USMLE Step 3 case studies
USMLE Step 3 · Put your knowledge to work in context.
USMLE Step 3 is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. It assesses whether a candidate can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. The USMLE Step 3 case studies are 5 cases and about 3,581 words.
1Anticoagulation in an Older Adult Who Falls
An 82-year-old woman with permanent atrial fibrillation is seen in clinic with her daughter. Her CHA2DS2-VASc score is 5 (age, hypertension, diabetes, prior TIA, female sex) and her HAS-BLED score is 3.
742 words, about 4 min2Postpartum Preeclampsia With Severe Features on Day Six
A 29-year-old woman, G1P1, delivered vaginally at 38 weeks six days ago after an uncomplicated pregnancy and was discharged on day 2 with blood pressure 138/88. She now presents to obstetric triage with a severe frontal headache for 12 hours, blurred vision with flashing lights, and right upper quadrant discomfort.
675 words, about 3 min3Hyperkalemia After Starting an MRA in Heart Failure
A 66-year-old man with heart failure with reduced ejection fraction (EF 28%, NYHA class II) comes for routine follow-up. Three weeks ago spironolactone 25 mg daily was added to sacubitril/valsartan 24/26 mg twice daily, carvedilol 6.25 mg twice daily, furosemide 40 mg daily, and empagliflozin 10 mg daily.
680 words, about 3 min4A Critical Value at 23:40 on a Cross-Cover List
You are the night-float resident covering six inpatient units at a community hospital; your cross-cover list has 62 patients and none of them are yours. At 23:40 the laboratory calls a critical potassium of 6.8 mmol/L, confirmed on repeat, for a 58-year-old man admitted three days ago with cellulitis.
750 words, about 4 min5Day Six of Sinus Symptoms and a Request for Antibiotics
A 41-year-old woman presents to an urgent care clinic on day 6 of nasal congestion, thick yellow-green discharge, and mild bilateral facial pressure. She is afebrile at 37.6°C, has no severe pain, and reports her symptoms have been stable - neither improving nor worsening - since day 3.
734 words, about 4 min