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USMLE Step3 Surgery
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
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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. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dumping syndrome; small and frequent meals; no simple sugar
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Dm neuropathy; stocking glove pattern
Klinefelter syndrome; 50 fold increase;
2. 3 mo with groin bulge; bulge appears when child cries
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
CRPS
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Low anterior resection and radio; add chemo if node positive
3. sudden onset of postoperative hyperglycemia when patient on TPN
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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
4. most frequent complication of TURP
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Retrograde ejaculation
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
5. acute colonic ischemia
Abd pain and tenderness; bloody diarrhoea or hematochezia
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
6. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Subphrenic abscess or other abdominal abscesses; order US or CT
CRPS
7. SAH due to posterior inferior cerebellar aneurysm
Headache - ataxia - bulbar dysfunction
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;
Tendons more likely
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
8. What is prehn sign?
Less than 5mm
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
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
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
9. management of gunshot wound
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Klinefelter syndrome; 50 fold increase;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
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
10. clavicle fx
Mammogram
Fx displace >1mm - nonunion during followup - osteonecrosis
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
Displaced ORIF ; nondisplaced sling immobilization
11. pregnant patient with asymptomatic gall stones
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
12. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
Urethral stricture; pelvic of urethral trauma
Epi and chest compressio for prolong period of time; atropine is given after epi;
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
13. first step for evaluation of testicular swelling
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
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Low anterior resection and radio; add chemo if node positive
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
14. what size of ureteral stone for non op mx
Less than 5mm
Mammogram
Klinefelter syndrome; 50 fold increase;
Elevated non seminomas
15. anal sphincter tone
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
S2-S4
Dumping syndrome; small and frequent meals; no simple sugar
16. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Abd pain and tenderness; bloody diarrhoea or hematochezia
17. how hyperventilation lowers ICP
Right varicocele drains to inferior vena cava; unless patient has obstrction of inf vena cava by intra abdominal mass or big clot from DVT - varicocele doesn't occur; do ct scan to eval caUse of rt varicocele
Compression stocking - weight reduction - leg elevation
Displaced ORIF ; nondisplaced sling immobilization
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
18. most common fx when falling on outsretched hand
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
19. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
ACL injury
Meniscus injury; medial most common; pain/swelling; popping sensation
Study showed no adverse effect; but they are contraindicated for PVD
Brardycardia - HTN - resp depression
20. What are the common injuries from lightning?
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Unilateral vocal cord paralysis
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
21. cat/dog bites
Amoxicillin-clavulanate
4-6 weeks for noncontact sports and longer time for contact sports
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;
22. types of hip fracture
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Pure motor stroke; limited neurological dysfunction
23. aspiration of breast cyst is bloody
Mammogram
Progressive fibrosis of palmar fascia. etiololgy not known;
If they are given excess glucose; glucose produces more C02 for each liter of 02 than other two nutrients; excessive C02 causes hypercapnia; weaning from ventilation will be difficult
If any compressive symptoms eg. dysphagia
24. What percent of anal abscess deveolop fisutula
Malignancy until proven otherwise
Headache - ataxia - bulbar dysfunction
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
50%; tunneling between rectum or kin
25. management of stone 8-10mm
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
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
24-48 hours of supportive therapy followed by cholecystectomy
Tendons more likely
26. contraindication of urethral catheterization
CRPS
Urethral stricture; pelvic of urethral trauma
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
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
27. menisci injury
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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
Twisting force with the foot fixed on the ground seen in football and basketball games;
Dumping syndrome; small and frequent meals; no simple sugar
28. how ABI help dx of PVD
Ispilateral hypoglossal nerve injury
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
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
29. How to differentiate communicative and non-communicative hydrocele
Increased size during the day and valsalva means it is communicated with peritoneal cavity
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
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
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
30. aspiration of breast cyst is nonbloody
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Elderly and critically ill patients
Nonunion and avascular necrosis; fx can block blood supply;
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
31. How to manage obesity
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
Nonunion and avascular necrosis; fx can block blood supply;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Pulmonary contusion; p/w dyspenoea - tachypnoea - hypoxemia - hemoptysis; decreased breath sound in the affected site; cxr homogenous opacification; mild cases resolve in 3-5 days
32. When to stop raloxifene before surgery
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
33. varicose veins with ulcer - bleeding and thrombophlebitits
Unilateral vocal cord paralysis
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
34. common complication of inadequate mx of scaphoid fx
Nonunion and avascular necrosis; fx can block blood supply;
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
35. swelling and tenderness in anterior part of knee
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Patellar tendon tear; difficulty in extension
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
36. What is the complications of undescended testis
Even after ochiopexy risk of ochiopexy higher then general population
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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
37. managment of animal bite in hands
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;
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Supraglottic edema; low threshold for intubation
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
38. severe pain in leg after MVC
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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
Mammogram
39. varicocele
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Epi and chest compressio for prolong period of time; atropine is given after epi;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Sphincter sparing surgery (local resection) - abdomnio perineal resection
40. complications of TPN
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
10-12 months
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
41. diarrhoea 4-5 days after cholecystectomy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Strok and traumatic brain injury
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
42. acalculus cholecystitis
Elderly and critically ill patients
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
Right varicocele drains to inferior vena cava; unless patient has obstrction of inf vena cava by intra abdominal mass or big clot from DVT - varicocele doesn't occur; do ct scan to eval caUse of rt varicocele
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
43. Tx of pulmonary contusion
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
15-40%; self limiting;doesn't require tx
10-12 months
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
44. when patient with severe lung disease have C02 retention
Patellar tendon tear; difficulty in extension
Pure motor stroke; limited neurological dysfunction
Elderly and critically ill patients
If they are given excess glucose; glucose produces more C02 for each liter of 02 than other two nutrients; excessive C02 causes hypercapnia; weaning from ventilation will be difficult
45. ct scan; cystic lesion in head of pancreas; next step
Malignancy until proven otherwise
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
46. How varicocele causes testicular atrophy
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Dumping syndrome; small and frequent meals; no simple sugar
47. beta hcg and AFP
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
Elevated non seminomas
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
48. When to do surgery in undesceneded testis?
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
49. How mcmurray manuver perform
Twisting force with the foot fixed on the ground seen in football and basketball games;
Elderly and critically ill patients
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
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
50. prostate enlarged - nontender - no nodularity - elevated PSA
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Fx displace >1mm - nonunion during followup - osteonecrosis
Abd pain and tenderness; bloody diarrhoea or hematochezia
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Sorry!:) No result found.
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