USMLE STEP 3 EXAM COMPREHENSIVE
PRACTICE QUESTIONS AND ANSWERS 2026
◉ 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
PRACTICE QUESTIONS AND ANSWERS 2026
◉ 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
