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