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USMLE STEP3 Exam
Step3 (Page 20 )

Updated On: 15-Feb-2026
Page 20 of 162
PDF with 804 Questions

Vitamin D supplementation can be helpful in treating which disease?

  1. hyperparathyroidism
  2. hypoparathyroidism
  3. alcoholic neuritis
  4. pernicious anemia
  5. scurvy

Answer(s): B

Explanation:

Vitamin D is actually a hormone that, along with parathyroid hormone and calcitonin, regulates plasma calcium concentration. One action of vitamin D is to increase plasma Ca2+, which can be reduced in hypoparathyroidism. Scurvy is associated with vitamin C deficiency. Alcoholic neuritis is associated with thiamine deficiency.



A34-year-old woman was found to have a 2-cm right thyroid nodule at the time of a well woman examination. The remainder of the thyroid was palpably normal and there were no lymph nodes palpable. There was no history of thyroid disease or radiation therapy to her head or neck. She was clinically euthyroid. Thyroid-stimulating hormone (TSH) was normal. Which of the following tests would be the most useful in establishing a specific diagnosis?

  1. ultrasound of the thyroid
  2. nuclear scan of the thyroid
  3. thyroid antibody studies
  4. fine needle aspiration of the nodule
  5. CT of the neck

Answer(s): D

Explanation:

In evaluating a sporadic thyroid nodule in a patient who is euthyroid, it is critical to determine whether the nodule is malignant or benign. The most diagnostic test is the fine needle aspiration. Ultrasound will only distinguish between cystic and solid structures, and most nodules have some solid component. The nuclear scan will demonstrate a photopenic area in over 85% of patients. Neither these tests nor CT scan will reliably separate benign from malignant nodules. Thyroid antibody studies do not play a role in the evaluation of a thyroid nodule in a euthyroid patient. They are sometimes used in the evaluation of thyroiditis.



A 32-year-old woman presents with complaints of irritability, heat intolerance, hyperdefecation, and frequent palpitations. She has lost 20 lb over the past six months. She has always been in good health and does not take any prescription or OTC medications. She denies any prior history of thyroid disease or exposure to head/neck irradiation, but she states that one of her relatives was diagnosed with a thyroid disorder at roughly the same age. Vital signs are as follows: BP 138/78, HR 112, RR 22, temp. 98.8°F. On examination, her thyroid is diffusely enlarged and smooth. Auscultation of the thyroid reveals a bruit. Her hair is fine in texture, and she has warm velvety skin. She has hyperactive deep tendon reflexes. There is a fine tremor in her outstretched hands. Which of the following is a common finding in this condition?

  1. macroglossia
  2. hyperkeratosis
  3. infiltrative ophthalmopathy
  4. cerebellar ataxia
  5. pericardial effusion

Answer(s): C

Explanation:

This patient's presentation is consistent with Graves' disease. Infiltrative ophthalmopathy is a common finding in this condition. Approximately 2040% of patients with Graves' disease possess clinically evident eye disease. Complaints include photophobia, diplopia, reduced visual acuity, and easy tearing; and, signs of corneal or conjunctival irritation are oftentimes present. Periorbital edema, chemosis, lid retraction with restricted ocular movement, proptosis, and upward gaze impairment may also be found. Optic nerve compression may also arise, leading to decreased visual acuity, visual field defects, impaired color vision, and papilledema. Macroglossia, hyperkeratosis, cerebellar ataxia, and pericardial effusion are all findings in hypothyroidism. (Ceci Textbook of Medicine, pp. 13961400) Free T3 levels are elevated in all patients with Graves' disease. Most patients also have elevated free T4 levels, but occasionally this level will remain within the normal reference range in a state known as T3 toxicosis. This generally occurs during the initial phases of Graves' disease or at the onset of a relapse. TSH levels are suppressed by the elevated thyroid hormone levels.



A 32-year-old woman presents with complaints of irritability, heat intolerance, hyperdefecation, and frequent palpitations. She has lost 20 lb over the past six months. She has always been in good health and does not take any prescription or OTC medications. She denies any prior history of thyroid disease or exposure to head/neck irradiation, but she states that one of her relatives was diagnosed with a thyroid disorder at roughly the same age. Vital signs are as follows: BP 138/78, HR 112, RR 22, temp. 98.8°F. On examination, her thyroid is diffusely enlarged and smooth. Auscultation of the thyroid reveals a bruit. Her hair is fine in texture, and she has warm velvety skin. She has hyperactive deep tendon reflexes. There is a fine tremor in her outstretched hands.

Which of the following sets of laboratory results would be consistent with this patient's presentation? TSH free T3 free T4

  1. low lowhigh
  2. low normal normal
  3. low high high
  4. highlow low
  5. high high high

Answer(s): C

Explanation:

This patient's presentation is consistent with Graves' disease. Infiltrative ophthalmopathy is a common finding in this condition. Approximately 2040% of patients with Graves' disease possess clinically evident eye disease. Complaints include photophobia, diplopia, reduced visual acuity, and easy tearing; and, signs of corneal or conjunctival irritation are oftentimes present. Periorbital edema, chemosis, lid retraction with restricted ocular movement, proptosis, and upward gaze impairment may also be found. Optic nerve compression may also arise, leading to decreased visual acuity, visual field defects, impaired color vision, and papilledema. Macroglossia, hyperkeratosis, cerebellar ataxia, and pericardial effusion are all findings in hypothyroidism. (Ceci Textbook of Medicine, pp. 13961400) Free T3 levels are elevated in all patients with Graves' disease. Most patients also have elevated free T4 levels, but occasionally this level will remain within the normal reference range in a state known as T3 toxicosis. This generally occurs during the initial phases of Graves' disease or at the onset of a relapse. TSH levels are suppressed by the elevated thyroid hormone levels.



A 32-year-old woman presents with complaints of irritability, heat intolerance, hyperdefecation, and frequent palpitations. She has lost 20 lb over the past six months. She has always been in good health and does not take any prescription or OTC medications. She denies any prior history of thyroid disease or exposure to head/neck irradiation, but she states that one of her relatives was diagnosed with a thyroid disorder at roughly the same age. Vital signs are as follows: BP 138/78, HR 112, RR 22, temp. 98.8°F. On examination, her thyroid is diffusely enlarged and smooth. Auscultation of the thyroid reveals a bruit. Her hair is fine in texture, and she has warm velvety skin. She has hyperactive deep tendon reflexes. There is a fine tremor in her outstretched hands.

Which of the following interventions is most appropriate at this time?

  1. propylthiouracil
  2. thyroidectomy
  3. radioactive iodine therapy
  4. propranolol
  5. potassium iodide

Answer(s): A

Explanation:

This patient's presentation is consistent with Graves' disease. Infiltrative ophthalmopathy is a common finding in this condition. Approximately 2040% of patients with Graves' disease possess clinically evident eye disease. Complaints include photophobia, diplopia, reduced visual acuity, and easy tearing; and, signs of corneal or conjunctival irritation are oftentimes present. Periorbital edema, chemosis, lid retraction with restricted ocular movement, proptosis, and upward gaze impairment may also be found. Optic nerve compression may also arise, leading to decreased visual acuity, visual field defects, impaired color vision, and papilledema. Macroglossia, hyperkeratosis, cerebellar ataxia, and pericardial effusion are all findings in hypothyroidism. (Ceci Textbook of Medicine, pp. 13961400) Free T3 levels are elevated in all patients with Graves' disease. Most patients also have elevated free T4 levels, but occasionally this level will remain within the normal reference range in a state known as T3 toxicosis. This generally occurs during the initial phases of Graves' disease or at the onset of a relapse. TSH levels are suppressed by the elevated thyroid hormone levels.






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