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USMLE STEP 3 REVIEW QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE.
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USMLE STEP 3 REVIEW QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE.
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USMLE STEP 3 REVIEW QUESTIONSWITH CORRECT ANSWERS LATEST
UPDATE
Tx of IBS - Answer Best initial therapy: *Fiber*
If fiber fails: Antispasmodic/anticholinergic agents.
First line:
1. Dicyclomine
2. Hyoscyamine
Secondline:
1. TCA's (amitriptyline)
CCS, What test should you order for IBS? - Answer 1. Stool: stool guiac, leukocytes,
cultures, ova & parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? - Answer Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
What three metabolic conditions do most states require newborn screening? - Answer
1. Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - Answer Ciprofloxacin + Metrodinazole (they have some
kind of immune modulatory effect)
Middle-aged woman with itching and xanthelesmas = primary biliary cirrhosis. What is
the best initial test, and the most accurate test? - Answer Initial: elevated ALP, normal
bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - Answer Primary biliary cirrhosis
,Antismooth muscle antibody? - Answer Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - Answer
IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? - Answer
Initial: elevated ALP, *elevated bilirubin*
Best: ERCP (beading of biliary system)
Others: antismooth muscle antibody, ANCA positive
Treatment for both primary biliary cirrhosis and primary sclerosing cholangitis? - Answer
Ursodeoxycholic acid
Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial
test, and most accurate? - Answer Initial: ANA & antismooth muscle positive
Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis) with
hypergammaglobulinemia
Best initial test for hemochromatosis - Answer Serum iron, iron binding capacity (low),
ferritin (high)
Most accurate test for hemochromatosis - Answer MRI of liver + genetic testing for HFe
gene mutation
(Spares liver biopsy)
Last two indications for amphotericin - Answer Cryptococcus and mucormycosis
Best drug for aspergillus - Answer Voriconazole
Best fungal drug for neutropenic fever - Answer Caspofungin
Best drug for candida - Answer Fluconazole
Heberden's nodule, where is it and what disease is it associated with? - Answer DIP
and osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - Answer PIP and
both RA and osteoarthritis
(key is to remember Heberden;s is DIP and is only associated with osteoarthritis)
,Heberden's nodule, where is it and what disease is it associated with? - Answer DIP
and osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - Answer PIP and
both RA and osteoarhtitis
Heberden's nodule (where is it and what disease is it associated with) - Answer DIP and
osteoarthritis
Squamous cell carcinoma of the lung is associated with production of what hormone? -
Answer parathyroid like hormone (look for patient with a cavitary lesions near a
bronchus who has hypercalcemia)
Small cell carcinoma of the lung is associated with production of what hormone -
Answer ADH (causes SIADH)
Look for normovolemic hyponatremia (sodium loss tends to be much higher than water
retention)
Treatment of SIADH? - Answer water restriction
If hyponatremia is severe then use hypertonic saline and loop diuretics.
Persistent hyponatremia should be treated with demeclocycline or conivaptan
Best therapy for hairy cell leukemia? - Answer Cladribine
Rulonoxitib - Answer Jak2 inhibitor used as adjunct in myelofibrosis
Bortezomib
What is it used for?
What specific indication does it have for that disease?
What should be done before administration? - Answer Used for MM
Indicated for renal failure in MM
Acyclovir should be given before administration due to reactivation of varicella
(shingles)
Best treatment for MM - Answer If young autologous BM transplant (<70)
Allogenic only for <50 (increased graft vs host in older patients
Best chemotherapy for MM - Answer 1. Melphalan + steroids
2. Thalidomide or lenalidomide
3. Bortezomib
, Best Tx for symptomatic Waldenostrom's (high IgM, hyperviscosity) - Answer
Plasmapheresis
Best chemotherapy for Waldenostrom's - Answer Rituximab (if CD20 positive)
Fludarabine
Chlorambucil
(All used in CLL)
Aplastic anemia best tx if bone marrow transplant is unavailable - Answer
Antithymocytw globulin and cyclosporine
Causes of aplastic anemia - Answer Chronic hep C and B
Mostly idiopathic however
What makes Hodgkin's lymphoma different from nonhodgkin's? - Answer Reed-
Sternberg Cells
Best next step in lymphoma? - Answer Excisional biopsy
After you confirm the diagnosis with excisional biopsy (lymphoma) best next step? -
Answer Determine stage with:
CXR
CT scan of chest, abd., pelvis, and head
Bone marrow biopsy
Asymptomatic lymphoma Stage 1 and 2 (1-2 LN only one side) best tx - Answer
Radiation + low dose chemo
Symptomatic or advanced dx lymphoma tx - Answer Chemotherapy
Chemotherapy for Hodgkin's lymphoma - Answer ABVD
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
Chemotherapy for non-Hodgkin's - Answer CHOP
Cyclophosphamide
Hydroxyadriamycin
Oncovin (vincristine)
Prednisone
Add rituximab if CD20 positive (test for anti-CD20 antigen)
TX for acute ITP - Answer Prednisone
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