Gastroenterology — USMLE Step 3 Practice
Gastroenterology is heavily tested on USMLE Step 3, covering GI bleeding, inflammatory bowel disease, liver disease, pancreatitis, and colorectal cancer screening. Management algorithms for acute presentations are frequently examined.
Frequently Asked Questions
How do you manage acute upper GI bleeding on Step 3?
Stabilize with 2 large-bore IVs and IV fluids. Transfuse to hemoglobin >7 g/dL (or >8 in cardiovascular disease). Give IV PPI (pantoprazole) infusion and IV octreotide if variceal bleeding is suspected. Upper endoscopy within 24 hours is both diagnostic and therapeutic.
What is the medical management of Crohn disease vs. ulcerative colitis?
Both IBD subtypes are treated with 5-ASA agents (mesalamine) for mild disease. Moderate-severe disease requires corticosteroids for induction, then immunomodulators (azathioprine, 6-MP) or biologics (infliximab, adalimumab) for maintenance. Crohn disease may need antibiotics (metronidazole, ciprofloxacin) for perianal disease.
What are the criteria for severe acute pancreatitis on Step 3?
The Ranson criteria and BISAP score assess severity. Organ failure (respiratory, renal, cardiovascular) defines severe pancreatitis. Initial management: aggressive IV fluid resuscitation with lactated Ringer's, NPO or early enteral nutrition, analgesia, and monitoring in ICU. ERCP is indicated for gallstone pancreatitis with cholangitis.
When do you start colorectal cancer screening?
Average-risk individuals: colonoscopy every 10 years starting at age 45 (updated ACS guidelines, also now reflected in USPSTF). High-risk patients (first-degree relative with CRC before age 60, or two first-degree relatives): colonoscopy starting at age 40 or 10 years before the youngest affected relative.
What is the hepatic encephalopathy management on Step 3?
Identify and treat precipitating cause (infection, GI bleeding, constipation, drugs). Give lactulose titrated to 2-3 soft stools per day. Rifaximin is added for recurrent episodes. Protein restriction is no longer recommended; maintain adequate nutrition.
Related Articles
- High-Yield Gastroenterology for USMLE Step 3: GI Bleeding, IBD, and Liver Disease
Master gastroenterology for USMLE Step 3 — upper GI bleeding management, IBD pharmacotherapy, liver disease complications, and pancreatitis criteria.
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