USMLE Step 3 Exam Review Latest

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Tx of IBS - ANSWER Best initial therapy: *Fiber* If fiber fails: Antispasmodic/anticholinergic agents. First line: 1. Dicyclomine 2. Hyoscyamine Secondline: 1. TCA's (amitriptyline) CCS, ... What test should you order for IBS? - ANSWER 1. Stool: stool guiac, leukocytes, cultures, ova & parasites. 2. Colonoscopy 3. Abdominal CT scan Umbilical hernia in newborns is associated with? - ANSWER Congenital hypothyroidism Screen with TSH (you should screen for TSH anyway) What three metabolic conditions do most states require newborn screening? - ANSWER 1. Phenylketonuria 2. Galactosemia 3. Hypothyroidism Antibiotics of choice in IBD - ANSWER Ciprofloxacin + Metrodinazole (they have some kind of immune modulatory effect) Middle-aged woman with itching and xanthelesmas = primary biliary cirrhosis. What is the best initial test, and the most accurate test? - ANSWER Initial: elevated ALP, normal bilirubin Accurate: antimitochondrial antibodies Liver Biopsy Antimitochondrial antibodies? - ANSWER Primary biliary cirrhosis Antismooth muscle antibody? - ANSWER Primary sclerosing cholangitis What condition accounts for most causes of primary sclerosing cholangitis? - ANSWER IBD What is the best initial test for primary sclerosing cholangitis? Most accurate? - ANSWER 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? - ANSWER Ursodeoxycholic acid Young woman with hepatitis with thyroiditis or ITP, autoimmune hepatitis. Best initial test, and most accurate? - ANSWER Initial: ANA & antismooth muscle positive Best: Liver biopsy Other: liver/kidney microsomL antibody, SPEP (serum protein electrophoresis) with hypergammaglobulinemia Best initial test for hemochromatosis - ANSWER Serum iron, iron binding capacity (low), ferritin (high) Most accurate test for hemochromatosis - ANSWER MRI of liver + genetic testing for HFe gene mutation (Spares liver biopsy) Last two indications for amph [Show More]

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