Medical Student Exam Review

Med-Challenger USMLE is the highest quality, easiest to use United States Medical Licensing Examination (USMLE) Step 2 CK and USMLE Step 3 board review question bank for the shelf exam, in-training exam, and USMLE Initial Certification exam. With ongoing updates, the Med-Challenger USMLE exam review Qbank provides everything you need to ace exams and fulfill requirements without having to attend an in-person board review course or buy products over and over.

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Med-Challenger USMLE

USMLE Exam Review, Med-Challenger USMLE

Asset Overview

Up-to-date content and Q&A for USMLE board exam review, self-assessment, and exam simulation to quickly get prepared – pass-guaranteed.

  • Adaptive NBME board exam prep & USMLE Step 2 CK and Step 3 review Qbank
  • 2000+ USMLE blueprint-based board exam questions
  • 100% Pass-guaranteed

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    Blueprint-based Board Exam Simulation

    Tailored to the actual exam content specifications so you get the right amount of study in each area.

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    Every use finds and fixes knowledge gaps by re-issuing missed Q&A. Ensures you see and master all content without repeats or wasted time.

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Content + Q&A

For Med-Challenger USMLE United States Medical Licensing Exam Review Qbank

Topics Covered
Board-style Questions

Medical Student Question Topics

USMLE publishes a content blueprint of the material that will appear on the exam.

This is how we determine which material appears in your adaptive Qbank.


1% – 3%
General Principles of Foundational Science

85% – 95%
Immune System
Blood & Lymphoreticular Systems
Behavioral Health
Nervous System & Special Senses
Skin & Subcutaneous Tissue
Musculoskeletal System
Cardiovascular System
Respiratory System
Gastrointestinal System
Renal & Urinary Systems
Pregnancy, Childbirth, & the Puerperium
Female Reproductive System & Breast
Male Reproductive System
Endocrine System
Multisystem Processes & Disorders

Biostatistics & Epidemiology/Population Health
Interpretation of the Medical Literature

10% – 15%
Medical Knowledge/Scientific Concepts

40% – 50%
Diagnosis - History/Physical Examination
Diagnosis - Laboratory/Diagnostic Studies
Diagnosis - Diagnosis
Diagnosis - Prognosis/Outcome

30% – 35%
Disease Prevention - Pharmacotherapy
Disease Prevention - Clinical Interventions
Disease Prevention - Mixed Management
Disease Prevention - Surveillance for Disease Recurrence

3% – 7%
Systems-based Practice/Patient Safety
Practice-based Learning

Author Information

Continually Updated
All content is continually maintained by clinical expert peer-review.

Gerard Kiernan, MD
Dartmouth Hitchcock Clinic
Keene, NH

Contributing Editors / Clinical Reviewers:

Jennifer Amani, MD
Attending Physician
MBI Occupational Healthcare
Phoenix, AZ

David Auerbach, MD
Attending Physician
Montgomery Radiology Associates
Pottstown, PA

Deborah Brunson, MD
Boulder, CO

Joseph Cama, MD
Carabou Medical
Towanda, PA

Gina Chung, MD
Assistant Professor
Dept. of Internal Medicine, Section of Medical Oncology
Yale University School of Medicine
New Haven, CT

Adam Cohen, MD
Depatment of Oncology
Huntsman Cancer Institute
Salt Lake City, UT

Arthur Frazzano, MD, FAAFP
Founding Director, Area Health Education Center of RI Network
Director, Division of Health Policy and Advocacy and Associated
Fellowship Program
Associate Professor
Warren Alpert Medical School
Brown University
Providence, Rhode Island

Roger P. Holland, MD, PhD
Eisenhower Army Medical Center
Family Medicine Residency Program
Fort Gordon, GA

Andrea K. Irving, DO, CLE
Site Medical Director
Wexford Health Sources
Goodyear, AZ

Jassin M. Jouria, Jr., MD
University of Miami
Leonard M. Miller School of Medicine
Miami, FL

Alex Kadner, PhD
Medical Writer/Scientific Consultant, Neuroscience
Ballston Spa, NY

Laurie LeMauviel, DO
Assistant Professor of Medicine
University of North Carolina School of Medicine
Asheville, NC

Miguel G. Madariaga, MD, MSc, FACP, DLSHTM
Director, Center for Wound Healing and Hyperbaric Medicine
Physician, Infectious Disease
Doylestown Hospital
Doylestown, Pennsylvania

Amy Marcini, MD
General and Orthopedic Surgeon
Boston, MA

Elaine Melamud, MD, FACOG
JK Medical Associates
Clark, NJ

Luis A. Mojicar, MD
Center for Living Well Clinic
Orlando, FL

Laeth Nasir, MBBS
Professor and Chairman
Creighton University
Omaha, NE

Jahan Porhomayon, MD. CBA, FCCP
Clinical Associate Professor of Anesthesiology
University at Buffalo
Buffalo, New York

George Smolinksi III, MD
Major, Medical Corps, U.S. Army
Physical Medicine Clinic
Landstuhl Regional Medical Center
Landstuhl, Germany

Richard Snyder, DO
Integrative Medicine Practitioner
LeHigh Valley Nephrology Associates

Iren Solomon, MD
Adjunct Professor
Olivet Nazarene University
Bourbonnais, IL

Theresa Suozzi, MD
Hartford Medical Group
Wethersfield, CT

Rodrigo Tanchanco, MD, FACP
Christiana Medical Group
Newark, DE

Frank Townsend, III, MD, JD
Attending Physician
Greater Baltimore Medical Center
Baltimore, MD

Jeffrey R. Unger, MD
Associate Clinical Professor
Loma Linda University School of Medicine
Loma Linda, CA

Tricia A. Walters, MD
Family Medicine w/ Obstetrics
Wyatt, IN

Cezary Wojcik, MD, PhD
Deaconess Hospital
Assistant Professor
Indiana University School of Medicine
Evansville, IN

Our USMLE Questions

NBME-style, blueprint-based Q&A.
Just like you’ll see on the actual USMLE exam.

Positively-stated, Case-based Question Stems

No “negatively phrased” questions, no “A and B”…you know what we mean. Our questions always address important “key point” blueprint-based content in a well structured manner.

A 22-year-old woman who is pregnant with her first child presents to the emergency department (ED) at 23 weeks of gestation. She is complaining of chest pain. She tells you that she put herself through college by working as a fashion model in New York because she is “tall, thin, and long-legged.”

The chest pain is sharp, diffuse, nonpleuritic, nonradiating, and nonpositional. There are no modifiers to the pain, including food and position. She tells you that the onset of pain was rapid and occurred while she was walking up a flight of stairs after an argument with her aunt.

On examination, you note pectus excavatum, scoliosis, and a high-arched palate.

Of the following list, the most likely diagnosis for this patient is which of the following?

Clear Answer Options

A question’s difficulty is defined by the choice of distractors. Good distractors determine the difficulty level of a question. Therefore, good distractors are one of the most important features of a high quality question.

aortic dissection

High-yield Remediation

Understanding why an answer choice is incorrect is just as important as knowing why it is correct. Med-Challenger questions contain detailed explanations for the correct and incorrect answer choices along with integrated media for those that learn best by visual stimuli.

Educational Objective:

Understand that Marfan syndrome is associated with aortic dissection.

Key Point:

Several chest pain patterns of aortic dissection are similar to those seen in cases of pulmonary embolism and acute coronary syndromes.


The most likely diagnosis for this patient is aortic dissection. This patient has Marfan syndrome. Other features to look for are arachnodactyly (spider fingers), myopia, pes planus, and striae on the shoulders and buttocks (but not the abdomen). Although mitral regurgitation may be seen, this condition occurs in about 25% of patients.

Aortic dissection can often be triggered by pregnancy, emotional upset, and physical stress. In this case, all 3 potential causes were present. Of note, Marfan syndrome is one of the most highly prevalent of all genetic diseases, occurring in 1 in 3,000 to 5,000 births.

Guidelines published in 2015 from the American Heart Association on chest pain now recommend computed tomography (CT) angiogram of the aorta in the ED as the preferred study for ruling out an aortic dissection. CT angiogram of the aorta is preferable to transesophageal echocardiography (TEE), even in initially unstable patients as long as they can be sufficiently stabilized to tolerate the trip to the CT scanner. In patients who cannot be stabilized, bedside TEE is the most acceptable alternative. TTE can be used in highly unstable patients to rule out a hemopericardium (accuracy of TTE is somewhat low for establishing an aortic dissection per se). Ultrasonography is not recommended as an option in the context of aortic dissection.


Prockup D, Bateman J. Heritable disorders of connective tissue. In: Longo D, et al. Harrison’s Principles of Internal Medicine. 18th ed., 2012:3212.

Rybicki FJ, Udelson JE, Peacock WF, et al. 2015 ACR / ACC / AHA / AATS / ACEP / ASNC / NASCI / SAEM / SCCT / SCMR / SCPC / SNMMI / STR / STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: a joint report of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol. 2016;67(7):853-879.

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