USMLE Step 3 Exam Questions with Answers
1. Pseudogout associations correct answer hemochromatosis, hyperparathyroidism,
acromegaly, hypothyroidism
2. Gout crystals correct answer negatively birefringent needles
3. Pseudogout crystals correct answer positively birefringent needles
4. Vasculitis associated with chronic Hep B correct answer polyarteritis
nodosa
5. Vasculitis associated with chronic Hep C correct answer cryoglobulinemia
6. Best blood test for polyarteritis nodosa correct answer There is none. Get
abdominal angiography first, then biopsy of muscle, skin, or sural nerve.
7. Churg-Strauss correct answer vasculitis + eosinophilia + asthma
8. Takayasu's arteritis correct answer young asian female with diminished pulses (usually
preceeded by fatigue, weight loss, arthralgia, anemia, elevated ESR)
9. Best test for Takayasu's correct answer aortic angiography or MRA
10. Bite cells on blood smear correct answer G6PD
11. Burr/Spur cells on blood smear correct answer liver disease
12. Acanthocytes on blood smear (looks like spur cell but with
more rounded spurs) correct answer liver disease, hypothyroidism, alcoholism
13. Basophilic stippling on blood smear correct answer lead poisoning
14. Schistocytes on blood smear correct answer TTP-HUS, DIC, prosthetic heart valve,
malignant htn, sepsis
15. Target cells on blood smear correct answer thalassemia, other
hemoglobinopathies, liver disease
16. 5 causes of microcytic anemia correct answer iron deficiency, lead poisoning,
anemia of chronic disease (but usually normocytic), thalassemia, sideroblastic anemia (can
also have high MCV)
17. Antibody test for celiac disease correct answer anti-endomysial, tissue
transglutaminase (small bowel bx is best though)
18. Antibiotics for MRSA correct answer IV correct answer vanc, linezolid, daptomycin,
tigecycline;
if minor infection, can use oral correct answer TMP/SMX, doxy, minocycline, or maybe clindamycin (there is
,inducible resistance to clinda though)
19. Antibiotics for MSSA correct answer Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin
(IV), cephalexin (oral)
20. Can you use cephalosporins in pt allergic to PCN? correct answer yes, if
the rxn is rash only; no if pt has true anaphylaxis
21. Antibiotics to use for Staph with PCN allergy correct answer
cephalosporins if rash only; macrolides, clindamycin, vancomycin, linezolid,
daptomycin, TMP/SMX
22. Antibiotics for strep correct answer PCN, ampicillin, amoxicillin
, 23. Antibiotics for GNRs correct answer
Cephalosporins correct answer cefepime, ceftazidime
PCNs correct answer piperacillin, ticaricillin
Monobactam correct answer
Aztreonam Quinolones correct
answer cipro, levo, gati, moxi
minoglycs correct answer gentamicin, tobramycin,
amikacin Carbapenems correct answer imipenem,
mero, erta
24. Limitation of ertapenem correct answer does NOT cover pseudomonas
25. Piperacillin and
ticarcillin correct answer
GNRs strep
anaerobes
26. Carbapenems correct answer
good anaerobic coverage strep
MSSA
27. Tigecyclin
e correct answer
MRSA good GNR
coverage
28. Anaerobes correct answer -metronidazole is BEST for abdominal anaerobes (carbapenems,
piperacillin, and ticarcillin have equal eflcacy)
-cefoxitin and cefotetan are the ONLY cephalosporins
-respiratory anaerobes correct answer clindamycin
29. Abx with NO anaerobic coverage correct answer aminoglycs, aztreonam,
fluoroquinolones, oxacillin/nafcillin, all cephalosporins EXCEPT cefoxitin and cefotetan
30. Red man syndrome correct answer red, flushed skin from histamine release,
associated with rapid infusion of van- comycin (so slow down the infusion rate)
31. Osteomyelitis correct answer -most common is staph correct answer oxacillin or nafcillin
IV for 4-6 wks for MSSA; vanc, linezolid or dapto for MRSA
-GNRs correct answer salmonella or pseudomonas, can use orals, but must cx org. first and make sure it is
, sensitive (BONE bx and cx)
32. Cellulitis tx correct answer -minor infection correct answer oral dicloxacillin or
cephalexin
-severe correct answer IV oxacillin, nafcillin or cefazolin
-PCN allergy correct answer if rash, then cephalosporin; if anaphylaxis, then vanc, linezolid, dapto
(macrolides or clinda for minor infection)
33. Sequelae of strep infection correct answer -throat correct answer rheumatic
fever AND glomerulonephritis
-skin correct answer ONLY glomerulonephritis
1. Pseudogout associations correct answer hemochromatosis, hyperparathyroidism,
acromegaly, hypothyroidism
2. Gout crystals correct answer negatively birefringent needles
3. Pseudogout crystals correct answer positively birefringent needles
4. Vasculitis associated with chronic Hep B correct answer polyarteritis
nodosa
5. Vasculitis associated with chronic Hep C correct answer cryoglobulinemia
6. Best blood test for polyarteritis nodosa correct answer There is none. Get
abdominal angiography first, then biopsy of muscle, skin, or sural nerve.
7. Churg-Strauss correct answer vasculitis + eosinophilia + asthma
8. Takayasu's arteritis correct answer young asian female with diminished pulses (usually
preceeded by fatigue, weight loss, arthralgia, anemia, elevated ESR)
9. Best test for Takayasu's correct answer aortic angiography or MRA
10. Bite cells on blood smear correct answer G6PD
11. Burr/Spur cells on blood smear correct answer liver disease
12. Acanthocytes on blood smear (looks like spur cell but with
more rounded spurs) correct answer liver disease, hypothyroidism, alcoholism
13. Basophilic stippling on blood smear correct answer lead poisoning
14. Schistocytes on blood smear correct answer TTP-HUS, DIC, prosthetic heart valve,
malignant htn, sepsis
15. Target cells on blood smear correct answer thalassemia, other
hemoglobinopathies, liver disease
16. 5 causes of microcytic anemia correct answer iron deficiency, lead poisoning,
anemia of chronic disease (but usually normocytic), thalassemia, sideroblastic anemia (can
also have high MCV)
17. Antibody test for celiac disease correct answer anti-endomysial, tissue
transglutaminase (small bowel bx is best though)
18. Antibiotics for MRSA correct answer IV correct answer vanc, linezolid, daptomycin,
tigecycline;
if minor infection, can use oral correct answer TMP/SMX, doxy, minocycline, or maybe clindamycin (there is
,inducible resistance to clinda though)
19. Antibiotics for MSSA correct answer Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin
(IV), cephalexin (oral)
20. Can you use cephalosporins in pt allergic to PCN? correct answer yes, if
the rxn is rash only; no if pt has true anaphylaxis
21. Antibiotics to use for Staph with PCN allergy correct answer
cephalosporins if rash only; macrolides, clindamycin, vancomycin, linezolid,
daptomycin, TMP/SMX
22. Antibiotics for strep correct answer PCN, ampicillin, amoxicillin
, 23. Antibiotics for GNRs correct answer
Cephalosporins correct answer cefepime, ceftazidime
PCNs correct answer piperacillin, ticaricillin
Monobactam correct answer
Aztreonam Quinolones correct
answer cipro, levo, gati, moxi
minoglycs correct answer gentamicin, tobramycin,
amikacin Carbapenems correct answer imipenem,
mero, erta
24. Limitation of ertapenem correct answer does NOT cover pseudomonas
25. Piperacillin and
ticarcillin correct answer
GNRs strep
anaerobes
26. Carbapenems correct answer
good anaerobic coverage strep
MSSA
27. Tigecyclin
e correct answer
MRSA good GNR
coverage
28. Anaerobes correct answer -metronidazole is BEST for abdominal anaerobes (carbapenems,
piperacillin, and ticarcillin have equal eflcacy)
-cefoxitin and cefotetan are the ONLY cephalosporins
-respiratory anaerobes correct answer clindamycin
29. Abx with NO anaerobic coverage correct answer aminoglycs, aztreonam,
fluoroquinolones, oxacillin/nafcillin, all cephalosporins EXCEPT cefoxitin and cefotetan
30. Red man syndrome correct answer red, flushed skin from histamine release,
associated with rapid infusion of van- comycin (so slow down the infusion rate)
31. Osteomyelitis correct answer -most common is staph correct answer oxacillin or nafcillin
IV for 4-6 wks for MSSA; vanc, linezolid or dapto for MRSA
-GNRs correct answer salmonella or pseudomonas, can use orals, but must cx org. first and make sure it is
, sensitive (BONE bx and cx)
32. Cellulitis tx correct answer -minor infection correct answer oral dicloxacillin or
cephalexin
-severe correct answer IV oxacillin, nafcillin or cefazolin
-PCN allergy correct answer if rash, then cephalosporin; if anaphylaxis, then vanc, linezolid, dapto
(macrolides or clinda for minor infection)
33. Sequelae of strep infection correct answer -throat correct answer rheumatic
fever AND glomerulonephritis
-skin correct answer ONLY glomerulonephritis
