USMLE Step 3 Exams with Complete Solutions | Latest Update

USMLE Step 3 Exams with Complete

Solutions | Latest Update


Pseudogout associations - ✔✔hemochromatosis, hyperparathyroidism,

acromegaly, hypothyroidism

Gout crystals - ✔✔negatively birefringent needles

Pseudogout crystals - ✔✔positively birefringent needles

Vasculitis associated with chronic Hep B - ✔✔polyarteritis nodosa

Vasculitis associated with chronic Hep C - ✔✔cryoglobulinemia

Best blood test for polyarteritis nodosa - ✔✔There is none. Get abdominal

angiography first, then biopsy of muscle, skin, or sural nerve.

Churg-Strauss - ✔✔vasculitis + eosinophilia + asthma

Takayasu's arteritis - ✔✔young asian female with diminished pulses

(usually preceeded by fatigue, weight loss, arthralgia, anemia, elevated

ESR)

Best test for Takayasu's - ✔✔aortic angiography or MRA

Bite cells on blood smear - ✔✔G6PD

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,Burr/Spur cells on blood smear - ✔✔liver disease

Acanthocytes on blood smear (looks like spur cell but with more rounded

spurs) - ✔✔liver disease, hypothyroidism, alcoholism

Basophilic stippling on blood smear - ✔✔lead poisoning

Schistocytes on blood smear - ✔✔TTP-HUS, DIC, prosthetic heart valve,

malignant htn, sepsis

Target cells on blood smear - ✔✔thalassemia, other hemoglobinopathies,

liver disease

5 causes of microcytic anemia - ✔✔iron deficiency, lead poisoning, anemia

of chronic disease (but usually normocytic), thalassemia, sideroblastic

anemia (can also have high MCV)

Antibody test for celiac disease - ✔✔anti-endomysial, tissue

transglutaminase (small bowel bx is best though)

Antibiotics for MRSA - ✔✔IV: vanc, linezolid, daptomycin, tigecycline;

if minor infection, can use oral: TMP/SMX, doxy, minocycline, or maybe

clindamycin (there is inducible resistance to clinda though)

Antibiotics for MSSA - ✔✔Oxacillin/nafcillin, dicloxacillin (IV and oral),

cefazolin (IV), cephalexin (oral)


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,Can you use cephalosporins in pt allergic to PCN? - ✔✔yes, if the rxn is

rash only; no if pt has true anaphylaxis

Antibiotics to use for Staph with PCN allergy - ✔✔cephalosporins if rash

only; macrolides, clindamycin, vancomycin, linezolid, daptomycin,

TMP/SMX

Antibiotics for strep - ✔✔PCN, ampicillin, amoxicillin

Antibiotics for GNRs - ✔✔Cephalosporins: cefepime, ceftazidime

PCNs: piperacillin, ticaricillin

Monobactam: Aztreonam

Quinolones: cipro, levo, gati, moxi

Aminoglycs: gentamicin, tobramycin, amikacin

Carbapenems: imipenem, mero, erta

Limitation of ertapenem - ✔✔does NOT cover pseudomonas

Piperacillin and ticarcillin - ✔✔GNRs

strep

anaerobes

Carbapenems - ✔✔good anaerobic coverage

strep

MSSA
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, Tigecycline - ✔✔MRSA

good GNR coverage

Anaerobes - ✔✔-metronidazole is BEST for abdominal anaerobes

(carbapenems, piperacillin, and ticarcillin have equal efficacy)

-cefoxitin and cefotetan are the ONLY cephalosporins

-respiratory anaerobes: clindamycin

Abx with NO anaerobic coverage - ✔✔aminoglycs, aztreonam,

fluoroquinolones, oxacillin/nafcillin, all cephalosporins EXCEPT cefoxitin

and cefotetan

Red man syndrome - ✔✔red, flushed skin from histamine release,

associated with rapid infusion of vancomycin (so slow down the infusion

rate)

Osteomyelitis - ✔✔-most common is staph: oxacillin or nafcillin IV for 4-6

wks for MSSA; vanc, linezolid or dapto for MRSA

-GNRs: salmonella or pseudomonas, can use orals, but must cx org. first

and make sure it is sensitive (BONE bx and cx)

Cellulitis tx - ✔✔-minor infection: oral dicloxacillin or cephalexin

-severe: IV oxacillin, nafcillin or cefazolin



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