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. How to confirm dx of compartment syndrom
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Malignancy until proven otherwise
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

2. How to confirm achiles tendon rupture
24-48 hours of supportive therapy followed by cholecystectomy
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
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
MAT; medial meniscus injury; ACL and Tibial colateral ligament

3. popping sensation; rapid onset of knee effusion. athelet
ACL injury
Retrograde ejaculation
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
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;

4. 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
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
50%; tunneling between rectum or kin
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

5. suprapubic catheterization
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
When urethral catherization is unsuccessful
Dumping syndrome; small and frequent meals; no simple sugar
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

6. acalculus cholecystitis
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Elderly and critically ill patients

7. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Brardycardia - HTN - resp depression
Klinefelter syndrome; 50 fold increase;

8. When to stop raloxifene before surgery
Brardycardia - HTN - resp depression
Cystic scrotal fluid collection between parietal and visceral layers of testis
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

9. Most common of sudden death due to steering wheel injury
Amoxicillin-clavulanate
Subphrenic abscess or other abdominal abscesses; order US or CT
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
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

10. most frequent complication of TURP
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
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Retrograde ejaculation
Unilateral vocal cord paralysis

11. Dupuytren contracture
Progressive fibrosis of palmar fascia. etiololgy not known;
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
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

12. ct scan; cystic lesion in head of pancreas; next step
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Amoxicillin-clavulanate
Ispilateral hypoglossal nerve injury
Abd pain and tenderness; bloody diarrhoea or hematochezia

13. when scaphoid fx patient needs to be referred to orthopedic
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Fx displace >1mm - nonunion during followup - osteonecrosis
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Elevated non seminomas

14. menisci injury
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Progressive fibrosis of palmar fascia. etiololgy not known;
Twisting force with the foot fixed on the ground seen in football and basketball games;

15. diarrhoea 4-5 days after cholecystectomy
Progressive fibrosis of palmar fascia. etiololgy not known;
Elderly and critically ill patients
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

16. how hyperventilation lowers ICP
15-40%; self limiting;doesn't require tx
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
S2-S4

17. When to do surgery in undesceneded testis?
Elevated non seminomas
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Saline and silicone

18. recurrent laryngeal nerve injury
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
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
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Unilateral vocal cord paralysis

19. dumping syndrome after gastrectomy
Mammogram
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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

20. aspiration of breast cyst is nonbloody
Check ET tube placement if correct needle decompresion
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

21. severe pain in leg after MVC
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
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
Klinefelter syndrome; 50 fold increase;
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

22. cat/dog bites
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
4-6 weeks for noncontact sports and longer time for contact sports
Amoxicillin-clavulanate
Even after ochiopexy risk of ochiopexy higher then general population

23. perioral numbness after parathyroidectomy
10-12 months
Sphincter sparing surgery (local resection) - abdomnio perineal resection
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
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

24. What is terrible triad
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
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
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare

25. What is most common lung injury after blunt chest trauma?
Amoxicillin-clavulanate
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
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
Progressive fibrosis of palmar fascia. etiololgy not known;

26. 27 yo with scrotal mass; warm tender testes feel like bag of worms
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Progressive fibrosis of palmar fascia. etiololgy not known;
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

27. clavicle fx
Meniscus injury; medial most common; pain/swelling; popping sensation
Low anterior resection and radio; add chemo if node positive
Displaced ORIF ; nondisplaced sling immobilization
Check ET tube placement if correct needle decompresion

28. 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
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;
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
If any compressive symptoms eg. dysphagia

29. swelling and tenderness in anterior part of knee
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Sphincter sparing surgery (local resection) - abdomnio perineal resection
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Patellar tendon tear; difficulty in extension

30. Why initial xrays are negative in scaphoid fx
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
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
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

31. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
Meniscus injury; medial most common; pain/swelling; popping sensation
Less than 5mm
Progressive fibrosis of palmar fascia. etiololgy not known;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

32. beta hcg and AFP
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Elevated non seminomas

33. cremasteric reflex
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
Even after ochiopexy risk of ochiopexy higher then general population
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

34. how ABI help dx of PVD
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Urethral stricture; pelvic of urethral trauma
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

35. What types of breast implants are available
15-40%; self limiting;doesn't require tx
Saline and silicone
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Seminomas

36. surgery for acute cholecystities
24-48 hours of supportive therapy followed by cholecystectomy
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
When urethral catherization is unsuccessful
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

37. What percent of anal abscess deveolop fisutula
Patellar tendon tear; difficulty in extension
50%; tunneling between rectum or kin
Seminomas
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

38. stress fx
4-6 weeks for noncontact sports and longer time for contact sports
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

39. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Elevated non seminomas
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

40. Tx of proximal non metastatic rectal ca
Patellar tendon tear; difficulty in extension
Low anterior resection and radio; add chemo if node positive
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;
Amoxicillin-clavulanate

41. 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;
Saline and silicone
Less than 5mm
Tendons more likely

42. Valgus and Varus tests
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
ACL injury
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
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

43. Why varicocele more common in the left side
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Retrograde ejaculation
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Compression stocking - weight reduction - leg elevation

44. diarrhoea after gastric bypass
Epi and chest compressio for prolong period of time; atropine is given after epi;
Dumping syndrome; small and frequent meals; no simple sugar
Subphrenic abscess or other abdominal abscesses; order US or CT
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

45. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
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
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

46. first line of management of PVD
S2-S4
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Twisting force with the foot fixed on the ground seen in football and basketball games;
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

47. How to manage obesity
50%; tunneling between rectum or kin
Patellar tendon tear; difficulty in extension
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

48. 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
24-48 hours of supportive therapy followed by cholecystectomy
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Carpal tunnel syndrom

49. most common complication of acute cholecystitis
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Epi and chest compressio for prolong period of time; atropine is given after epi;
S2-S4

50. When goiter needs surgery
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Patellar tendon tear; difficulty in extension
If any compressive symptoms eg. dysphagia
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

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