USMLE STEP 3 COMPREHENSIVE TEST
BANK 2026 COMPLETE ANSWERS
ACCURATE
⫸ 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)
BANK 2026 COMPLETE ANSWERS
ACCURATE
⫸ 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)
