies alcohol use, she eventually concedes that she drinks daily, her last drink being "late last night."

Which of the following medications would be most helpful in decreasing her future cravings for alcohol?

  1. disulfiram (Antabuse)
  2. fluoxetine (Prozac)
  3. lithium
  4. naltrexone (ReVia)
  5. risperidone (Risperdal)

Answer(s): D

Explanation:

This patient is at risk for alcohol withdrawal. Although the progression of withdrawal may vary, tremors are generally the first signs seen. These usually begin 68 hours after cessation of drinking. Psychotic symptoms, such as delusions or hallucinations, typically develop 812 hours after cessation. Seizures typically occur between 12 and 24 hours, and DTs takes place within 72 hours. (Synopsis, p. 403) Disulfiram is used in individuals with alcohol dependence. As it inhibits acetaldehyde dehydrogenase, thereby causing a deleterious reaction when combined with alcohol, it is used as a deterrent and not for cravings. Antidepressants, lithium, and antipsychotics have not been shown to reduce cravings. Naltrexone, an opiate antagonist, has shown small but positive results in promoting abstinence, reducing heavy drinking days, and blunting cravings. The presumed mechanism involves the blockade of opiate receptors, thereby interfering with the euphoric and rewarding effects of alcohol.



A 26-year-old man is brought into the emergency room via ambulance, minimally responsive to questioning or examination. According to his girlfriend, he has a history of major depressive disorder as well as alcohol dependence. He was found unconscious with a suicide note and many empty beer bottles. She also believes that he had taken "some other drug" that he purchased from a local drug dealer. Which of the following substances found in urine toxicology would be the most dangerous in this patient?

  1. barbiturate
  2. cannabis
  3. cocaine
  4. opiate
  5. PCP

Answer(s): A

Explanation:

Even large amounts of cannabis do not cause death. Cocaine, PCP, and opiates can certainly be lethal in overdose, particularly when combined with alcohol. However, because of their similar effects on the GABA (gammaaminobutyric acid) receptors in the brain, barbiturates (and benzodiazepines) are especially deadly when added to alcohol in an overdose



A 26-year-old divorced woman is brought into the emergency room after being found wandering the streets aimlessly. She is a relatively good historian but gives few spontaneous answers to questions. She describes a 1-year history of the belief that she is being followed by "agents" of the Vatican, who watch her closely to "see if I'm a good Catholic." While they monitor her, they also use radio signals to tell her she is a "whore" and a "slut." Due to these experiences, she has been unable to work. She is afraid to associate with others for fears of being "judged." She enies any medical problems and takes no medications. Her parents were divorced when she was an infant. She does not know anything about her father, but her mother has "manic-depression" and is taking lithium. Her MSE is notable for significant psychomotor slowing, paucity of speech, and a flat affect.

Which of the above symptoms or signs is necessary in order to make a diagnosis of schizophrenia?

  1. belief of being followed by the Vatican
  2. inability to work and social dysfunction
  3. psychomotor slowing and paucity of speech
  4. radio signals transmitting curses
  5. wandering in the streets

Answer(s): B

Explanation:

This patient likely suffers from schizophrenia. While the paranoid and persecutory delusions, auditory hallucinations, disorganization, and negative symptoms (e.g., alogia) are all commonly seen in schizophrenia, none of these alone is necessary. Her occupational and social dysfunction, however, are necessary criteria when making the diagnosis of schizophrenia (DSM IV-TR). Even with appropriate antipsychotic treatment, the likelihood of maintaining a high level of functioning is low. Studies indicate that with treatment, approximately 50% of patients will still exhibit significant symptomatology and display poor functioning. Only 2040% of patients with schizophrenia will be able to lead somewhat unimpaired lives



A 26-year-old divorced woman is brought into the emergency room after being found wandering the streets aimlessly. She is a relatively good historian but gives few spontaneous answers to questions. She describes a 1-year history of the belief that she is being followed by "agents" of the Vatican, who watch her closely to "see if I'm a good Catholic." While they monitor her, they also use radio signals to tell her she is a "whore" and a "slut." Due to these experiences, she has been unable to work. She is afraid to associate with others for fears of being "judged." She denies any medical problems and takes no medications. Her parents were divorced when she was an infant. She does not know anything about her father, but her mother has "manic-depression" and is taking lithium. Her MSE is notable for significant psychomotor slowing, paucity of speech, and a flat affect.

She is hospitalized and eventually stabilized on quetiapine 400 mg twice daily. As she nears discharge, she asks about her prognosis if she maintains medication compliance. What should she be told about her likelihood of leading a moderately well-functioning life?

  1. 020%
  2. 2040%
  3. 4060%
  4. 6080%
  5. 80100%

Answer(s): B

Explanation:

This patient likely suffers from schizophrenia. While the paranoid and persecutory delusions, auditory hallucinations, disorganization, and negative symptoms (e.g., alogia) are all commonly seen in schizophrenia, none of these alone is necessary. Her occupational and social dysfunction, however, are necessary criteria when making the diagnosis of schizophrenia (DSM IV-TR). Even with appropriate antipsychotic treatment, the likelihood of maintaining a high level of functioning is low. Studies indicate that with treatment, approximately 50% of patients will still exhibit significant symptomatology and display poor functioning. Only 2040% of patients with schizophrenia will be able to lead somewhat unimpaired lives



A25-year-old woman returns for her well-baby check 1 week after delivery. The baby has been gaining weight adequately and awakens several times per night to breast feed. Although the mother claims she enjoys being a mom overall, she looks sad and does reluctantly admit to feeling "down" quite a bit. While she feels a great deal of support by her husband, she finds herself crying when alone. Her sleep is erratic, and she often feels tired, but she is eating adequately. She denies significant guilt or any thoughts of suicide or infanticide. What is the appropriate treatment approach for this patient?

  1. antidepressant
  2. hospitalization
  3. mood stabilizer
  4. psychotherapy
  5. reassurance

Answer(s): E

Explanation:

This woman is likely suffering from "baby blues," which is considered a normal reaction to the stress of the postpartum period. It occurs in up to 50% of women after delivery, usually beginning within several days. It is very important to distinguish this from a major depressive episode, postpartum onset, which requires antidepressant treatment and/or psychotherapy. Hospitalization would be indicated only if there were concerns over suicide, or, in cases of "postpartum psychosis," where psychotic symptoms put the infant in immediate danger. Mood stabilizers would be appropriate if the mood disorder were considered to be a bipolar illness. Baby blues are usually self-limiting and respond to reassurance and support.



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