USMLE STEP 3 REVIEW EXAM
QUESTIONS AND ANSWERS 100% PASS.
Tx of IBS - ANS 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? - ANS 1. Stool: stool guiac, leukocytes, cultures, ova
& parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? - ANS Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
2026 STUDY MATERIAL @COPYRIGHT RESERVED 1
,What three metabolic conditions do most states require newborn screening? - ANS 1.
Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - ANS 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? - ANS Initial: elevated ALP, normal bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - ANS Primary biliary cirrhosis
Antismooth muscle antibody? - ANS Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - ANS IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? - ANS 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? -
ANS Ursodeoxycholic acid
2026 STUDY MATERIAL @COPYRIGHT RESERVED 2
,Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial test, and
most accurate? - ANS Initial: ANA & antismooth muscle positive
Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis) with
hypergammaglobulinemia
Best initial test for hemochromatosis - ANS Serum iron, iron binding capacity (low), ferritin
(high)
Most accurate test for hemochromatosis - ANS MRI of liver + genetic testing for HFe gene
mutation
(Spares liver biopsy)
Last two indications for amphotericin - ANS Cryptococcus and mucormycosis
Best drug for aspergillus - ANS Voriconazole
Best fungal drug for neutropenic fever - ANS Caspofungin
Best drug for candida - ANS Fluconazole
Heberden's nodule, where is it and what disease is it associated with? - ANS DIP and
osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - ANS PIP and both RA
and osteoarthritis
2026 STUDY MATERIAL @COPYRIGHT RESERVED 3
, (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? - ANS DIP and
osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - ANS PIP and both RA
and osteoarhtitis
Heberden's nodule (where is it and what disease is it associated with) - ANS DIP and
osteoarthritis
Squamous cell carcinoma of the lung is associated with production of what hormone? -
ANS 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 - ANS ADH
(causes SIADH)
Look for normovolemic hyponatremia (sodium loss tends to be much higher than water
retention)
Treatment of SIADH? - ANS 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? - ANS Cladribine
Rulonoxitib - ANS Jak2 inhibitor used as adjunct in myelofibrosis
2026 STUDY MATERIAL @COPYRIGHT RESERVED 4
QUESTIONS AND ANSWERS 100% PASS.
Tx of IBS - ANS 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? - ANS 1. Stool: stool guiac, leukocytes, cultures, ova
& parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? - ANS Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
2026 STUDY MATERIAL @COPYRIGHT RESERVED 1
,What three metabolic conditions do most states require newborn screening? - ANS 1.
Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - ANS 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? - ANS Initial: elevated ALP, normal bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - ANS Primary biliary cirrhosis
Antismooth muscle antibody? - ANS Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - ANS IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? - ANS 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? -
ANS Ursodeoxycholic acid
2026 STUDY MATERIAL @COPYRIGHT RESERVED 2
,Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial test, and
most accurate? - ANS Initial: ANA & antismooth muscle positive
Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis) with
hypergammaglobulinemia
Best initial test for hemochromatosis - ANS Serum iron, iron binding capacity (low), ferritin
(high)
Most accurate test for hemochromatosis - ANS MRI of liver + genetic testing for HFe gene
mutation
(Spares liver biopsy)
Last two indications for amphotericin - ANS Cryptococcus and mucormycosis
Best drug for aspergillus - ANS Voriconazole
Best fungal drug for neutropenic fever - ANS Caspofungin
Best drug for candida - ANS Fluconazole
Heberden's nodule, where is it and what disease is it associated with? - ANS DIP and
osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - ANS PIP and both RA
and osteoarthritis
2026 STUDY MATERIAL @COPYRIGHT RESERVED 3
, (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? - ANS DIP and
osteoarthritis
Bouchard's nodule, where is it and what disease is it associated with? - ANS PIP and both RA
and osteoarhtitis
Heberden's nodule (where is it and what disease is it associated with) - ANS DIP and
osteoarthritis
Squamous cell carcinoma of the lung is associated with production of what hormone? -
ANS 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 - ANS ADH
(causes SIADH)
Look for normovolemic hyponatremia (sodium loss tends to be much higher than water
retention)
Treatment of SIADH? - ANS 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? - ANS Cladribine
Rulonoxitib - ANS Jak2 inhibitor used as adjunct in myelofibrosis
2026 STUDY MATERIAL @COPYRIGHT RESERVED 4
