The #1 USMLE Exam Review Course for Medical Students

Med-Challenger USMLE Review


Med-Challenger USMLE is the highest quality, easiest to use United States Medical Licensing Examination (USMLE) Step 2 CS, Step 2 CK and USMLE Step 3 board review question bank and knowledge improvement suite for medical student exam review and the USMLE Initial Certification exam. Med-Challenger’s USMLE review course is 100% pass-guaranteed and provides over 2000 case-based Q&A following the United States Medical Licensing Examination exam blueprint, media banks, and ongoing content updates.

Med-Challenger’s USMLE exam review Qbank gives medical students everything needed to ace USMLE exams and accelerate their clinical knowledge acumen with less time, labor, and worry.

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Board Exam Pass-rate
Avg. Score Improvement
Avg. Study Time Saved
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Medical Students Served

Included Content & Questions

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

Over 0
Topics Covered
Over 0
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

High-Yield USMLE Review 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.

Table of Contents

Everything you need to know for USMLE exams.

Geriatrics: Assessment I, II
Geriatrics: Medical Conditions
Geriatrics: Special Problems of the Elderly I, II
Infant Nutrition
Menopause and Hormone Therapy
Normal and Abnormal Female Puberty
Periodic Health Examination: Adolescents
Periodic Health Examination: Adult
Periodic Health Examination: Birth to 10 years
Prevention of Cancer and the Role of Lifestyle Modification
Prevention of Coronary Heart Disease and Stroke
Prevention of Infectious Diseases
Sexuality and Sexual Counseling
End of Life Care: Acute Care
End of Life Care: General Care
Establishing Rapport
Fundamentals of Culturally Competent Care
Interviewing Techniques
Medical Ethics I, II
Medical Law I, II
Preconceptional Counseling and Routine Prenatal Care
Psychosocial Crises Intervention
Relationship-Centered Care
Risk Prevention
Speaking of Culturally Competent Care
Structuring Culturally Competent Care
The Dying Patient: General
The Dying Patient: Pain Control
Interpreting Laboratory Tests: General I, II
Interpreting Medical Literature
Statistics and Medical Evidence
Clinical Handoffs for Clinicians and Managers
Handoffs of Patient Care
Hospital Infection Control Bundles
Patient Safety
Bacterial Infections – Diphtheria, Pertussis, Tetanus
Bacterial Infections – Meningococcemia, Pneumococcemia
Bacterial Infections – Pediatric I, II
Tuberculosis – Bacterial Infections
Bacterial Infections – MRSA, VRE, ESBL
Parasitic Infections
Sepsis Syndromes
Systemic Fungal Infections
Systemic Fungal Infections – Pediatric
Tick-Borne Illnesses
Tick-Borne Illnesses – Pediatric
Viral Infections – Hantavirus
HIV and AIDS – Viral Infections
Viral Infections – Influenza, Mononucleosis, Herpes
Viral Infections – Pediatric
Rabies – Viral Infections
Breast Cancer
Cancer and The Elderly
Colorectal Cancer
Invasive Cervical Cancer
Lung Cancer
Malignancy-Associated Problems
Malignant Bone Tumors
Neoplasms of the Head and Neck
Oncologic Emergencies
Ovarian Cancer
Upper Gastrointestinal Malignancies
Urologic Cancer
Allergic Reactions
Arthritis: Infectious, Inflammatory, and Reactive
Crystal Arthropathies
Ehlers-Danlos Syndrome
Leukocytoclastic Vasculitis
Mixed Connective Tissue Disease
Myofascial Pain Syndrome
Psoriasis/Psoriatic Arthritis
Raynaud Phenomenon
Rheumatoid Arthritis
Sjögren’s Syndrome
Systemic Lupus Erythematosus
The Immunocompromised Patient
Amyloidosis, Systemic
Anemia, Polycythemia, and White Blood Cell Disorders
Disseminated Intravascular Coagulation
Hemostasis Disorders I, II
Hyperlipidemia and Dyslipidemia
Sickle Cell Disease
Psychiatric Assessment
Addiction Medicine
Affective Disorders
Anxiety Disorders
Dissociative Disorders
Factitious Disorders and Malingering
Obsessive-Compulsive Disorder
Personality Disorders
Psychological Factors Affecting Medical Disorders
Somatoform Disorders
Suicidal Behavior
Thought Disorders
Violent Behavior
Neurologic Assessment I, II
Brain and Cranial Nerve Disorders
Central Nervous System Infections
Cerebrovascular Accidents – Epidemiology, Presentation
Cerebrovascular Accidents – Treatment
Cerebrovascular Accidents – Preventive Care
Cerebrovascular Accidents – Initial Work-Up
Dementia: General
Eye: Assessment
Eye: Glaucoma
Eye: Inflammation and Infection
Eye: Pharmacology
Eye: Vascular Disorders
Headache I, II
Myasthenia Gravis
Neuromuscular Disorders
Oral Cavity: Medical Disorders
Organic Brain Syndrome
Otologic Infections
Otologic Signs, Symptoms, Presentations
Peripheral Nerve Disorders
Seizures I, II
Spinal Cord Disorders
Cardiac Failure: Congestive State/Cor Pulmonale I, II
Circulation Disorders: Aortic Aneurysms
Circulation Disorders: Aortic Dissection
Circulation Disorders: Hypertension – Emergency Management
Circulation Disorders: Hypertension – General Management I, II
Circulation Disorders: Peripheral Vascular Disease I, II
Coronary Artery Disease I, II
Coronary Syndromes: Acute I, II
Dysrhythmia: Antiarrhythmic Pharmacology
Dysrhythmia: Basic Concept – Cardiac Dysrhythmias
Dysrhythmia: Conduction Disorders I, II
Dysrhythmia: Implantable Devices
Dysrhythmia: Supraventricular Dysrhythmias
Dysrhythmia: Ventricular Dysrhythmias
Pediatric Cardiac Disorders
Pericarditis/Pericardial Tamponade (Non-Traumatic)
Valvular Heart Disease – Emergency Management
Valvular Heart Disease: Baseline Presentations
Acute Respiratory Distress Syndrome
Asthma I, II
Chronic Obstructive Pulmonary Disease
Nose: Infections and Inflammations
Pediatric Respiratory Emergencies: Disease of the Lungs I, II
Pediatric Respiratory Emergencies: Lower Airway Obstruction
Pediatric Respiratory Emergencies: Upper Airway Obstruction and Infections
Pleural Effusion I, II
Pneumonia I, II, III, IV, V
Pulmonary Abscess
Pulmonary Embolism I, II, III
Throat and Soft Tissue Neck: Medical Disorders
Upper Respiratory Tract Infections
Anorectal Disease
Dietary Supplements: Herbal Therapies I, II, III
Dietary Supplements: Nutraceuticals I, II, III
Diverticular Disease
Esophageal Disorders, Miscellaneous
Esophageal Varices
Esophagus, Stomach, and Duodenum
Foodborne and Waterborne Diseases
Gastroenteritis I, II
Gastroesophageal Reflux Disease
Gastrointestinal Foreign Bodies
Gastrointestinal Perforation
Hepatic Encephalopathy
Hepatitis I, II
Inflammatory Bowel Disease
Intestinal Obstruction
Large Intestine: Acute Disorders
Liver and Biliary Tract: Acute Disorders
Meckel’s Diverticulum
Mesenteric Ischemia
Nutrition: Diet Strategies
Nutrition: Vitamins I, II
Occult Blood Testing
Pediatric Gastrointestinal Disorders
Peptic Ulcer Disease
Pseudomembranous Enterocolitis
Small Intestine: Acute Disorders
Ulcerative Colitis
Vitamins and Herbals
Urological Assessment
Glomerular Disease
Interstitial Nephritis
Nephropathy, Contrast Induced
Pediatric Renal and Genitourinary Tract Disorders
Renal Failure: Acute
Renal Failure: Chronic
Renal Transplantation
Urinary Retention
Urinary Tract Infection
Gynecological Assessment
Chronic Pelvic Pain In Women
Gynecology: Genetics
Pelvic Inflammatory Disease
Pre-Malignant and Malignant Disease of the Cervix
Premenstrual Syndrome (PMS) Premenstrual and Dysphoric Disorder (PMDD)
Pubertal Development and Gynecological Assessment
Sexual Assault
Sexually Transmitted Infections: Female Genital Lesions
Sexually Transmitted Infections: Vaginal Discharge
Vaginal Bleeding
Erectile Dysfunction
Penis Problems
Prostate Disorders
Sexually Transmitted Infections – Male Genital Lesions/Infections
Testicular Problems
Chronic Medical Illness During Pregnancy I, II
Diabetes in Pregnancy
Drug Therapy and Substance Abuse In Pregnancy
Ectopic Pregnancy
General Approach to the Pregnant Patient
Invasive Procedures in Pregnancy
IUGR and Doppler
Labor and Delivery and Their Complications
Multiple Gestation
Normal Labor and Delivery
Operative Deliveries
Post-Term Pregnancy
Postpartum Hemorrhage
Pregnancy: Acute Complications
Prenatal Care
Preterm Premature Rupture of Membranes
Cancers of the Skin
Cutaneous Infections
Dermatitis (non-infectious)
Maculopapular Lesions
Papular/Nodular Lesions
Ulcerative Lesions
Vesicular/Bullous Lesions
Pediatric Dermatology
Bacterial Infections – Bone and Joint Infections
Bacterial Infections – Deep Soft Tissues
Carpal Tunnel Syndrome
Disorders of the Spine
Pediatric Musculoskeletal Disorders
Tendinopathy, Bursitis, and Overuse Syndromes
Adrenal Insufficiency
Alcoholic Ketoacidosis
Calcium Metabolism
Diabetes Mellitus I, II
Diabetic Ketoacidosis
Hyperosmolar Coma
Lactic Acidosis
Male Hypogonadism
Thyroid and Adrenal Disorders
Congestive Heart Failure – Pediatric
Inherited Disorders
Abdominal Pain
Alcohol-Related Disease: Acute Care
Back Pain
Blood and Blood Components
Chest Pain I, II
Coma and Altered Mental Status I, II, III
Delirium: General
Dizziness and Vertigo
Fever in the Adult Patient
Gastrointestinal Bleeding
Monitoring the Emergency Patient
Nausea and Vomiting
Neutropenic Fever
Pelvic Pain: Acute
Shock I, II
Sleep Disorders
Burns – Chemical
Burns – Thermal
EENT Trauma: Eye
EENT Trauma: Nose
EENT Trauma: Oral-Dental
EENT Trauma: Otologic
Electrical and Lightning Injuries
Mammalian Bite Wounds (Including Humans)
Orthopedic Injuries: Ankle and Foot
Orthopedic Injuries: Cervical Spine
Orthopedic Injuries: Femur and Hip
Orthopedic Injuries: Hand I, II
Orthopedic Injuries: Humerus and Elbow
Orthopedic Injuries: Knee and Lower Leg
Orthopedic Injuries: Shoulder
Orthopedic Injuries: Wrist and Forearm I, II
Peripheral Vascular Injury
Trauma in Pregnancy
Trauma: Abdominal I, II
Trauma: Assessment and Stabilization I, II
Trauma: Face
Trauma: Foreign Bodies
Trauma: Genitourinary I, II, III
Trauma: Head
Trauma: Multiple and Blast Injuries
Trauma: Pelvic
Trauma: Soft Tissue Neck I, II
Trauma: Spinal Cord
Trauma: Thoracic – Cardiovascular Injuries I, I
Trauma: Thoracic – Chest Wall
Trauma: Thoracic – Esophageal Injuries
Trauma: Thoracic – Pulmonary Injuries
General Approach to the Poisoned Patient
Acetaminophen Toxicity
Antibiotics Toxicity and Side Effects
Anticholinergics Toxicity
Anticonvulsant Toxicity
Antidepressants Toxicity (inc. Serotonin Syndrome) I, II
Antipsychotics Toxicity
Aspirin and NSAIDs Toxicity
Bronchodilator Toxicity
Cardiovascular Drug Toxicity
Cocaine and Other Sympathomimetics Toxicity
Hallucinogen Toxicity
Heavy Metal Toxicity
Hydrocarbon Toxicity
Inhaled Toxins
Lithium Toxicity
Opiate Toxicity
Pesticide Toxicity (incl. Organophosphates)
Toxic Alcohols
Toxic Plant Ingestions (incl. Mushrooms)

Written and Maintained by Experts

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


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