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. DD of acute scrotal pain
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Subphrenic abscess or other abdominal abscesses; order US or CT

2. aspiration of breast cyst is bloody
Mammogram
Less than 5mm
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
15-40%; self limiting;doesn't require tx

3. several knee pain after being tackled in football game
Headache - ataxia - bulbar dysfunction
Progressive fibrosis of palmar fascia. etiololgy not known;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

4. cat/dog bites
Amoxicillin-clavulanate
Seminomas
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

5. pregnant patient with asymptomatic gall stones
Urethral stricture; pelvic of urethral trauma
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
Nonunion and avascular necrosis; fx can block blood supply;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole

6. 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;
Brardycardia - HTN - resp depression
Abd pain and tenderness; bloody diarrhoea or hematochezia
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

7. What are the common injuries from lightning?
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Increased size during the day and valsalva means it is communicated with peritoneal cavity

8. most frequent complication of TURP
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
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Meniscus injury; medial most common; pain/swelling; popping sensation
Retrograde ejaculation

9. popping sensation; rapid onset of knee effusion. athelet
ACL injury
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Cystic scrotal fluid collection between parietal and visceral layers of testis

10. common complication of inadequate mx of scaphoid fx
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Nonunion and avascular necrosis; fx can block blood supply;
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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

11. What is prehn sign?
If patient ambulatory - surgery and pain control; if not nonop mx
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
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
Headache - ataxia - bulbar dysfunction

12. How to evaluate painless testicular swelling suspicious for cancer
Saline and silicone
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

13. How to dx ACL tear?
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
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
Elderly and critically ill patients
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

14. What is hydrocele?
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
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Cystic scrotal fluid collection between parietal and visceral layers of testis
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

15. How varicocele causes testicular atrophy
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;
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Headache - ataxia - bulbar dysfunction
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

16. acalculus cholecystitis
Elderly and critically ill patients
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;
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
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

17. surgery for acute cholecystities
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Next best step surgery; not ultrasound
24-48 hours of supportive therapy followed by cholecystectomy
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

18. What is the complications of undescended testis
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
If any compressive symptoms eg. dysphagia
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;
Even after ochiopexy risk of ochiopexy higher then general population

19. what size of ureteral stone for non op mx
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Less than 5mm
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

20. beta hcg and AFP
Pure motor stroke; limited neurological dysfunction
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Elevated non seminomas

21. Tx of pulmonary contusion
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
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
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
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

22. lacerated wound in palmer surface of hand. what structure is injured?
Malignancy until proven otherwise
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Tendons more likely
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

23. when patient with severe lung disease have C02 retention
If any compressive symptoms eg. dysphagia
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Mammogram
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

24. What types of breast implants are available
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Saline and silicone
Dumping syndrome; small and frequent meals; no simple sugar
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

25. Why right varicocele is more concerning?

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

26. 3 mo with groin bulge; bulge appears when child cries
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Increased size during the day and valsalva means it is communicated with peritoneal cavity

27. What is the strongest risk factor for male breast cancer
Malignancy until proven otherwise
Amoxicillin-clavulanate
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Klinefelter syndrome; 50 fold increase;

28. When patient can go back to sports after clavicle fx
Urethral stricture; pelvic of urethral trauma
4-6 weeks for noncontact sports and longer time for contact sports
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

29. complications of TPN
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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

30. when scaphoid fx patient needs to be referred to orthopedic
Fx displace >1mm - nonunion during followup - osteonecrosis
Headache - ataxia - bulbar dysfunction
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Next best step surgery; not ultrasound

31. inhalation of hot air - steam - smoke in burn victim
Elevated non seminomas
When urethral catherization is unsuccessful
Supraglottic edema; low threshold for intubation
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

32. How to confirm dx of compartment syndrom
Next best step surgery; not ultrasound
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

33. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Subphrenic abscess or other abdominal abscesses; order US or CT
Saline and silicone
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Seminomas

34. tx distal rectal ca
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Abd pain and tenderness; bloody diarrhoea or hematochezia
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
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

35. How to differentiate communicative and non-communicative hydrocele
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

36. SOB - confusion - petechial rash after trauma - fracture
Dumping syndrome; small and frequent meals; no simple sugar
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
Unilateral vocal cord paralysis
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

37. first line of management of PVD
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Study showed no adverse effect; but they are contraindicated for PVD
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

38. How to confirm achiles tendon rupture
Unilateral vocal cord paralysis
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
Brardycardia - HTN - resp depression
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

39. menisci injury
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Twisting force with the foot fixed on the ground seen in football and basketball games;
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

40. recurrent laryngeal nerve injury
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Unilateral vocal cord paralysis
50%; tunneling between rectum or kin
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

41. perioral numbness after parathyroidectomy
Compression stocking - weight reduction - leg elevation
Increased size during the day and valsalva means it is communicated with peritoneal cavity
15-40%; self limiting;doesn't require tx
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

42. Valgus and Varus tests
Elevated non seminomas
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Headache - ataxia - bulbar dysfunction

43. diarrhoea after gastric bypass
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Dumping syndrome; small and frequent meals; no simple sugar
Klinefelter syndrome; 50 fold increase;
Less than 5mm

44. 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.
L5 to S2
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Cystic scrotal fluid collection between parietal and visceral layers of testis

45. What is hungry bone syndrome?
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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
Malignancy until proven otherwise
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

46. Indication for bariatric surgery in obese patients
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
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;
Patellar tendon tear; difficulty in extension
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

47. What time frame required for bone remodeling
Displaced ORIF ; nondisplaced sling immobilization
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
10-12 months
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

48. characteristics of ureteral stone?
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Brardycardia - HTN - resp depression
4-6 weeks for noncontact sports and longer time for contact sports

49. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Check ET tube placement if correct needle decompresion
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Retrograde ejaculation

50. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Urethral stricture; pelvic of urethral trauma
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
ACL injury
Ispilateral hypoglossal nerve injury