USMLE STEP 3



The material collected here are neither real USMLE material nor are collected from people who took the test. These are only notes usded by previous applicants to get top scores. The notes are dividied into 21 groups, this is Group 1:


1. Gastroparesis (DM) Rx = metoclopramide, erythromycin;
    symptoms: post-prandial fullness, hypoglycemia, sweating, dizziness, constipation

2. Drugs that lead to hypercalcemia = thiazides and lithium

3. Calcium greater than 12 or symptoms = NSS IV 3- 6 l in 24 h, furosemide if necessary

4. Hungry bones syndrome = hypocalcemia post op removal of parathyroid adenoma

5. Sarcoidosis = increase in vit D levels

6. Familial hypocalciuric hypercalcemia = low 24 h urine calcium

7. Chronic thyroiditis (Hashimoto) = antimicrosomal antibodies

8. Drugs that lead to hypothyroidism = lithium and ASA

9. Large nodule (cold) in multinodular goiter (hot) = FNA; if follicular elements = excision

10. Psammoma bodies = papillary carcinoma of thyroid = MC type of thyroid cancer, RF radiation exposure, lymphatic spread

11. Thyroid cancer types = papillary, follicular (hematogenic spread), anaplastic, medullary (MEN); painful, low uptake, increased ESR

12. Graves disease Rx = bring the patient to euthyroid stae, then: radioactive iodine, steroids for ophtalmopathy

13. Plummer disease = long-standing multinodular goiters that become thyrotoxic later

14. Thyroiditis = low 24 h radioactive iodine uptake

15. Graves disease Dx = increased thyroid, "hot", proptosis, positive TSH Ig

16. Nitroblue tetrazolium test = chronic granulomatous disease; tets phagocyte fuction, oxidative burst

17. Cellular deficiency disease = fatal infections after receiving live viral vaccines (MMR, varicella)

18. Ab deficiency disease = encapsulated organisms, sino=pulmonary bacterian infections, sepsis

19. Phagocytic deficiency disease = recurrent abcesses, lymphadenitis, periodontal infections, Gram negatives, catalase positives, e.g. CGD, Ch├ędiak-Higashi

20. Complement deficiency dis = C2-C4: autoimmune dis; terminal: Neisseria; C3: encapsulated, unusual strains

21. Severe combined immunodeficiency = first year of life, decrease in T and B cells

22. Ig A deficiency = MC primary immune deficiency, major anaphylatic reaction to blood products

23. X-linked hypogammaglobulinemia Rx = IV Ig; defect in tyrosine kinase

24. X-linked lymphoproliferative disease = catastrophic after EBV infection

25. Chronic granulomatous disease = decreased intracelular and fungal killing; S. aureus, Aspergillus; Rx: prophylatic antibiotics (TMP/SMX, doxycycline), interferon gamma; vaccinate: Haemophilus, Pneumoccocus, Neisseria, viral vaccines

26. T-cell deficiency Rx = bone marrow transplant

27. Transfusion in cellular deficient patient = irradiated, leukodepleted, virus free product

28. C3 deficiency = increased number of pyogenic infections

29. Properidin and C5 deficiency = increased Neisseria infections

30. C1 inhibitor deficiency = hereditary angioedema

31. Decay accelerating factor deficiency = paroxysmal nocturnal hemoglobinuria

32. Clomiphene citrate use = ovulation induction (for patients with good estrogen production, such as in OPCD)

33. Pregnancy = increase in alkaline phosphatase does not indicate disease necessarily, may be normal finding

34. Primary hypothyroidism = may lead to increase in pituitary, amenorrhea, galactorrhea

35. Meconium ileus suspicion = barium enema

36. Cystic fibrosis tests = sweat test, nasal potential testing

37. Hepatitis B mother = breastfeed is OK!

38. Graves in pregnancy Rx = propylthiouracil

39. Cocaine use in pregnancy = placental abruption

40. Clue cells = bacterial vaginosis; Rx = metronidazole - counsel not to drink alcohol because of disulfiram-like reaction

41. Pruritic urticarial papules and plaques of pregnancy = third trimester

42. RF for ectopic pregnancy = age, PID, salpingitis, more than 3 pregnancies

43. Testicular feminization = dysfunction or absence of testosterone receptors; patient is XY, normal breast development, scant pubic and axilar hair, blind vagina, undescendent testicles, may be felt on the groin.

44. fever greater than 38 C in less than 4 m.o. = admission, IV antibiotics, full evaluation, multiple cultures

45. Pyloric stenosis = non-bilious emesis, midepigastric olive: Dx = USG; RF = erythromycin use

46. MCC of jaundice in pregnancy = viral hepatitis

47. Symptomatic biliary stones = pregnancy Rx = laparoscopic cholecystectomy

48. Asymptomatic biliary stones Rx = none

49. N. gonorrhea = Gram negative diplococci; Rx = ceftriaxone + azithromycin (to cover Chlamydia, which generally is there too); notify publc health authorities

50. Trichomonas vaginalis = motile flagellated microorganisms in vaginal wet mount

51. Low grade squamous intraepithelial lesion (cervix) = CIN I; Rx = rescreen in 4-6 months

52. Abnormal vaginal bleeding in woman older than 35 yo next step = office endometrial pipelle biopsy

53. Small subchorionic henorrhage Rx = clinical and USG observation

54. Menorrhagis, anovulatory bleeding = order a TSH!

55. Group B strep prophylaxis = penicillin or ampicillin to mother during active labor, CBC and blood culture on the newborn

56. Low plasma bicarbonate causes = diarthea, renal tubular acidosis

57. Erythema infectiosum = not contagiuos during the rash (slapped face, lacy), only before it

58. Bleeding in pregnancy = order bood type, Rh, atypical antibodies

59. Bilious vomiting in infant = think malrotation with volvulus; if no peritoneal signs, flexible sigmoidoscopy is diagnostic and treatment at the same time

60. Bilious vomiting in newborn = remember the 3 Ds: duodenal atresia, double bubble on abd XR, greater incidence in Down's syndrome

61. Side effects of MgSo4 use for the NB: meconium plug syndrome; in this case, contrast enema is both diagnostic and curative

62. Polythelia = accessory nipple

63. Polymastia = extraglandular breast tissue

64. Hugh grade intraepithelial lesion (cervix) management = colposcopy + endocervical curetage + biopsy

65. Following a molar pregnancy = contraceptives for 1 year, monitor beta HCG, if it goes up, it could be choriocarcinoma

66. Fetal alcohol syndrome = cardiac malformation (VSD), CNS abnormalities, face deformities

67. Tuboovarian abscess Rx = IV atbtcs; surgery only if necessary - it's one of the few cases of abscess that are cured without incision!

68. Prostate cancer Dx = USG guided needle biopsy with 6-12 specimens

69. Metastatic prostate cancer Rx = GnRh agonists (flutamide), orchiectomy + chemo

70. Staging for testicular cancer = serum LDH, AFP, beta HCG, CT chest/abd/pelvis; Rx = radical inguinal orchiectomy + spermatic cord ligation

71. MC sites of melanoma = trunk for men, legs for women

72. Basophilic palisiding cells, pearl apperance, upper 1/3 of the face = basal cell ca (the MC skin ca)

73. Moh's micrographic surgery = for squamous cell ca (lower 1/3 of the face), makes 1-2 mm margins

74. MCC of encephalitis in adults = HSV; meningeal signs + focal neurological signs, temporal lobe changes on CT; Rx = IV Acyclovir 14-21 days

75. Listeria monocytogenes meningitis Rx = ampicillin; NB, elderly

76. Chronic sinusitis = longer than 3 months; clinical

Dx, but if something is going to be ordered = CT sinus; Rx = amoxicillin +/- clavulanate +/- clindamycin for 21 days, nasal steroid sprays, endoscopic surgery if necessary

77. Otitis media, ac. sinusitis Rx = TMP/SMX or amoxicillin +/- clavulanate

78. Otitis externa Rx = topical ofloxacin with steroids; remember to clean the ear before applying the Rx; Pseudomonas, swimmers

79. Chr carriers of group A strep Rx = clindamycin

80. Smoker with pneumonia, diarrhea, increased LDH = think Legionella; Dx = urine Ag; Rx = doxycycline

81. Cystic fibrosis pneumonia Rx = IV ceftazidime + IV levofloxacine = IV aminoglycoside; MCC = Pseudomonas

82. Aspiration pneumonia Rx = IV ceftriaxone + IV azythromycin + IV clindamycin; chronic, not presentiated, RF positive

83. Aspiration pneumonitis = acute event, presentiated by somebody, no need for atbtcs

84. PCP pneumonia Dx = silver stain of sputum, bronchial lavage; Rx = IV TMP/SMX or inhaled pentamidine, add prednisone if: PaO2 less than 70 or A-a gradient more than 35

85. TB Rx = RIPE for 8 w., then INH + rifampin for 16 w. more

86. Add vit. B6 for INH

87. Keep an eye on uric acid for Pyrazinamide

88. Order ophtalmologic avaliation for Ethambutol

89. Latent TB Rx = nine months of INH (+ B6)

90. TB + HIV = use Rifabutin instead of Rifampin because of possible drug interaction