Step 3 Usmle exam must know high yield concepts
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USMLE Step 3 high yield topics 2025 must know concepts
Now I have what I need. Let me compile the comprehensive high-yield USMLE Step 3 tables directly from my medical knowledge, cross-referenced with the official USMLE content outline weights.
USMLE Step 3 - High Yield Must-Know Concepts
Based on the official USMLE Step 3 content outline. Systems are weighted by % of exam content.
EXAM STRUCTURE AT A GLANCE
| Feature | Details |
|---|---|
| Format | 2 days: Day 1 (FIP) + Day 2 (ACM) |
| MCQs | ~232 (Day 1) + ~180 (Day 2) = ~412 total |
| CCS Cases | 13 interactive computer-based case simulations |
| Key Day 1 skills | Biostatistics, EBM, foundational science application |
| Key Day 2 skills | Clinical management, pharmacotherapy, outpatient care |
SYSTEM WEIGHT ON EXAM (MCQ %)
| System | % of Exam | Priority |
|---|---|---|
| Cardiovascular | 9-11% | ★★★★★ |
| Respiratory | 8-10% | ★★★★★ |
| Nervous System & Special Senses | 8-10% | ★★★★★ |
| Immune/Blood/Lymph/Multisystem | 6-8% | ★★★★ |
| GI System | 6-8% | ★★★★ |
| Pregnancy/Childbirth & Female Repro | 6-8% | ★★★★ |
| Musculoskeletal | 5-7% | ★★★ |
| Behavioral Health | 4-6% | ★★★ |
| Renal/Urinary & Male Repro | 4-6% | ★★★ |
| Skin & Subcutaneous Tissue | 4-6% | ★★★ |
| Human Development | 1-3% | ★★ |
1. CARDIOLOGY (9-11%)
| Topic | High-Yield Facts |
|---|---|
| STEMI management | PCI within 90 min (door-to-balloon); tPA if PCI unavailable within 120 min; give aspirin + P2Y12 (clopidogrel/ticagrelor) immediately |
| NSTEMI/UA | Anticoagulate (heparin) + antiplatelet; risk stratify with TIMI/GRACE; early invasive if high-risk |
| Heart failure with reduced EF (HFrEF) | ACEi/ARB + beta-blocker (carvedilol, metoprolol succinate) + mineralocorticoid antagonist + SGLT2 inhibitor; ICD if EF ≤35% |
| Heart failure with preserved EF (HFpEF) | Diuretics for symptom relief; treat underlying HTN/AFib; SGLT2 inhibitors now indicated |
| Atrial fibrillation | Rate vs rhythm control; anticoagulate if CHA₂DS₂-VASc ≥2 (men) / ≥3 (women); DOACs preferred over warfarin |
| Hypertensive emergency | DBP >120 with end-organ damage; IV labetalol/nicardipine; lower MAP by ≤25% in first hour |
| Aortic stenosis | Severe: AVA <1 cm², gradient >40 mmHg; TAVR for high-surgical-risk patients |
| Endocarditis prophylaxis | Only for high-risk cardiac lesions + dental procedures; amoxicillin 2g 30-60 min before |
| Cardiac tamponade | Beck's triad (hypotension, JVD, muffled sounds); pulsus paradoxus; urgent pericardiocentesis |
| PE management | Hemodynamically unstable → systemic thrombolytics; stable → anticoagulation (DOACs first-line) |
| Syncope | Vasovagal most common; cardiac syncope (no prodrome, exertional) requires urgent workup with ECG, echo |
2. PULMONOLOGY (8-10%)
| Topic | High-Yield Facts |
|---|---|
| Community-acquired pneumonia (CAP) | Outpatient (healthy): amoxicillin or doxycycline; outpatient (comorbidities): respiratory fluoroquinolone or amox-clav + macrolide; inpatient non-ICU: beta-lactam + macrolide |
| COPD exacerbation | SABA + SAMA (ipratropium), systemic steroids x5 days, antibiotics if purulent sputum; consider BiPAP |
| Asthma | Step-up therapy; severe attack = SABA + IV steroids + Mg sulfate; intubate if failing |
| Pulmonary hypertension | Idiopathic: PDE-5 inhibitors (sildenafil), endothelin antagonists (bosentan), prostacyclins; anticoagulate |
| ARDS | Berlin criteria (acute onset, bilateral infiltrates, PaO₂/FiO₂ <300, no cardiac cause); low tidal volume ventilation (6 mL/kg) |
| Lung cancer screening | Annual low-dose CT for 50-80 year olds with 20 pack-year history, current smoker or quit <15 years |
| Solitary pulmonary nodule | <6mm: no follow-up if low risk; 6-8mm: CT at 6-12 months; >8mm: consider PET/CT or biopsy |
| Pleural effusion | Transudates (heart failure, cirrhosis, nephrotic): Light's criteria protein <0.5, LDH <0.6; exudates → thoracentesis + culture |
| Obstructive sleep apnea | CPAP is first-line; complications: HTN, atrial fibrillation, pulmonary HTN |
3. NEUROLOGY (8-10%)
| Topic | High-Yield Facts |
|---|---|
| Ischemic stroke | tPA within 4.5 hours of onset (if no contraindications); mechanical thrombectomy up to 24 hours for large vessel occlusion |
| Hemorrhagic stroke | CT head first (no tPA); BP control; reverse anticoagulation; neurosurgery consult |
| TIA workup | Admit, ABCD² score; carotid imaging + echo + cardiac monitoring; start aspirin immediately |
| Meningitis | Bacterial: LP immediately (or CT first if papilledema/focal deficits); empiric ceftriaxone + vancomycin + dexamethasone; add ampicillin if >50 yrs or immunocompromised |
| Status epilepticus | Lorazepam → fosphenytoin/levetiracetam → propofol/phenobarbital (refractory) |
| MS | Relapsing-remitting: disease-modifying therapy (interferon-beta, natalizumab); acute attack → IV methylprednisolone |
| Parkinson's disease | Levodopa/carbidopa is gold standard; dopamine agonists for younger patients; avoid antipsychotics |
| Guillain-Barre syndrome | Ascending paralysis after infection; absent reflexes; IVIG or plasmapheresis; monitor FVC |
| Myasthenia gravis | Fatigable weakness; anti-AChR antibodies; pyridostigmine; thymectomy; IVIG or plasmapheresis for crisis |
| Headache - when to image | Thunderclap, worst headache of life (SAH), new in >50 yrs, progressive, focal deficits, fever → CT urgently |
4. GASTROENTEROLOGY (6-8%)
| Topic | High-Yield Facts |
|---|---|
| GI bleeding - upper | Peptic ulcer most common; Mallory-Weiss = post-vomiting; resuscitate → endoscopy within 24 hours; H. pylori eradicate if positive |
| GI bleeding - lower | Diverticulosis most common overall; young patient with IBD consider; colonoscopy after stabilization |
| H. pylori treatment | Triple therapy: PPI + clarithromycin + amoxicillin x 14 days; confirm eradication with urea breath test 4 weeks after |
| IBD - Crohn's vs UC | Crohn's: skip lesions, transmural, any GI tract, perianal disease, fistulas; UC: continuous, mucosal, colon only, bloody diarrhea |
| Colorectal cancer screening | Average risk: colonoscopy at age 45, q10 years (ACS 2018/USPSTF 2021); FIT annually as alternative |
| Liver disease / cirrhosis | Complications: portal HTN, varices, ascites, SBP, HRS, HE, HCC; Child-Pugh / MELD scores for prognosis |
| SBP diagnosis/treatment | Ascitic PMN >250/mm³; empiric cefotaxime; prophylaxis with norfloxacin if prior SBP or protein <1g/dL |
| Acute pancreatitis | Gallstones #1, alcohol #2; NPO + aggressive IV fluids; Ranson/BISAP criteria for severity; ERCP if cholangitis |
| Liver transplant indications | MELD >15; acute liver failure; HCC (Milan criteria) |
| Celiac disease | Anti-tissue transglutaminase IgA; villous atrophy on biopsy; gluten-free diet; check for IgA deficiency |
5. INTERNAL MEDICINE - ENDOCRINE & METABOLISM
| Topic | High-Yield Facts |
|---|---|
| DM2 management | First-line: metformin; add SGLT2i or GLP-1 agonist for CV disease or CKD; HbA1c target <7% (individualized) |
| Diabetic ketoacidosis | IV fluids → insulin drip → replace K⁺ (must be ≥3.5 before insulin); anion gap metabolic acidosis |
| HHS | Glucose >600, hyperosmolar, minimal ketosis; elderly T2DM; aggressive hydration |
| Hypothyroidism | TSH elevated, free T4 low; levothyroxine; recheck TSH in 6-8 weeks |
| Hyperthyroidism | Graves' disease (diffuse goiter, ophthalmopathy); PTU or methimazole; radioactive iodine or surgery |
| Thyroid nodule | TSH low → nuclear scan first; TSH normal/high → ultrasound → FNA if >1cm or suspicious features |
| Adrenal insufficiency | Primary (Addison's): hyperpigmentation, hyperkalemia, hyponatremia; secondary: no hyperpigmentation; treat crisis with IV hydrocortisone |
| Cushing's syndrome | 24-hr urine cortisol or late-night salivary cortisol → low-dose dexamethasone suppression test; pituitary source most common |
| Hypercalcemia | CHIMPANZEES mnemonic; most common outpatient: hyperparathyroidism; most common inpatient: malignancy; treat with IV saline |
| Pheochromocytoma | HTN crisis; alpha-block FIRST (phenoxybenzamine) before beta-block; never give beta-blocker first |
| Metabolic syndrome | 3 of 5: waist >40" (M) />35" (F), TG ≥150, HDL low, BP ≥130/85, FBS ≥100 |
6. NEPHROLOGY
| Topic | High-Yield Facts |
|---|---|
| AKI classification | Pre-renal (BUN:Cr >20, FeNa <1%); intrinsic renal (FeNa >2%); post-renal (obstruction) |
| CKD management | ACEi/ARB to slow progression; SGLT2i for proteinuria/CV protection; avoid NSAIDs; adjust drug doses |
| Nephrotic syndrome | Massive proteinuria (>3.5g/day), edema, hypoalbuminemia, hyperlipidemia; MCD in children (steroids), FSGS in adults |
| Nephritic syndrome | Hematuria, RBC casts, HTN, proteinuria; PSGN (post-strep, low C3); IgA nephropathy (Berger's, after URI) |
| Hyperkalemia ECG changes | Peaked T waves → prolonged PR → wide QRS → sine wave → VF; treat with calcium gluconate first (stabilizes membrane) |
| SIADH vs DI | SIADH: low serum Na, low serum osm, high urine Na, high urine osm; treat with fluid restriction; DI: high serum Na, low urine osm |
| Renal stones | Calcium oxalate most common (70%); uric acid (radiolucent); struvite (staghorn, infection); CT KUB best initial test |
| Renovascular HTN | Young woman: fibromuscular dysplasia; elderly with atherosclerosis; MR angiography; ACEi → worsens GFR in bilateral stenosis |
7. HEMATOLOGY / ONCOLOGY
| Topic | High-Yield Facts |
|---|---|
| Anemia classification | MCV <80 (iron def, thalassemia, sideroblastic); MCV 80-100 (ACD, renal, hypothyroid); MCV >100 (B12/folate def, liver disease, hemolysis) |
| Iron deficiency anemia | Ferritin <30 (most specific); low serum iron, high TIBC; treat cause + oral iron; IV iron if intolerant |
| B12 deficiency | Megaloblastic + neurologic (subacute combined degeneration); elevated MMA and homocysteine; treat with IM B12 |
| Sickle cell | Vaso-occlusive crisis: IV fluids + opioids; acute chest: exchange transfusion; prevention: hydroxyurea, penicillin prophylaxis, pneumococcal vaccine |
| TTP | Pentad (MAFAHT): Microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, neuro; ADAMTS13 deficiency; TREAT with plasmapheresis (NOT platelets!) |
| HIT | Thrombocytopenia 5-10 days after heparin; paradoxical thrombosis; STOP heparin → argatroban/fondaparinux |
| Anticoagulation reversal | Warfarin: vitamin K + FFP (urgent); DOACs: andexanet alfa (factor Xa inhibitors), idarucizumab (dabigatran) |
| CML | Philadelphia chromosome t(9;22); BCR-ABL; treat with imatinib (tyrosine kinase inhibitor) |
| Neutropenic fever | ANC <500; empiric ceftazidime or pip-tazo (antipseudomonal); add vancomycin if catheter infection, skin/soft tissue, hemodynamic instability |
8. OBSTETRICS & GYNECOLOGY (6-8%)
| Topic | High-Yield Facts |
|---|---|
| Preeclampsia | HTN (≥140/90) + proteinuria after 20 wks; severe: ≥160/110 or end-organ damage; Mg sulfate for seizure prophylaxis; deliver at 37 wks (severe: immediately) |
| Eclampsia | Seizure in preeclamptic patient; IV Mg sulfate; stabilize then deliver |
| Ectopic pregnancy | Beta-hCG + transvaginal US; treat with methotrexate (stable) or surgery (unstable); discriminatory zone ~1500-2000 |
| Placenta previa vs abruption | Previa: painless bleeding, AVOID digital exam; abruption: painful, rigid uterus, fetal distress |
| GDM | Oral glucose challenge test at 24-28 weeks; treat with diet → insulin (metformin controversial); C-section if macrosomia concerns |
| Preterm labor | <37 weeks; tocolytics (indomethacin <32 wks, nifedipine); betamethasone for fetal lung maturity at 24-34 wks; Mg sulfate for neuroprotection <32 wks |
| Cervical cancer screening | Pap smear: start at 21; 21-29: Pap q3 years; 30-65: Pap + HPV co-test q5 years or Pap alone q3 years; HPV 16/18 highest risk |
| Ovarian cancer | CA-125 (not a screening tool); BRCA1/2 mutations; pelvic mass in postmenopausal woman → surgery |
| Menopause / HRT | Vasomotor symptoms: HRT is most effective; contraindicated with active breast cancer, unexplained vaginal bleeding, prior DVT/PE |
| PCOS | Irregular cycles, hyperandrogenism, polycystic ovaries; treat with OCPs (cycle regulation) + metformin (insulin resistance) |
9. PEDIATRICS
| Topic | High-Yield Facts |
|---|---|
| Developmental milestones | 2 months: social smile; 6 months: sits with support; 9 months: pincer grasp developing; 12 months: single words, walks with support; 18 months: 10-25 words; 2 years: 2-word phrases; 3 years: 3-word sentences |
| Vaccinations | Review childhood schedule; HepB at birth; pneumococcal, Hib, DTaP, IPV at 2/4/6 months; MMR at 12-15 months; varicella 12-15 months |
| Febrile seizure | Simple (focal <15 min): reassure parents; complex (focal, >15 min, recurrent): workup; NOT epilepsy |
| Neonatal jaundice | Physiologic: peaks day 2-3; treat with phototherapy (TSB >15-17); exchange transfusion if very high; rule out hemolytic causes |
| Meningitis in neonate | GBS + E. coli + Listeria; ampicillin + gentamicin (or cefotaxime) |
| Kawasaki disease | Fever ≥5 days + 4 of 5: conjunctivitis, rash, strawberry tongue, cracked lips, cervical LAD, hand/foot changes; IVIG + aspirin; complication = coronary artery aneurysm |
| Intussusception | 6 months-3 years; colicky pain, currant jelly stool; target sign on US; air/hydrostatic enema (diagnostic + therapeutic) |
| Lead poisoning | BLL >5 μg/dL abnormal; BLL >45: chelation (succimer orally); BLL >70 or encephalopathy: IV dimercaprol + EDTA |
| RSV | Bronchiolitis in infants; supportive care; palivizumab prophylaxis for high-risk infants (premature, CHD) |
10. PSYCHIATRY (4-6%)
| Topic | High-Yield Facts |
|---|---|
| Major depressive disorder | ≥5 symptoms for ≥2 weeks; first-line: SSRI; add psychotherapy; ECT for severe/refractory |
| Bipolar disorder | Manic episode ≥1 week; mood stabilizers: lithium (best long-term), valproate, lamotrigine (bipolar II/depression); avoid antidepressants alone |
| Schizophrenia | Positive (hallucinations, delusions, disorganized speech) + negative symptoms; atypical antipsychotics first-line; clozapine for refractory (monitor ANC) |
| Anxiety disorders | GAD: buspirone or SSRI; panic disorder: SSRI + CBT; social phobia: SSRI; PTSD: SSRIs (sertraline, paroxetine FDA-approved) |
| Substance use - alcohol | Withdrawal: CIWA score; benzodiazepines (lorazepam) for seizure prevention; Wernicke's → IV thiamine BEFORE glucose |
| Opioid use disorder | MAT: buprenorphine/naloxone (Suboxone) or methadone; naltrexone for maintaining abstinence; overdose: naloxone |
| ADHD | Stimulants first-line (methylphenidate, amphetamines); atomoxetine for ADHD + anxiety or substance abuse |
| Eating disorders | Anorexia: lowest mortality of eating disorders - FALSE (highest!); Bulimia: Russell's sign, parotid hypertrophy; fluoxetine for bulimia |
| Suicide risk | Specific plan + means + intent = HIGH risk; psychiatric hold (5150); document thoroughly |
| Medical-legal | Informed consent requires capacity (not competence - legal term); involuntary commitment: danger to self/others; confidentiality exceptions: Tarasoff, abuse, public health |
11. INFECTIOUS DISEASE
| Topic | High-Yield Facts |
|---|---|
| HIV management | Start ART regardless of CD4; preferred regimen: 2 NRTIs + integrase inhibitor; prophylaxis: PCP (TMP-SMX) if CD4 <200, MAC (azithromycin) if CD4 <50 |
| HIV complications by CD4 | >500: none; 200-500: thrush, shingles; 100-200: PCP, toxoplasmosis; 50-100: cryptococcal meningitis; <50: CMV, MAC |
| Sepsis management | Hour-1 bundle: blood cultures x2, lactate, IV fluids (30 mL/kg), start antibiotics, vasopressors (norepinephrine) if needed |
| C. difficile | Pseudomembranous colitis; after antibiotics; white WBC >15K; treat with oral vancomycin or fidaxomicin (NOT metronidazole first-line anymore) |
| UTI management | Uncomplicated: nitrofurantoin or TMP-SMX or fosfomycin; pyelonephritis: fluoroquinolone or 3rd-gen cephalosporin; catheter-associated: remove catheter first |
| STI treatment | Chlamydia: azithromycin 1g or doxycycline 7 days; Gonorrhea: ceftriaxone 500mg IM; Syphilis: penicillin G; Herpes: acyclovir |
| TB | Latent: INH x9 months or INH+rifapentine x3 months; active: RIPE x2 months → IR x4 months; MDR-TB: longer regimens |
| Lyme disease | Early localized: doxycycline; disseminated (Lyme carditis, neuro): IV ceftriaxone; diagnose with 2-tier serology |
12. BIOSTATISTICS & EVIDENCE-BASED MEDICINE (High-Yield Day 1!)
| Concept | Formula / Key Fact |
|---|---|
| Sensitivity | TP / (TP + FN) - good for RULING OUT (SnNOut) - use for screening |
| Specificity | TN / (TN + FP) - good for RULING IN (SpPIn) - use for confirmation |
| PPV | TP / (TP + FP) - affected by disease prevalence |
| NPV | TN / (TN + FN) - affected by disease prevalence |
| Likelihood ratio + | Sensitivity / (1 - Specificity) - >10 strong positive test |
| Number needed to treat | 1 / Absolute Risk Reduction |
| Number needed to harm | 1 / Attributable Risk |
| Relative risk | Risk in exposed / Risk in unexposed (used in cohort studies) |
| Odds ratio | Used in case-control studies; approximates RR when disease is rare |
| Absolute risk reduction | Risk(control) - Risk(treatment) |
| Confidence interval | Does NOT cross 1.0 → statistically significant (for RR/OR) |
| Type I error (α) | Rejecting a true null hypothesis (false positive); p-value = probability of type I error |
| Type II error (β) | Failing to reject a false null hypothesis (false negative); 1-β = power |
| Bias types | Selection, recall, lead-time, length-time, confounding; randomization eliminates confounding |
13. ETHICS & PROFESSIONALISM (High-Yield!)
| Scenario | Correct Action |
|---|---|
| Patient lacks decision-making capacity | Use surrogate (healthcare proxy → spouse → adult children → parents → siblings) |
| Advance directive exists | Follow patient's documented wishes even over family objection |
| Minor seeking contraception/STI/psych/substance tx | Confidential in most states - do NOT require parental consent |
| Patient wants to leave AMA | Assess capacity; if has capacity, allow; document; do NOT withhold care |
| Colleague impaired/incompetent | Report to appropriate authority (chief/department head); do NOT confront alone |
| Genetic test results - family member at risk | Maintain patient confidentiality; counsel patient to inform relatives |
| Breaking confidentiality - Tarasoff | Identifiable, serious, imminent threat → warn AND protect potential victim |
| Informed consent elements | Diagnosis, proposed treatment, risks/benefits, alternatives, right to refuse |
| Do Not Resuscitate (DNR) | Does NOT mean "do not treat" - full care continues unless otherwise specified |
| Patient safety / medical error | Disclose to patient, report through appropriate channels; apology does not imply liability |
14. PREVENTIVE MEDICINE & SCREENING
| Screening Test | Recommendation |
|---|---|
| Breast cancer | Mammography: USPSTF 40-74 q2 yrs; ACS 40+ annually |
| Cervical cancer | Pap smear starting age 21; q3 yrs (21-29); q5 yrs with co-test (30-65) |
| Colorectal cancer | Colonoscopy starting age 45, q10 yrs; annual FIT as alternative |
| Lung cancer | Low-dose CT: age 50-80, ≥20 pack-year, current/quit <15 yrs |
| AAA | One-time US for men 65-75 who ever smoked |
| Osteoporosis | DEXA scan: all women ≥65; younger postmenopausal with risk factors |
| Hypertension | Screen adults ≥18; confirm with 2 readings; home/ambulatory BP monitoring |
| Diabetes (T2DM) | Screen overweight/obese adults ≥35 (or younger with risk factors) q3 yrs |
| Lipid screening | Adults 35+ (men) / 45+ (women); younger if risk factors; statin threshold: 10-yr ASCVD ≥10% |
| Depression | Screen all adults (PHQ-2 then PHQ-9) |
| HIV | Screen all adults 15-65 at least once; higher risk: annually |
| Hepatitis C | All adults 18-79 once; plus all pregnant women |
| STIs | Chlamydia/gonorrhea: sexually active women <25 annually |
15. CCS CASE SIMULATION - KEY STRATEGY
| Step | What to Do |
|---|---|
| Initial orders | Vital signs, IV access, oxygen if needed, ECG for chest pain/dyspnea |
| History + physical | Do early - sets up diagnosis |
| Labs | Order relevant panels (CBC, BMP, troponin, UA, etc.) |
| Imaging | CXR, CT, US based on presentation |
| Advance the clock | Move time forward to get results; re-examine patient after each interval |
| Management | Treat the most urgent condition; don't delay definitive treatment |
| Consults | Call specialists (cardiology, surgery, GI) at appropriate time |
| Disposition | ICU for unstable; floor for moderate; discharge with follow-up for stable |
| Common pitfalls | Forgetting to advance time; not getting cultures before antibiotics; missing pregnancy test in reproductive-age women |
| Universal early steps | Oxygen, IV fluids, ECG, CXR, 2 large-bore IVs for any unstable patient |
QUICK PHARMACOLOGY PEARLS
| Drug | Must-Know Fact |
|---|---|
| Metformin | Hold if eGFR <30; hold before contrast dye; risk of lactic acidosis |
| ACE inhibitors | Contraindicated in pregnancy (teratogenic); bilateral renal artery stenosis; cause dry cough |
| Warfarin | Interactions with vitamin K foods, many drugs; reverse with FFP + Vit K; follow INR |
| Lithium | Narrow therapeutic window; check TSH, creatinine, levels; toxicity: tremor, ataxia, confusion; NSAIDs increase levels |
| Aminoglycosides | Nephrotoxic + ototoxic; peak and trough levels; avoid in pregnancy |
| Fluoroquinolones | Tendinopathy/tendon rupture; prolonged QT; avoid in children/pregnancy |
| SSRIs | First-line for depression, anxiety, PTSD, OCD; serotonin syndrome: hyperthermia, clonus, diarrhea; treat with cyproheptadine |
| Clozapine | Agranulocytosis - monitor ANC weekly; also causes metabolic syndrome, seizures, myocarditis |
| Heparin | Unfractionated: PTT monitoring; LMWH: no monitoring needed, renally cleared; HIT: stop all heparin immediately |
| Steroids (systemic) | Complications: hyperglycemia, HTN, osteoporosis, adrenal suppression, cataracts, avascular necrosis, immunosuppression |
Top 3 overall priorities for Step 3: Internal medicine management decisions, biostatistics/epidemiology, and medical ethics/professionalism - these appear heavily across both exam days and in CCS cases.
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