USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
ascites that is:
New, Painful, or Feverish - ANSWER--tap it
initial hypercalcemia workup - ANSWER--CMP
Chest x-ray
urinary calcium
PTH immunoassay
hyperventilation definition - ANSWER-->22
daily medication for esophageal varices
(NOT ACUTELY) - ANSWER--propanolol
SAAG - ANSWER--Serum : Ascites Albumin Gradient
increased PT + bleeding - ANSWER--give FFP
hepatic encephalopathy treatment - ANSWER--Lactulose
(A lactose look-alike that when metabolized by gut flora acidifies the inside of the
bowel. Thus, ammonia (NH3) is converted to ammonium (NH4+). Both lactulose
and the ammonium ion cannot be absorbed and are therefore excreted.)
,USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Neomycin is 2nd line
How do you quickly replace low albumin? - ANSWER--give FFP
SAAG >1.1 - ANSWER--Portal HTN (transudate)
SAAG <1.1 - ANSWER--Cancer and Infxn (exudate)
Portal System:
1. splenic vein hypertension
2. superior mesenteric vein - ANSWER--1. esophageal & gastric varices
2. hemmorhoids
percent mortality of variceal bleeds - ANSWER--50%
causes of cirrhosis - ANSWER--Alcohol
PBC
PSC
,USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Wilsons
Hemochromatosis
Autoimmune
Nonalcoholic Steatohepatitis (caused by obesity, diabetes, and hyperlipidemia)
single BEST liver test - ANSWER--PT
(the day you die of liver disease your transaminases can be normal)
AST elevation - ANSWER--ETOH and drugs
ALT elevation - ANSWER--viral infection
portal hypertension causes... - ANSWER--SPLENOMEGALY which then
yields...sequestration of platelets (thrombocytopenia)
ALK PHOS & GGTP elevation - ANSWER--biliary obstruction
Liver Failure - ANSWER--Hypercholesterolemia (lipid mismanagement) =
Acanthosis (lipids on RBC's) and increased MCV
PBC (primary biliary cirrhosis) looks like: - ANSWER--An itchy, middle-aged female
with xanthelasmas and other autoimmunities.
, USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
best: elevated Alk Phos (normal bilirubin)
accurate: AMA (antimitochondrial antibody) & Liver Biopsy
alpha 1 antitrypsin deficiency - ANSWER--COPD & hepatic failure
PSC (primary sclerosing cholangitis) looks like: - ANSWER--An itchy patient with
inflammatory bowel disease.
best: elevated Alk Phos & Bilirubin
accurate: ASMA (antismooth muscle antibody), ANCA, ERCP (beaded biliary
system)
PBC, PSC, alpha 1 antitrypsin deficiency - ANSWER--give ursodeoxycholic acid
Wilsons Disease looks like... - ANSWER--liver disease with choreiform movement.
best: slit lamp exam (Kayser Fleisher Rings)
accurate: liver biopsy
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
ascites that is:
New, Painful, or Feverish - ANSWER--tap it
initial hypercalcemia workup - ANSWER--CMP
Chest x-ray
urinary calcium
PTH immunoassay
hyperventilation definition - ANSWER-->22
daily medication for esophageal varices
(NOT ACUTELY) - ANSWER--propanolol
SAAG - ANSWER--Serum : Ascites Albumin Gradient
increased PT + bleeding - ANSWER--give FFP
hepatic encephalopathy treatment - ANSWER--Lactulose
(A lactose look-alike that when metabolized by gut flora acidifies the inside of the
bowel. Thus, ammonia (NH3) is converted to ammonium (NH4+). Both lactulose
and the ammonium ion cannot be absorbed and are therefore excreted.)
,USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Neomycin is 2nd line
How do you quickly replace low albumin? - ANSWER--give FFP
SAAG >1.1 - ANSWER--Portal HTN (transudate)
SAAG <1.1 - ANSWER--Cancer and Infxn (exudate)
Portal System:
1. splenic vein hypertension
2. superior mesenteric vein - ANSWER--1. esophageal & gastric varices
2. hemmorhoids
percent mortality of variceal bleeds - ANSWER--50%
causes of cirrhosis - ANSWER--Alcohol
PBC
PSC
,USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Wilsons
Hemochromatosis
Autoimmune
Nonalcoholic Steatohepatitis (caused by obesity, diabetes, and hyperlipidemia)
single BEST liver test - ANSWER--PT
(the day you die of liver disease your transaminases can be normal)
AST elevation - ANSWER--ETOH and drugs
ALT elevation - ANSWER--viral infection
portal hypertension causes... - ANSWER--SPLENOMEGALY which then
yields...sequestration of platelets (thrombocytopenia)
ALK PHOS & GGTP elevation - ANSWER--biliary obstruction
Liver Failure - ANSWER--Hypercholesterolemia (lipid mismanagement) =
Acanthosis (lipids on RBC's) and increased MCV
PBC (primary biliary cirrhosis) looks like: - ANSWER--An itchy, middle-aged female
with xanthelasmas and other autoimmunities.
, USMLE STEP 3 AND ABIM INTERNAL MEDICINE BOARDS
EXAM LATEST VERSION 2023- 2024 ACTUAL EXAM 500+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
best: elevated Alk Phos (normal bilirubin)
accurate: AMA (antimitochondrial antibody) & Liver Biopsy
alpha 1 antitrypsin deficiency - ANSWER--COPD & hepatic failure
PSC (primary sclerosing cholangitis) looks like: - ANSWER--An itchy patient with
inflammatory bowel disease.
best: elevated Alk Phos & Bilirubin
accurate: ASMA (antismooth muscle antibody), ANCA, ERCP (beaded biliary
system)
PBC, PSC, alpha 1 antitrypsin deficiency - ANSWER--give ursodeoxycholic acid
Wilsons Disease looks like... - ANSWER--liver disease with choreiform movement.
best: slit lamp exam (Kayser Fleisher Rings)
accurate: liver biopsy
