USMLE UWorld Step 3 High Yield Facts complete test
with all correct answers
What is the genetic inheritance pattern of Hemophilia A? Correct Answer: X-linked recessive: women
born to fathers with X linked recessive disorder will be carriers. Males are 50% carriers if born to an
affected mother.
What is tx of Lewy body dementia? Correct Answer: Dopamine agonist therapy (PD) & AchE inhibitors
(Alzeihmer's) - watch for dopamine agonist therapy causing complex visual hallucinations.
A patient treated for LTBI and now has positive PPD. Asymptomatic and also has negative CXR. Correct
Answer: Asymptomatic patients without radiographic evidence of active TB who have been treated
previously for active TB or LTBI need no further treatment.
Initial tx of lupus? Correct Answer: - steroids + hydroxychloroquine - remember that
hydroxychloroquine reduces the risk of arthralgias and serositis
- you use steroids to bridge until hydroxychloroquine takes affect
- MTX if u have organ damage.
- Rituximab causes PML.
What is the IGRA used for? Correct Answer: Another means of diagnosing LTBI - cannot tell the
difference between latent and active TB just like the TST. They are advantage when you have BCG
vaccinated patient.
Isotretinoin in a boy what do you look for? Correct Answer: - hyperglycemia, triglyceridemia,
hepatotoxicity, mucocuteanous reaction, blood dyscrasias, and ocular toxicity.
-tell them to avoid alcohol bc of pancreatitis.
Pt with keratoconjunctivitis sicca (engorgement of eye BV, and stringey discharge), who has caries and
submandibular mass. NBS? Correct Answer: Ro/La antibody for Sjogren's .
50% will be negative.
A patient undergoing UGI and has mechanical valve. No active infection foci. What is the likely abx
prophylaxis for endocarditis? Correct Answer: Valve + ONGOING GI/GU manipulation tract procedure
gets SBE prophylaxis prior to procedure - if they did, you would give them ampicillin.
What do you do to monitor the disease progression in patients with AS? Correct Answer: Radiographs
of hip/chest/and pelvis + ESR markers Q3 months
What is the relationship between alcoholics and pancreatitis? Correct Answer: Alcoholics - decreased
Vit D, and alcohol itself damages proximal tubule reabsorption.
- Alcholic compensates by pushing PO4 out of the cell, however once refed/hydrated - PO4 becomes
intracellular and you get HYPOPO4 which can cause rhabdomyolasis and myopathy.
- Especially in the setting of respiratory alkalosis
What are the only requirements to hospice care? Correct Answer: only requirements of hospice are
prognosis <6 months and the patient's willingness to forgo life sustaining treatment.
,What is verification bias? Correct Answer: AKA workup bias. It is when a study only SELECTIVELY uses
the gold standard test in order to confirm a positive result of preliminary testing. This can result in
overestimates and increase in sensitivity.
How do you overcome this bias? Correct Answer: Use the gold standard in a control population as well.
African man with UTI + blood on dipstick microhematuria and anemia. What is NBS? Correct Answer:
The diagnosis of schistomiasis is demonstration of parasite eggs in the stool or urine.
Patient with esophageal variceal bleed x 2 after banding. What is the NBS? Correct Answer: Repeat
upper GI endoscopy to do treatment with sclerotherapy or banding. If not, then you should do shunt or
TIPS.
What is chance of adult who gets Hep B of going to chronic HBV? Correct Answer: Adults have <5%
chance of chronic Hep B infection - however perinatal transmission is 90%.
After starting HAART what do you expect VL of HIV in 6 months? Correct Answer: <200 copies / mL
otherwise resistance or non-compliance.
Preventive management of a cluster headache? Correct Answer: Verapamil is the only preventative
measure in RCT.
What epidemiological parameter does not vary with disease prevalence and is based on Sn, and Sp?
Correct Answer: Likelihood ratio
For a positive test result: sensitivity / (1-specificity).
For a negative test result: (1-sensitivity) / specificity.
What is the definition of likelihood ratio? Correct Answer: Probability of a given test result occurring in a
patient with a disorder compared to the probability of the same result occurring in a patient without the
disorder.
What is cataplexy treated with? Correct Answer: SNRI (venlafaxine)
SSRI or sodium oxybate.
When a patient has a stroke - dysphagia and aspiration causes in an increased risk of death. What is
NBS? Correct Answer: Make sure to do a quick swallow evaluation (water swallow test or Toronto
Bedside Swallowing Screening test).
What is the insulin administration in DKA? Correct Answer: Continuous insulin.
What is the fluid management in DKA? Correct Answer: Add K to fluids if K is less than <5.2 meQ/L.
How long should IV insulin be continued in DKA? Correct Answer: Until anion gap normalized.
DKA patient with glucose <200 but still elevated anion gap. What do you do? Correct Answer: Half the
rate of continuous insulin and add dextrose to the fluids.
,What is first step in pheochromocytoma work up? Correct Answer: Get MRI of abdomen - if this is
negative, you get MIBG - control BP for 10-14 days with alpha blocker.
What has best long term outcome when behavior modifications fail for enuresis? Correct Answer:
Enuresis alarm.
Cocaine ingestion patient with persistent chest pain and new neurologic finding of right sided weakness
in upper arm. What is suspicion and what is NBS? Correct Answer: Suspect acute dissection of aorta,
and get CT angiography of the chest.
A patient with hypermobility, h/o velevty hyperextensible skin with easy bruisability and atrophic scars
and has hyperdynamic precordium. What is the suspicion? Correct Answer: Acute mitral regurgitation,
with myxomatous degeneration and rupture of chordae.
Later life depression (occuring after age 65) has been found to be a significant risk factor for the
development of what condition? Correct Answer: Alzeihmer's disease.
A pt with asymptomatic high TSH and normal t4 NBS? Correct Answer: TPO Ab testing.
warranted tx if:
- +antithyroid ab
- abnormal lipid profile
- sx of hypothyroidism
- ovulatory dysfunction.
What should you assess for in the days following a stroke? Correct Answer: After stroke make sure you
also assess for DVT prophylaxis - risk of DVT is highest2-7 days following a stroke and particularly high in
patients with hemiparessis. Subsequent PE is MCC death after this.
What are the BP guidelines after stroke? Correct Answer: Permissive htn (<220/120 mmHg) and aspirin.
If you got thrombolysis then <185/105 BP.
A patient with asymptomatic CHF who presents with a low EF but no sx should have what test? Correct
Answer: Cardiac stress test - because ischemic heart disease is the most common etiology for heart
failure.
What is the NBS in a patient with acute coronary syndrome NSTEMI? Correct Answer: - dual
antiplatelet: aspirin + P2Y12 clopidogril prasugruel or ticagrelor
- beta blocker
- statin,
- anticoagulant therapy. In NSTEMI use heparin not thrombolytics.
Multiple skin tags are associated with what disease? Correct Answer: Insulin resistance.
A pt on azithromycin for ngu chlamydia and does not get better think of other causes of ngu such as
trichomonas, ureaplasma, etc. What is the tx? Correct Answer: Metronidazole.
What is the management of somatic symptom disorder? Correct Answer: Regular follow up with
provider.
, A patient who has h/o of papillary and follicular thyroid cancer that was treated with thyroidectomy and
then with RAIU. TSH is borderline high. What is tx? Correct Answer: Levothyroxine treatment to normal-
ish values of TSH. If highly malignant consider treating TSH to <0.1 TSH.
What is the preferred treatment for botulism toxin? Correct Answer: Equine derived botox antitoxin is
preferred tx of wound and foodborne botulism however it is usually avoided in infants due to the risk of
lifelong hypersenstivity so use human.
If a patient has increasing glucose concentrations, at bedtime what is the likely treatment? Correct
Answer: The most appropriate insulin adjustment to make in patients who have hyperglycemia at
bedtime is to increase pre-dinner short-acting insulin, such as insulin lispro. Other factors, may help like
dec meal size.
Entamoeba presents how? Correct Answer: A patient with fever RUQ and hypoechoic liver lesion -
causes liver absess. Watch for recent travel to SA.
How do you diagnose entameoba? Correct Answer: serology. Dont aspirate the anchovy paste area.
Hydatid cysts are due to what infection? Correct Answer: Echinococcus - no fever without cyst rupture.
What is the treatment for a male patient with perineal pain and weak urinary stream. Correct Answer:
Empiric TMPSMX or Fluroquinolone for 4 to 6 weeks due to poor penetration of abx into the prostate
gland.
Fluoroquinolone ESP, cephalasporin, and clinda most frequently associated with long term Cdiff
infection.
A old man afib with high pitched bowel sounds no leukocytosis, and a small tender mass in the right
groin. He has abdominal cramping and vomiting. NBS? Correct Answer: Surgery - incarcerated hernia
causing SBO.
What is the treatment for a spiral femur fracture? Correct Answer: Spica cast - remember that spiral
femur fractures are suspicious for child abuse.
A patient who had an MI and is on simvastatin - should be swtiched to what medication? Correct
Answer: Rosuvustatin, and atorvastatin are HIGH dose statins.
What is the most common cause of erythema multiforme? Correct Answer: Herpes simplex virus.
A patient after surgery who has peripheral wedge shaped opacity in the lung may have suffered what
pathology? Correct Answer: Pulmonary embolism.
A patient with normal AFP and high alkphos with history of hepatitis B who on ultrasound has 3 cm
lesion is concerning for malignancy arising from what structure? Correct Answer: Hepatocyte.
with all correct answers
What is the genetic inheritance pattern of Hemophilia A? Correct Answer: X-linked recessive: women
born to fathers with X linked recessive disorder will be carriers. Males are 50% carriers if born to an
affected mother.
What is tx of Lewy body dementia? Correct Answer: Dopamine agonist therapy (PD) & AchE inhibitors
(Alzeihmer's) - watch for dopamine agonist therapy causing complex visual hallucinations.
A patient treated for LTBI and now has positive PPD. Asymptomatic and also has negative CXR. Correct
Answer: Asymptomatic patients without radiographic evidence of active TB who have been treated
previously for active TB or LTBI need no further treatment.
Initial tx of lupus? Correct Answer: - steroids + hydroxychloroquine - remember that
hydroxychloroquine reduces the risk of arthralgias and serositis
- you use steroids to bridge until hydroxychloroquine takes affect
- MTX if u have organ damage.
- Rituximab causes PML.
What is the IGRA used for? Correct Answer: Another means of diagnosing LTBI - cannot tell the
difference between latent and active TB just like the TST. They are advantage when you have BCG
vaccinated patient.
Isotretinoin in a boy what do you look for? Correct Answer: - hyperglycemia, triglyceridemia,
hepatotoxicity, mucocuteanous reaction, blood dyscrasias, and ocular toxicity.
-tell them to avoid alcohol bc of pancreatitis.
Pt with keratoconjunctivitis sicca (engorgement of eye BV, and stringey discharge), who has caries and
submandibular mass. NBS? Correct Answer: Ro/La antibody for Sjogren's .
50% will be negative.
A patient undergoing UGI and has mechanical valve. No active infection foci. What is the likely abx
prophylaxis for endocarditis? Correct Answer: Valve + ONGOING GI/GU manipulation tract procedure
gets SBE prophylaxis prior to procedure - if they did, you would give them ampicillin.
What do you do to monitor the disease progression in patients with AS? Correct Answer: Radiographs
of hip/chest/and pelvis + ESR markers Q3 months
What is the relationship between alcoholics and pancreatitis? Correct Answer: Alcoholics - decreased
Vit D, and alcohol itself damages proximal tubule reabsorption.
- Alcholic compensates by pushing PO4 out of the cell, however once refed/hydrated - PO4 becomes
intracellular and you get HYPOPO4 which can cause rhabdomyolasis and myopathy.
- Especially in the setting of respiratory alkalosis
What are the only requirements to hospice care? Correct Answer: only requirements of hospice are
prognosis <6 months and the patient's willingness to forgo life sustaining treatment.
,What is verification bias? Correct Answer: AKA workup bias. It is when a study only SELECTIVELY uses
the gold standard test in order to confirm a positive result of preliminary testing. This can result in
overestimates and increase in sensitivity.
How do you overcome this bias? Correct Answer: Use the gold standard in a control population as well.
African man with UTI + blood on dipstick microhematuria and anemia. What is NBS? Correct Answer:
The diagnosis of schistomiasis is demonstration of parasite eggs in the stool or urine.
Patient with esophageal variceal bleed x 2 after banding. What is the NBS? Correct Answer: Repeat
upper GI endoscopy to do treatment with sclerotherapy or banding. If not, then you should do shunt or
TIPS.
What is chance of adult who gets Hep B of going to chronic HBV? Correct Answer: Adults have <5%
chance of chronic Hep B infection - however perinatal transmission is 90%.
After starting HAART what do you expect VL of HIV in 6 months? Correct Answer: <200 copies / mL
otherwise resistance or non-compliance.
Preventive management of a cluster headache? Correct Answer: Verapamil is the only preventative
measure in RCT.
What epidemiological parameter does not vary with disease prevalence and is based on Sn, and Sp?
Correct Answer: Likelihood ratio
For a positive test result: sensitivity / (1-specificity).
For a negative test result: (1-sensitivity) / specificity.
What is the definition of likelihood ratio? Correct Answer: Probability of a given test result occurring in a
patient with a disorder compared to the probability of the same result occurring in a patient without the
disorder.
What is cataplexy treated with? Correct Answer: SNRI (venlafaxine)
SSRI or sodium oxybate.
When a patient has a stroke - dysphagia and aspiration causes in an increased risk of death. What is
NBS? Correct Answer: Make sure to do a quick swallow evaluation (water swallow test or Toronto
Bedside Swallowing Screening test).
What is the insulin administration in DKA? Correct Answer: Continuous insulin.
What is the fluid management in DKA? Correct Answer: Add K to fluids if K is less than <5.2 meQ/L.
How long should IV insulin be continued in DKA? Correct Answer: Until anion gap normalized.
DKA patient with glucose <200 but still elevated anion gap. What do you do? Correct Answer: Half the
rate of continuous insulin and add dextrose to the fluids.
,What is first step in pheochromocytoma work up? Correct Answer: Get MRI of abdomen - if this is
negative, you get MIBG - control BP for 10-14 days with alpha blocker.
What has best long term outcome when behavior modifications fail for enuresis? Correct Answer:
Enuresis alarm.
Cocaine ingestion patient with persistent chest pain and new neurologic finding of right sided weakness
in upper arm. What is suspicion and what is NBS? Correct Answer: Suspect acute dissection of aorta,
and get CT angiography of the chest.
A patient with hypermobility, h/o velevty hyperextensible skin with easy bruisability and atrophic scars
and has hyperdynamic precordium. What is the suspicion? Correct Answer: Acute mitral regurgitation,
with myxomatous degeneration and rupture of chordae.
Later life depression (occuring after age 65) has been found to be a significant risk factor for the
development of what condition? Correct Answer: Alzeihmer's disease.
A pt with asymptomatic high TSH and normal t4 NBS? Correct Answer: TPO Ab testing.
warranted tx if:
- +antithyroid ab
- abnormal lipid profile
- sx of hypothyroidism
- ovulatory dysfunction.
What should you assess for in the days following a stroke? Correct Answer: After stroke make sure you
also assess for DVT prophylaxis - risk of DVT is highest2-7 days following a stroke and particularly high in
patients with hemiparessis. Subsequent PE is MCC death after this.
What are the BP guidelines after stroke? Correct Answer: Permissive htn (<220/120 mmHg) and aspirin.
If you got thrombolysis then <185/105 BP.
A patient with asymptomatic CHF who presents with a low EF but no sx should have what test? Correct
Answer: Cardiac stress test - because ischemic heart disease is the most common etiology for heart
failure.
What is the NBS in a patient with acute coronary syndrome NSTEMI? Correct Answer: - dual
antiplatelet: aspirin + P2Y12 clopidogril prasugruel or ticagrelor
- beta blocker
- statin,
- anticoagulant therapy. In NSTEMI use heparin not thrombolytics.
Multiple skin tags are associated with what disease? Correct Answer: Insulin resistance.
A pt on azithromycin for ngu chlamydia and does not get better think of other causes of ngu such as
trichomonas, ureaplasma, etc. What is the tx? Correct Answer: Metronidazole.
What is the management of somatic symptom disorder? Correct Answer: Regular follow up with
provider.
, A patient who has h/o of papillary and follicular thyroid cancer that was treated with thyroidectomy and
then with RAIU. TSH is borderline high. What is tx? Correct Answer: Levothyroxine treatment to normal-
ish values of TSH. If highly malignant consider treating TSH to <0.1 TSH.
What is the preferred treatment for botulism toxin? Correct Answer: Equine derived botox antitoxin is
preferred tx of wound and foodborne botulism however it is usually avoided in infants due to the risk of
lifelong hypersenstivity so use human.
If a patient has increasing glucose concentrations, at bedtime what is the likely treatment? Correct
Answer: The most appropriate insulin adjustment to make in patients who have hyperglycemia at
bedtime is to increase pre-dinner short-acting insulin, such as insulin lispro. Other factors, may help like
dec meal size.
Entamoeba presents how? Correct Answer: A patient with fever RUQ and hypoechoic liver lesion -
causes liver absess. Watch for recent travel to SA.
How do you diagnose entameoba? Correct Answer: serology. Dont aspirate the anchovy paste area.
Hydatid cysts are due to what infection? Correct Answer: Echinococcus - no fever without cyst rupture.
What is the treatment for a male patient with perineal pain and weak urinary stream. Correct Answer:
Empiric TMPSMX or Fluroquinolone for 4 to 6 weeks due to poor penetration of abx into the prostate
gland.
Fluoroquinolone ESP, cephalasporin, and clinda most frequently associated with long term Cdiff
infection.
A old man afib with high pitched bowel sounds no leukocytosis, and a small tender mass in the right
groin. He has abdominal cramping and vomiting. NBS? Correct Answer: Surgery - incarcerated hernia
causing SBO.
What is the treatment for a spiral femur fracture? Correct Answer: Spica cast - remember that spiral
femur fractures are suspicious for child abuse.
A patient who had an MI and is on simvastatin - should be swtiched to what medication? Correct
Answer: Rosuvustatin, and atorvastatin are HIGH dose statins.
What is the most common cause of erythema multiforme? Correct Answer: Herpes simplex virus.
A patient after surgery who has peripheral wedge shaped opacity in the lung may have suffered what
pathology? Correct Answer: Pulmonary embolism.
A patient with normal AFP and high alkphos with history of hepatitis B who on ultrasound has 3 cm
lesion is concerning for malignancy arising from what structure? Correct Answer: Hepatocyte.
