USMLE Step 3 Review Exam 2025
Questions and Answers
Antimitochondrial antibodies? - ✔✔Primary biliary cirrhosis
Antismooth muscle antibody? - ✔✔Primary sclerosing cholangitis
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
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,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 - ✔✔DIP and osteoarthritis
Bouchard's nodule - ✔✔PIP and both RA and osteoarthritis
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,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)
Best therapy for hairy cell leukemia? - ✔✔Cladribine
Rulonoxitib - ✔✔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? - ✔✔Used for MM
Indicated for renal failure in MM
Acyclovir should be given before administration due to reactivation of varicella
(shingles)
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, 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
After you confirm the diagnosis with excisional biopsy (lymphoma) best next step? -
✔✔Determine stage with:
CXR
CT scan of chest, abd., pelvis, and head
Bone marrow biopsy
Asymptomatic lymphoma Stage 1 and 2 (1-2 LN only one side) best tx - ✔✔Radiation +
low dose chemo
Chemotherapy for Hodgkin's lymphoma - ✔✔ABVD
Adriamycin
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 4
Questions and Answers
Antimitochondrial antibodies? - ✔✔Primary biliary cirrhosis
Antismooth muscle antibody? - ✔✔Primary sclerosing cholangitis
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
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 1
,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 - ✔✔DIP and osteoarthritis
Bouchard's nodule - ✔✔PIP and both RA and osteoarthritis
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 2
,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)
Best therapy for hairy cell leukemia? - ✔✔Cladribine
Rulonoxitib - ✔✔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? - ✔✔Used for MM
Indicated for renal failure in MM
Acyclovir should be given before administration due to reactivation of varicella
(shingles)
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 3
, 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
After you confirm the diagnosis with excisional biopsy (lymphoma) best next step? -
✔✔Determine stage with:
CXR
CT scan of chest, abd., pelvis, and head
Bone marrow biopsy
Asymptomatic lymphoma Stage 1 and 2 (1-2 LN only one side) best tx - ✔✔Radiation +
low dose chemo
Chemotherapy for Hodgkin's lymphoma - ✔✔ABVD
Adriamycin
COPYRIGHT © 2025 BY OLIVIA WEST, ALL RIGHTS RESERVED 4
