STEP3 Exam Questions and Answers | Exam-Dumps (Page: 6)

QUESTION: 26

A 64-year-old male with a history of hypertension and tobacco abuse presents for follow-up after a routine physical during which he was found to have 45 red blood cells (RBCs) per high-power field (HPF) on a screening urinalysis. The urinalysis was negative for leukocytes, nitrites, epithelial cells, and ketones. The patient denies any complaints and the review of systems is essentially negative.

In detecting microscopic hematuria, which of the following is true?

The office urine dipstick is 91100% sensitive and 6599% specific for detection of RBCs, Hgb, and myoglobin.
Urinalysis must reveal a minimum of 5 RBCs per HPF in order to continue the workup.
The presence of epithelial cells makes the urinalysis invalid.
The presence of "large blood" on a urine dipstick effectively distinguishes RBCs from myoglobinuria.
Any urinalysis with RBCs should be recollected via a catheterized specimen prior to initiating a workup for hematuria.

Answer(s): A

Explanation:

Asymptomatic microscopic hematuria is defined by the American Urological Association as three or more RBCs per high power field on urinary sediment from two out of three properly collected urinalyses. A proper sample can be a midstream clean-catch specimen. The urine dipstick is roughly 91100% sensitive and 65- 99% specific for detection of RBCs, Hgb, and myoglobin. Urine dipstick is not reliable in distinguishing myoglobin from Hgb or RBCs. Therefore, urinalysis with microscopy should be ordered to assess the number of RBCs per high power field. Microscopic hematuria is usually an incidental finding but deserves a thorough workup, as 10% can be due to malignancy. The initial approach is to repeat the urinalysis to rule out infection. If the urinalysis suggests infection by the presence of WBCs or nitrites, a culture should be ordered and the patient treated appropriately. If RBCs are present without any leukocytes, nitrites, or epithelial cells on the repeated urinalysis, a proper workup should ensue. After history and physical are done to rule out risk factors, comorbidities, or other etiologies to account for the hematuria, one must look to diagnostic tests. A serum creatinine is useful to assess for renal insufficiency. During the course of the workup, if the urinalysis and serum creatinine suggest a glomerular etiology (casts, elevated creatinine, dysmorphic RBCs) a renal consultation and possible renal biopsy may be warranted. Evaluation of the upper tract with either an IVP or CT scan of the abdomen/pelvis with and without contrast should be ordered to rule out renal cell carcinoma, nephrolithiasis, or aneurysms. Next, the lower tract should be visualized by cystoscopy and washings sent for cytology. If all the above workup is negative, the patient can be reassured and followed with a repeat urinalysis in 6 months.

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QUESTION: 27

A 52-year-old man presents to the ED with a complaint of rectal bleeding and hematuria. He has a medical history significant for atrial fibrillation diagnosed 10 years ago and states that he takes metoprolol as well as warfarin for this condition. Upon examination, you find that his blood pressure is 122/78, his pulse is 84, his respiratory rate is 18, and his O2 saturation is 98% on room air. He has an irregularly irregular heart rhythm, gingival bleeding, and some bruises on his extremities. He has a positive fecal occult blood test, and laboratory studies return showing an international normalized ratio (INR) of 16.5. You order that the patient's warfarin be held. Which of the following is the most appropriate additional intervention at this time?

repeat INR measurement as an outpatient in 5 days
admit the patient to the hospital and conduct serial INR measurements
administer vitamin K1
administer fresh frozen plasma
administer vitamin K1 and fresh frozen plasma

Answer(s): E

Explanation:

This patient has a markedly supratherapeutic INR and clinical evidence of bleeding. Discontinuation or dosage reduction of warfarin is an appropriate intervention by itself in patients with an INR less than 5.0 or in patients without signs of bleeding. In patients with bleeding or with an INR greater than 5.0, however, further interventions are indicated. Vitamin K1 administration provides a more rapid reversal of the anticoagulation caused by warfarin, but it takes 68 hours to begin having an effect and up to 24 hours to achieve its maximal effect. Immediate reversal may be obtained by the administration of fresh frozen plasma intravenously in addition to vitamin K1

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QUESTION: 28

A72-year-old African American male presents for a routine health examination. He states that he would like to have a "screening for cancer." In the United States, based on his sex, race, and age, what is the most likely malignancy for this patient?

lung cancer
prostate cancer
colon cancer
testicular cancer
multiple myeloma

Answer(s): B

Explanation:

Prostate cancer is the leading cancer in African American males in the United States. The cancer with the highest rate of mortality for the same subpopulation is lung cancer. Of African-American men diagnosed with a new cancer, approximately 42% will have prostate cancer, 14.6% lung cancer, and 10% colorectal cancer. The leading causes of cancer deaths in the same population are lung (28.4%), prostate (15.6%), and colorectal cancer (10.5%).

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QUESTION: 29

A 72-year-old man comes to your clinic for the first time, accompanied by his wife. His wife states that she is concerned because he has been growing increasingly forgetful over the past year. Within the past month, he has forgotten to turn off the stove and has got lost while walking to the post office one block away from their home. His past medical history is significant for well-controlled diabetes and chronic lower back pain. He has no history of falls or traumatic injury to the head. Examination of the patient is significant for a score of 18 on a Mini Mental Status Examination (MMSE). During the administration of the MMSE, the patient blurts out that his wife brought him to the doctor because she is having an extramarital relationship.

Which of the following accurately describes this patient's condition?

There is no genetic basis for development of this disease.
It is usually abrupt in onset.
There is no correlation between age and prevalence of this disease.
Environmental exposure is a proven risk factor for development of this disease.
It is one of the most common terminal illnesses in developed nations.

Answer(s): E

Explanation:

This patient's symptoms are most consistent with Alzheimer disease. Alzheimer disease is a prominent condition in developed nations, ranking as the third most common terminal illness behind heart disease and cancer. It is the most common form of dementia, with over 4 million Americans having the condition in the United States alone. There is a direct correlation between advanced age and increasing prevalence of Alzheimer disease. While there is an early-onset form of familial Alzheimer disease that may appear as early as the third decade of life, this accounts for only a small percentage of total Alzheimer cases. There does appear to be a genetic component to the development of Alzheimer disease, as it has been demonstrated that first-degree relatives of Alzheimer patients possess an increased risk for development of the condition. Genes on chromosomes 1, 14, and 21 have been implicated in this association. While age and family history are important risk factors, there is no evidence proving that environmental factors lead to an increased chance for development of the disease. Progression of Alzheimer dementia is typically insidious, spanning as many as several years. Anticholinergic agents and any other medication with anticholinergic effects are contraindicated in the setting of Alzheimer dementia. Their use may lead to worsening of cognition and may contribute to decreased efficacy of medications used in the treatment of Alzheimer dementia. Tricyclic antidepressants such as amitriptyline should be avoided for this reason. Risperidone, olanzapine, and quetiapine are atypical antipsychotic medications which are useful in the treatment of emotional withdrawal and delusions which may arise in Alzheimer patients. Trazodone, carbamazepine, and divalproex are moodstabilizing medications which are useful in patients who display marked agitation. While trazodone does display some anticholinergic side effects, they are far less pronounced than those seen with amitriptyline.

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QUESTION: 30

A 72-year-old man comes to your clinic for the first time, accompanied by his wife. His wife states that she is concerned because he has been growing increasingly forgetful over the past year. Within the past month, he has forgotten to turn off the stove and has got lost while walking to the post office one block away from their home. His past medical history is significant for well-controlled diabetes and chronic lower back pain. He has no history of falls or traumatic injury to the head. Examination of the patient is significant for a score of 18 on a Mini Mental Status Examination (MMSE). During the administration of the MMSE, the patient blurts out that his wife brought him to the doctor because she is having an extramarital relationship.

Use of which of the following medications would be the most likely to lead to worsening of symptoms in this patient?

risperidone
amitriptyline
olanzapine
quetiapine
trazodone

Answer(s): B

Explanation:

This patient's symptoms are most consistent with Alzheimer disease. Alzheimer disease is a prominent condition in developed nations, ranking as the third most common terminal illness behind heart disease and cancer. It is the most common form of dementia, with over 4 million Americans having the condition in the United States alone. There is a direct correlation between advanced age and increasing prevalence of Alzheimer disease. While there is an early-onset form of familial Alzheimer disease that may appear as early as the third decade of life, this accounts for only a small percentage of total Alzheimer cases. There does appear to be a genetic component to the development of Alzheimer disease, as it has been demonstrated that first-degree relatives of Alzheimer patients possess an increased risk for development of the condition. Genes on chromosomes 1, 14, and 21 have been implicated in this association. While age and family history are important risk factors, there is no evidence proving that environmental factors lead to an increased chance for development of the disease. Progression of Alzheimer dementia is typically insidious, spanning as many as several years.

Anticholinergic agents and any other medication with anticholinergic effects are contraindicated in the setting of Alzheimer dementia. Their use may lead to worsening of cognition and may contribute to decreased efficacy of medications used in the treatment of Alzheimer dementia. Tricyclic antidepressants such as amitriptyline should be avoided for this reason. Risperidone, olanzapine, and quetiapine are atypical antipsychotic medications which are useful in the treatment of emotional withdrawal and delusions which may arise in Alzheimer patients. Trazodone, carbamazepine, and divalproex are moodstabilizing medications which are useful in patients who display marked agitation. While trazodone does display some anticholinergic side effects, they are far less pronounced than those seen with amitriptyline.

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USMLE STEP3 Exam (page: 6) USMLE Step3 Updated on: 15-Feb-2026

QUESTION: 26

Explanation:

QUESTION: 27

Explanation:

QUESTION: 28

Explanation:

QUESTION: 29

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QUESTION: 30

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USMLE STEP3 Exam (page: 6)
USMLE Step3
Updated on: 15-Feb-2026