USMLE Step 3 Review 2025
Questions and Answers
Tx of IBS - ANSWER✔✔-Best initial therapy: *Fiber*
Antispasmodic/Anticholingergics: dicyclomine, Hyoscyamine
Second line- TCAs (amitryptiline)
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
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,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
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,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 - ANSWER✔✔-DIP and osteoarthritis
Bouchard's nodule - ANSWER✔✔-PIP and both RA and osteoarthritis
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, Squamous cell carcinoma of the lung is associated with production of what hormone? -
ANSWER✔✔-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 -
ANSWER✔✔-ADH (causes SIADH)
Look for normovolemic hyponatremia (sodium loss tends to be much higher than water
retention)
Treatment of SIADH? - ANSWER✔✔-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? - ANSWER✔✔-Cladribine
Rulonoxitib - ANSWER✔✔-Jak2 inhibitor used as adjunct in myelofibrosis
Bortezomib
What is it used for?
What specific indication does it have for that disease?
What should be done before administration? - ANSWER✔✔-Used for MM
Indicated for renal failure in MM
COPYRIGHT © 2025 ALL RIGHTS RESERVED
Questions and Answers
Tx of IBS - ANSWER✔✔-Best initial therapy: *Fiber*
Antispasmodic/Anticholingergics: dicyclomine, Hyoscyamine
Second line- TCAs (amitryptiline)
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
COPYRIGHT © 2025 ALL RIGHTS RESERVED
,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
COPYRIGHT © 2025 ALL RIGHTS RESERVED
,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 - ANSWER✔✔-DIP and osteoarthritis
Bouchard's nodule - ANSWER✔✔-PIP and both RA and osteoarthritis
COPYRIGHT © 2025 ALL RIGHTS RESERVED
, Squamous cell carcinoma of the lung is associated with production of what hormone? -
ANSWER✔✔-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 -
ANSWER✔✔-ADH (causes SIADH)
Look for normovolemic hyponatremia (sodium loss tends to be much higher than water
retention)
Treatment of SIADH? - ANSWER✔✔-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? - ANSWER✔✔-Cladribine
Rulonoxitib - ANSWER✔✔-Jak2 inhibitor used as adjunct in myelofibrosis
Bortezomib
What is it used for?
What specific indication does it have for that disease?
What should be done before administration? - ANSWER✔✔-Used for MM
Indicated for renal failure in MM
COPYRIGHT © 2025 ALL RIGHTS RESERVED
