,UWorld Step 3 (1833 Questions & Verified
Answers) – USMLE NBME Shelf Exam Master
Pack | Internal Medicine, OB-GYN, Pediatrics,
Neurology & More (2025/2026).
Hypochromic microcytic anemia in kids
- Most common cause cause
- Why get it?
Iron deficiency
- Low meat, grain, veggies, fruit
- High fatty snacks, sweets, soft drinks
OCPs ant thyroid meds
Estrogen increases TBG, increasing TOTAL T4 and decreasing FREE T4
- Normal thyroid can adjust
If hypothyroid, INCREASE med dose
- Check TSH after 12 weeks
% Hb A vs Hb S
- Sickle cell trait
- Sickle cell-beta thalassemia
SSt - A:S is 60:40
SSB(0)T is 100% S
SSB(+)T is up to 25 A:75 S
HbSC disease
Equal HbS and HbC on hgb electrophoresis
Central face flushing, telangiectasis
- What
- Tx if mild vs mod/severe (pustules)
-Common complication
Papulopustular rosacea
- Mild: topical brimonidine, avoid triggers
- Mod/sev: topical metronidazole (oral if refractory)
- Comp: ocular sx (burning, chalazion)
,Decrease opioid misuse
1.
2.
3.
1. Random UDS
2. Check prescription drug-monitoring program at visits
3. F/U at least every 3 months
Fever, breast pain in 1 quadrant, focal inflammation without fluctuance while breastfeeding
1. What
2. When
2. Tx, can she still breastfeed?
3. Worry about what developing? Next step?
Lactational mastitis - staph a
First 3 months
Oral dicloxacillin or cephalexin
Yes
Abscess - breast US then FNA and abs
Diffuse, b/l breast tenderness
1. What
2. Tx
Breast engorgement
Cold compress and NSAID
SE of TMP-SMX in breastfeeding
Kernicterus
- Med is excreted in milk
Next step if pain 2/2 breastfeeding
Lactation consultant - likely 2/2 poor positioning or latching
Obtain sexual hx as part of routine health visit
Keep things to ask postmenopausal women about
Vaginal dryness, dyspareunia
SE of SSRI/SNRI
Anorgasmia, decreased libido
High Ca, next step? Then what?
Repeat Ca and get PTH
- If high PTH, check PTHrP, 25- and 1,25 vit D
, Rapid onset cause of elevated Ca w/ associated renal dysfxn
Hypercalcemia of malignancy
Hyperthyroidism heart symptom and tx
Sx tacky or afib/aflutter -> beta blocker then thyroid med
Give what to prevent neural tube defects?
Risk factors for high risk? Give how much then?
0.4 mg folic acid at least 1 mo before pregnancy and during 1st trimester
4 mg if high risk - Methotrexate, antiepileptics, DM, prior NTD
When to get genetic counseling for miscarriages
After 3 or more miscarriages, not including ectopics
Tx of pediatric functional constipation
Long term: High fiber, low dairy, osmotic laxative
Acute: stimulant laxative, phosphate enema (lyte abnormalities)
Low back pain diagnostic algorithm
Sx cord comp? MRI
>50, worse at night, hx ca, IVDU, >1 mo? XR and ESR
Others get PT and NSAIDs
Parent and teen at visit. Parent concerned about teen. Next step?
Talk to teen alone
As about ____ if has depression symptoms
SI
Acute hep C
- Presentation
- Labs
Usually asx but may have malaise, RUQ pain, transaminitis
Initially Hep C RNA + and may take up to 12 weeks before anti-hep C antibody +
Elderly person fall - don't forget to check this
Postural stability - "get up and go" test
Answers) – USMLE NBME Shelf Exam Master
Pack | Internal Medicine, OB-GYN, Pediatrics,
Neurology & More (2025/2026).
Hypochromic microcytic anemia in kids
- Most common cause cause
- Why get it?
Iron deficiency
- Low meat, grain, veggies, fruit
- High fatty snacks, sweets, soft drinks
OCPs ant thyroid meds
Estrogen increases TBG, increasing TOTAL T4 and decreasing FREE T4
- Normal thyroid can adjust
If hypothyroid, INCREASE med dose
- Check TSH after 12 weeks
% Hb A vs Hb S
- Sickle cell trait
- Sickle cell-beta thalassemia
SSt - A:S is 60:40
SSB(0)T is 100% S
SSB(+)T is up to 25 A:75 S
HbSC disease
Equal HbS and HbC on hgb electrophoresis
Central face flushing, telangiectasis
- What
- Tx if mild vs mod/severe (pustules)
-Common complication
Papulopustular rosacea
- Mild: topical brimonidine, avoid triggers
- Mod/sev: topical metronidazole (oral if refractory)
- Comp: ocular sx (burning, chalazion)
,Decrease opioid misuse
1.
2.
3.
1. Random UDS
2. Check prescription drug-monitoring program at visits
3. F/U at least every 3 months
Fever, breast pain in 1 quadrant, focal inflammation without fluctuance while breastfeeding
1. What
2. When
2. Tx, can she still breastfeed?
3. Worry about what developing? Next step?
Lactational mastitis - staph a
First 3 months
Oral dicloxacillin or cephalexin
Yes
Abscess - breast US then FNA and abs
Diffuse, b/l breast tenderness
1. What
2. Tx
Breast engorgement
Cold compress and NSAID
SE of TMP-SMX in breastfeeding
Kernicterus
- Med is excreted in milk
Next step if pain 2/2 breastfeeding
Lactation consultant - likely 2/2 poor positioning or latching
Obtain sexual hx as part of routine health visit
Keep things to ask postmenopausal women about
Vaginal dryness, dyspareunia
SE of SSRI/SNRI
Anorgasmia, decreased libido
High Ca, next step? Then what?
Repeat Ca and get PTH
- If high PTH, check PTHrP, 25- and 1,25 vit D
, Rapid onset cause of elevated Ca w/ associated renal dysfxn
Hypercalcemia of malignancy
Hyperthyroidism heart symptom and tx
Sx tacky or afib/aflutter -> beta blocker then thyroid med
Give what to prevent neural tube defects?
Risk factors for high risk? Give how much then?
0.4 mg folic acid at least 1 mo before pregnancy and during 1st trimester
4 mg if high risk - Methotrexate, antiepileptics, DM, prior NTD
When to get genetic counseling for miscarriages
After 3 or more miscarriages, not including ectopics
Tx of pediatric functional constipation
Long term: High fiber, low dairy, osmotic laxative
Acute: stimulant laxative, phosphate enema (lyte abnormalities)
Low back pain diagnostic algorithm
Sx cord comp? MRI
>50, worse at night, hx ca, IVDU, >1 mo? XR and ESR
Others get PT and NSAIDs
Parent and teen at visit. Parent concerned about teen. Next step?
Talk to teen alone
As about ____ if has depression symptoms
SI
Acute hep C
- Presentation
- Labs
Usually asx but may have malaise, RUQ pain, transaminitis
Initially Hep C RNA + and may take up to 12 weeks before anti-hep C antibody +
Elderly person fall - don't forget to check this
Postural stability - "get up and go" test
