USMLE STEP 3 REVIEW UPDATED STUDY GUIDE QUESTIONS
AND CORRECT ANSWERS
27
Tx of IBS 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? 1. Stool: stool guiac, leukocytes, cultures, ova & parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
What three metabolic conditions do most states require 1. Phenylketonuria
newborn screening? 2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD Ciprofloxacin + Metrodinazole (they have some kind of immune modulatory
effect)
Middle-aged woman with itching and xanthelesmas = Initial: elevated ALP, normal bilirubin
primary biliary cirrhosis. What is the best initial test, and
the most accurate test? Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? Primary biliary cirrhosis
Antismooth muscle antibody? Primary sclerosing cholangitis
What condition accounts for most causes of primary IBD
sclerosing cholangitis?
What is the best initial test for primary sclerosing Initial: elevated ALP, elevated bilirubin
cholangitis? Most accurate?
Best: ERCP (beading of biliary system)
Others: antismooth muscle antibody, ANCA positive
Treatment for both primary biliary cirrhosis and primary Ursodeoxycholic acid
sclerosing cholangitis?
, Young woman with hepatitis with thyroiditis or ITP, Initial: ANA & antismooth muscle positive
autoimmune hepatitis. Best initial test, and most
accurate? Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis)
with hypergammaglobulinemia
Best initial test for hemochromatosis Serum iron, iron binding capacity (low), ferritin (high)
Most accurate test for hemochromatosis MRI of liver + genetic testing for HFe gene mutation
(Spares liver biopsy)
Last two indications for amphotericin Cryptococcus and mucormycosis
Best drug for aspergillus Voriconazole
Best fungal drug for neutropenic fever Caspofungin
Best drug for candida Fluconazole
Heberden's nodule, where is it and what disease is it DIP and osteoarthritis
associated with?
Bouchard's nodule, where is it and what disease is it PIP and both RA and osteoarthritis
associated with?
(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 DIP and osteoarthritis
associated with?
Bouchard's nodule, where is it and what disease is it PIP and both RA and osteoarhtitis
associated with?
Heberden's nodule (where is it and what disease is it DIP and osteoarthritis
associated with)
Squamous cell carcinoma of the lung is associated with parathyroid like hormone (look for patient with a cavitary lesions near a
production of what hormone? bronchus who has hypercalcemia)
Small cell carcinoma of the lung is associated with ADH (causes SIADH)
production of what hormone
Look for normovolemic hyponatremia (sodium loss tends to be much higher
than water retention)
Treatment of SIADH? 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? Cladribine
Rulonoxitib Jak2 inhibitor used as adjunct in myelofibrosis
AND CORRECT ANSWERS
27
Tx of IBS 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? 1. Stool: stool guiac, leukocytes, cultures, ova & parasites.
2. Colonoscopy
3. Abdominal CT scan
Umbilical hernia in newborns is associated with? Congenital hypothyroidism
Screen with TSH (you should screen for TSH anyway)
What three metabolic conditions do most states require 1. Phenylketonuria
newborn screening? 2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD Ciprofloxacin + Metrodinazole (they have some kind of immune modulatory
effect)
Middle-aged woman with itching and xanthelesmas = Initial: elevated ALP, normal bilirubin
primary biliary cirrhosis. What is the best initial test, and
the most accurate test? Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? Primary biliary cirrhosis
Antismooth muscle antibody? Primary sclerosing cholangitis
What condition accounts for most causes of primary IBD
sclerosing cholangitis?
What is the best initial test for primary sclerosing Initial: elevated ALP, elevated bilirubin
cholangitis? Most accurate?
Best: ERCP (beading of biliary system)
Others: antismooth muscle antibody, ANCA positive
Treatment for both primary biliary cirrhosis and primary Ursodeoxycholic acid
sclerosing cholangitis?
, Young woman with hepatitis with thyroiditis or ITP, Initial: ANA & antismooth muscle positive
autoimmune hepatitis. Best initial test, and most
accurate? Best: Liver biopsy
Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis)
with hypergammaglobulinemia
Best initial test for hemochromatosis Serum iron, iron binding capacity (low), ferritin (high)
Most accurate test for hemochromatosis MRI of liver + genetic testing for HFe gene mutation
(Spares liver biopsy)
Last two indications for amphotericin Cryptococcus and mucormycosis
Best drug for aspergillus Voriconazole
Best fungal drug for neutropenic fever Caspofungin
Best drug for candida Fluconazole
Heberden's nodule, where is it and what disease is it DIP and osteoarthritis
associated with?
Bouchard's nodule, where is it and what disease is it PIP and both RA and osteoarthritis
associated with?
(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 DIP and osteoarthritis
associated with?
Bouchard's nodule, where is it and what disease is it PIP and both RA and osteoarhtitis
associated with?
Heberden's nodule (where is it and what disease is it DIP and osteoarthritis
associated with)
Squamous cell carcinoma of the lung is associated with parathyroid like hormone (look for patient with a cavitary lesions near a
production of what hormone? bronchus who has hypercalcemia)
Small cell carcinoma of the lung is associated with ADH (causes SIADH)
production of what hormone
Look for normovolemic hyponatremia (sodium loss tends to be much higher
than water retention)
Treatment of SIADH? 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? Cladribine
Rulonoxitib Jak2 inhibitor used as adjunct in myelofibrosis
