USMLE Step 3 Review Exam 2025
Questions and Answers
Tx of IBS - ✔✔Best initial therapy: *Fiber*
Antispasmodic/Anticholingergics: dicyclomine, Hyoscyamine
Second line- TCAs (amitryptiline)
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 newborn screening? - ✔✔1.
Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - ✔✔Ciprofloxacin + Metrodinazole (they have some kind
of immune modulatory effect)
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 1
,Middle-aged woman with itching and xanthelesmas = primary biliary cirrhosis. What is
the best initial test, and the most accurate test? - ✔✔Initial: elevated ALP, normal
bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - ✔✔Primary biliary cirrhosis
Antismooth muscle antibody? - ✔✔Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - ✔✔IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? -
✔✔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? -
✔✔Ursodeoxycholic acid
Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial
test, and most accurate? - ✔✔Initial: ANA & antismooth muscle positive
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)
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,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 - ✔✔DIP and osteoarthritis
Bouchard's nodule - ✔✔PIP and both RA and osteoarthritis
Squamous cell carcinoma of the lung is associated with production of what hormone? -
✔✔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 -
✔✔ADH (causes SIADH)
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
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 3
, Bortezomib
What is it used for?
What specific indication does it have for that disease?
What should be done before administration? - ✔✔Used for MM
Indicated for renal failure in MM
Acyclovir should be given before administration due to reactivation of varicella
(shingles)
Best treatment for MM - ✔✔If young autologous BM transplant (<70)
Allogenic only for <50 (increased graft vs host in older pts
Best chemotherapy for MM - ✔✔1. Melphalan + steroids
2. Thalidomide or lenalidomide
3. Bortezomib
Best Tx for symptomatic Waldenostrom's (high IgM, hyperviscosity) -
✔✔Plasmapheresis
Best chemotherapy for Waldenostrom's - ✔✔Rituximab (if CD20 positive)
Fludarabine
Chlorambucil
(All used in CLL)
Aplastic anemia best tx if bone marrow transplant is unavailable - ✔✔Antithymocytw
globulin and cyclosporine
Causes of aplastic anemia - ✔✔Chronic hep C and B
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 4
Questions and Answers
Tx of IBS - ✔✔Best initial therapy: *Fiber*
Antispasmodic/Anticholingergics: dicyclomine, Hyoscyamine
Second line- TCAs (amitryptiline)
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 newborn screening? - ✔✔1.
Phenylketonuria
2. Galactosemia
3. Hypothyroidism
Antibiotics of choice in IBD - ✔✔Ciprofloxacin + Metrodinazole (they have some kind
of immune modulatory effect)
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 1
,Middle-aged woman with itching and xanthelesmas = primary biliary cirrhosis. What is
the best initial test, and the most accurate test? - ✔✔Initial: elevated ALP, normal
bilirubin
Accurate: antimitochondrial antibodies
Liver Biopsy
Antimitochondrial antibodies? - ✔✔Primary biliary cirrhosis
Antismooth muscle antibody? - ✔✔Primary sclerosing cholangitis
What condition accounts for most causes of primary sclerosing cholangitis? - ✔✔IBD
What is the best initial test for primary sclerosing cholangitis? Most accurate? -
✔✔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? -
✔✔Ursodeoxycholic acid
Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial
test, and most accurate? - ✔✔Initial: ANA & antismooth muscle positive
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)
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 2
,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 - ✔✔DIP and osteoarthritis
Bouchard's nodule - ✔✔PIP and both RA and osteoarthritis
Squamous cell carcinoma of the lung is associated with production of what hormone? -
✔✔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 -
✔✔ADH (causes SIADH)
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
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 3
, Bortezomib
What is it used for?
What specific indication does it have for that disease?
What should be done before administration? - ✔✔Used for MM
Indicated for renal failure in MM
Acyclovir should be given before administration due to reactivation of varicella
(shingles)
Best treatment for MM - ✔✔If young autologous BM transplant (<70)
Allogenic only for <50 (increased graft vs host in older pts
Best chemotherapy for MM - ✔✔1. Melphalan + steroids
2. Thalidomide or lenalidomide
3. Bortezomib
Best Tx for symptomatic Waldenostrom's (high IgM, hyperviscosity) -
✔✔Plasmapheresis
Best chemotherapy for Waldenostrom's - ✔✔Rituximab (if CD20 positive)
Fludarabine
Chlorambucil
(All used in CLL)
Aplastic anemia best tx if bone marrow transplant is unavailable - ✔✔Antithymocytw
globulin and cyclosporine
Causes of aplastic anemia - ✔✔Chronic hep C and B
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 4
