Test your basic knowledge |

USMLE Step3 Surgery

Subjects : health-sciences, usmle-step-3

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. When do we see complications due to hypophosphatemia
SAH due to post communicating artery aneurysm;
Meniscus injury; medial most common; pain/swelling; popping sensation
Progressive fibrosis of palmar fascia. etiololgy not known;
When phosphate levels fall below 1.0; 30% of patient on TPN has this prob; patient develop respiratory weakness - hemolysis - impaired oxygen release from Hb;

2. xray finding of stress fx after 3-4w
Cystic scrotal fluid collection between parietal and visceral layers of testis
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Pt hemodynamically stable and no sign of peritonitis: Ct scan ;unstable with sign of peritonitis - possible organ evicsceration (blood in urine) immediate laparatomy; most patients go for laparotomy
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

3. indication of ursodeoxycholic acid
Helps to dissolve GB cholesterol stone; slowly dissolve in 3 years - symptoms relief in 3 months; for symptomatic gall stones who are poor candidate for surgery
BMI<40 for low risk patient and >35 ofr high risk with obesity related comorbidites like OSA - OA - LBP - HTN - HLD; BMI >35 have high risk of complications and need to be managed aggresssively;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

4. menisci injury
Ispilateral hypoglossal nerve injury
50%; tunneling between rectum or kin
Twisting force with the foot fixed on the ground seen in football and basketball games;
If patient ambulatory - surgery and pain control; if not nonop mx

5. most common fx when falling on outsretched hand
10-12 months
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
It can take up to 2 weeks to show fx; if high clinical suspicion MRI is ideal test when xray neg - which differentiate ligament injury vs bone fx

6. transrectal prostate biopsy
Amoxicillin-clavulanate
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Fx displace >1mm - nonunion during followup - osteonecrosis

7. Tx of proximal non metastatic rectal ca
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Mammogram
Low anterior resection and radio; add chemo if node positive
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

8. how ABI help dx of PVD
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Saline and silicone
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

9. conservative Tx of varicose veins
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Compression stocking - weight reduction - leg elevation
Dm neuropathy; stocking glove pattern
Brardycardia - HTN - resp depression

10. Tx of pulmonary contusion
15-40%; self limiting;doesn't require tx
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

11. diarrhoea 4-5 days after cholecystectomy
Unilateral vocal cord paralysis
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
When urethral catherization is unsuccessful
Strok and traumatic brain injury

12. How to differentiate ACL and meniscus injury
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Supraglottic edema; low threshold for intubation
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Meniscus; tenderness medial side of knee - it takes 24hours to form effusion; effusion not bloody; ACL: rapid effusion - most serious form of knee injury; profound pain - inability to ambulate ; popping sensation in both cases

13. beta hcg and AFP
Elevated non seminomas
Malignancy until proven otherwise
Abd pain and tenderness; bloody diarrhoea or hematochezia
It can take up to 2 weeks to show fx; if high clinical suspicion MRI is ideal test when xray neg - which differentiate ligament injury vs bone fx

14. How to dx ACL tear?
Ant drawer test; foot placed on exam table; both hand behind knee to push it anteriorly; a difference of 1 cm compared with the opposite side suggests complete ACL tear
Epi and chest compressio for prolong period of time; atropine is given after epi;
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Check ET tube placement if correct needle decompresion

15. diarrhoea after gastric bypass
Acute comparment syndrome; increased pain with passive movement of involved muscles; early sensory impairment-decreased vibration sense - two point discrimination - numbness and hypoesthesia; late feature-absent distant pulses
Dumping syndrome; small and frequent meals; no simple sugar
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Less than 5mm

16. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Meniscus; tenderness medial side of knee - it takes 24hours to form effusion; effusion not bloody; ACL: rapid effusion - most serious form of knee injury; profound pain - inability to ambulate ; popping sensation in both cases
Dm neuropathy; stocking glove pattern
Supraglottic edema; low threshold for intubation

17. differential of ultrasound finding of breast mass
Simple breast mass - well circumscribed disappear with aspiraiton; complex cyst; thick walled contain both solid and cystic materials; may need core biopy; solid mass-mostly fibroadenoma-f/you us and biopsy in 6m
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Meniscus; tenderness medial side of knee - it takes 24hours to form effusion; effusion not bloody; ACL: rapid effusion - most serious form of knee injury; profound pain - inability to ambulate ; popping sensation in both cases
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

18. most common complication of acute cholecystitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Helps to dissolve GB cholesterol stone; slowly dissolve in 3 years - symptoms relief in 3 months; for symptomatic gall stones who are poor candidate for surgery
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Nonunion and avascular necrosis; fx can block blood supply;

19. pregnant patient with asymptomatic gall stones
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Klinefelter syndrome; 50 fold increase;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
L5 to S2

20. scrotal trauma
Next best step surgery; not ultrasound
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Dm neuropathy; stocking glove pattern

21. managment of animal bite in hands
10-12 months
L5 to S2
Irrigated with normal saline; all deviatlized tissues need to debrided; plain xray to see if there is any FB; wound will be left open and examined for any signs of infection;
Carpal tunnel syndrom

22. What percent of anal abscess deveolop fisutula
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
CRPS
When urethral catherization is unsuccessful
50%; tunneling between rectum or kin

23. When patient can go back to sports after clavicle fx
Even after ochiopexy risk of ochiopexy higher then general population
Mammogram
4-6 weeks for noncontact sports and longer time for contact sports
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

24. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
4-6 weeks for noncontact sports and longer time for contact sports
SAH due to post communicating artery aneurysm;
Thompson test; squeeszing of calf muscle cause plantar flexion; absence confirms dx; absence of active plantar flexion not reliable since patient can use accessory muscles
Fx displace >1mm - nonunion during followup - osteonecrosis

25. dorsiflexion and planter flexion
L5 to S2
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

26. lacunar stroke
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Pure motor stroke; limited neurological dysfunction
Look at pupil; are they small; check ABG; most likely respiratory acidosis due to opioids used for postop pain control; morphine decreases central chemoreceptor sensitivity to C02; although patient has rising C02 his respiratory drive is not working

27. characteristics of ureteral stone?
Twisting force with the foot fixed on the ground seen in football and basketball games;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

28. How to evaluate painless testicular swelling suspicious for cancer
Ispilateral hypoglossal nerve injury
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

29. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
It can take up to 2 weeks to show fx; if high clinical suspicion MRI is ideal test when xray neg - which differentiate ligament injury vs bone fx
Seminomas

30. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Klinefelter syndrome; 50 fold increase;
Seminomas
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

31. stress fx
Fx displace >1mm - nonunion during followup - osteonecrosis
Meniscus; tenderness medial side of knee - it takes 24hours to form effusion; effusion not bloody; ACL: rapid effusion - most serious form of knee injury; profound pain - inability to ambulate ; popping sensation in both cases
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

32. suprapubic catheterization
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
24-48 hours of supportive therapy followed by cholecystectomy
When urethral catherization is unsuccessful
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

33. cat/dog bites
Klinefelter syndrome; 50 fold increase;
Amoxicillin-clavulanate
Ispilateral hypoglossal nerve injury
Subphrenic abscess or other abdominal abscesses; order US or CT

34. aspiration of breast cyst is bloody
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Mammogram
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
50%; tunneling between rectum or kin

35. What is hungry bone syndrome?
Twisting force with the foot fixed on the ground seen in football and basketball games;
Pt with severe hypercalcemia and hyperparathyroidism underwent parathyroid removal; then sudden withdrawn of PTH causing an influx of ca from circulation to bone; developing severe hypocalcemia; devleoped 2-3 days after surgery
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
ACL injury

36. What is the strongest risk factor for male breast cancer
Amoxicillin-clavulanate
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Klinefelter syndrome; 50 fold increase;
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

37. Indication for bariatric surgery in obese patients
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Saline and silicone
BMI<40 for low risk patient and >35 ofr high risk with obesity related comorbidites like OSA - OA - LBP - HTN - HLD; BMI >35 have high risk of complications and need to be managed aggresssively;

38. perioral numbness after parathyroidectomy
Compression stocking - weight reduction - leg elevation
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Hypocalcemia; other signs are muscle cramps - carpopedal spasm; postive chvostek sign (ipsilateral contraction of facial muscles on tapping the angle of jaw) trousseau sign (rapid carpopedal spasm on occlusion of blood supply to upper extremity
Abd pain and tenderness; bloody diarrhoea or hematochezia

39. What are the common injuries from lightning?
Simple breast mass - well circumscribed disappear with aspiraiton; complex cyst; thick walled contain both solid and cystic materials; may need core biopy; solid mass-mostly fibroadenoma-f/you us and biopsy in 6m
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Subphrenic abscess or other abdominal abscesses; order US or CT
Meniscus injury; medial most common; pain/swelling; popping sensation

40. varicose veins with ulcer - bleeding and thrombophlebitits
Hypocalcemia; other signs are muscle cramps - carpopedal spasm; postive chvostek sign (ipsilateral contraction of facial muscles on tapping the angle of jaw) trousseau sign (rapid carpopedal spasm on occlusion of blood supply to upper extremity
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Mammogram
Strok and traumatic brain injury

41. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Progressive fibrosis of palmar fascia. etiololgy not known;
Cystic scrotal fluid collection between parietal and visceral layers of testis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

42. several knee pain after being tackled in football game
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

43. recurrent laryngeal nerve injury
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Unilateral vocal cord paralysis

44. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Low anterior resection and radio; add chemo if node positive
Tendons more likely
Meniscus injury; medial most common; pain/swelling; popping sensation

45. Patient underwent CABG; postoperatively drowsy. most likely cause?
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Look at pupil; are they small; check ABG; most likely respiratory acidosis due to opioids used for postop pain control; morphine decreases central chemoreceptor sensitivity to C02; although patient has rising C02 his respiratory drive is not working
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
ACL injury

46. how hyperventilation lowers ICP
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Check ET tube placement if correct needle decompresion
Pure motor stroke; limited neurological dysfunction
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

47. severe pain in leg after MVC
Acute comparment syndrome; increased pain with passive movement of involved muscles; early sensory impairment-decreased vibration sense - two point discrimination - numbness and hypoesthesia; late feature-absent distant pulses
Sphincter sparing surgery (local resection) - abdomnio perineal resection
BMI<40 for low risk patient and >35 ofr high risk with obesity related comorbidites like OSA - OA - LBP - HTN - HLD; BMI >35 have high risk of complications and need to be managed aggresssively;
Less than 5mm

48. Why right varicocele is more concerning?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

49. first step for evaluation of testicular swelling
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Epi and chest compressio for prolong period of time; atropine is given after epi;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

50. SAH due to posterior inferior cerebellar aneurysm
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Headache - ataxia - bulbar dysfunction
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Malignancy until proven otherwise

Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?

Major Subjects
Tests & Exams AP CLEP DSST GRE SAT GMAT	Certifications CISSP go to https://www.isc2.org/ PMP ITIL RHCE MCTS More...	IT Skills Android Programming Data Modeling Objective C Programming Basic Python Programming Adobe Illustrator More...	Business Skills Advertising Techniques Business Accounting Basics Business Strategy Human Resource Management Marketing Basics More...
Soft Skills Body Language People Skills Public Speaking Persuasion Job Hunting And Resumes More...	Vocabulary GRE Vocab SAT Vocab TOEFL Essential Vocab Basic English Words For All Global Words You Should Know Business English More...	Languages AP German Vocab AP Latin Vocab SAT Subject Test: French Italian Survival Norwegian Survival More...	Engineering Audio Engineering Computer Science Engineering Aerospace Engineering Chemical Engineering Structural Engineering More...
Health Sciences Basic Nursing Skills Health Science Language Fundamentals Veterinary Technology Medical Language Cardiology Clinical Surgery More...	English Grammar Fundamentals Literary And Rhetorical Vocab Elements Of Style Vocab Introduction To English Major Complete Advanced Sentences Literature Homonyms More...	Math Algebra Formulas Basic Arithmetic: Measurements Metric Conversions Geometric Properties Important Math Facts Number Sense Vocab Business Math More...	Other Major Subjects Science Economics History Law Performing-arts Cooking Logic & Reasoning Trivia

Test your basic knowledge |

USMLE Step3 Surgery

Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?

Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests

Major Subjects

Tests & Exams

Certifications

IT Skills

Business Skills

Soft Skills

Vocabulary

Languages

Engineering

Health Sciences

English

Math

Other Major Subjects

Browse all subjects

Browse all tests

Most popular tests