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. clavicle fx
Displaced ORIF ; nondisplaced sling immobilization
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Headache - ataxia - bulbar dysfunction
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

2. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Malignancy until proven otherwise
Subphrenic abscess or other abdominal abscesses; order US or CT

3. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
24-48 hours of supportive therapy followed by cholecystectomy
Increased size during the day and valsalva means it is communicated with peritoneal cavity
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
SAH due to post communicating artery aneurysm;

4. Can we use beta blocker for pvd?
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
CRPS
Study showed no adverse effect; but they are contraindicated for PVD
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx

5. complication displaced or communited distal radial 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
Carpal tunnel syndrom
Strok and traumatic brain injury
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

6. diarrhoea 4-5 days after cholecystectomy
Amoxicillin-clavulanate
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
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
L5 to S2

7. How to perform lachman test
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Even after ochiopexy risk of ochiopexy higher then general population
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

8. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Strok and traumatic brain injury
Even after ochiopexy risk of ochiopexy higher then general population
Supraglottic edema; low threshold for intubation

9. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Malignancy until proven otherwise
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

10. How varicocele causes testicular atrophy
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

11. Most common of sudden death due to steering wheel injury
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
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
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

12. xray finding of stress fx after 3-4w
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

13. aspiration of breast cyst is bloody
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
24-48 hours of supportive therapy followed by cholecystectomy
Mammogram
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

14. What percent of anal abscess deveolop fisutula
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
50%; tunneling between rectum or kin
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

15. Tx of proximal non metastatic rectal ca
Twisting force with the foot fixed on the ground seen in football and basketball games;
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Low anterior resection and radio; add chemo if node positive
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

16. cremasteric reflex
Ispilateral hypoglossal nerve injury
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
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Urethral stricture; pelvic of urethral trauma

17. what size of ureteral stone for non op mx
Twisting force with the foot fixed on the ground seen in football and basketball games;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Malignancy until proven otherwise
Less than 5mm

18. painless testicular mass in young male
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
L5 to S2
Malignancy until proven otherwise
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

19. complications of TPN
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

20. several knee pain after being tackled in football game
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
When urethral catherization is unsuccessful
Pure motor stroke; limited neurological dysfunction
Amoxicillin-clavulanate

21. mx of stress fx
4-6 weeks for noncontact sports and longer time for contact sports
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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
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

22. how ABI help dx of PVD
4-6 weeks for noncontact sports and longer time for contact sports
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
S2-S4

23. severe pain in leg after MVC
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;
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
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
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

24. surgery for acute cholecystities
Dumping syndrome; small and frequent meals; no simple sugar
Elevated non seminomas
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
24-48 hours of supportive therapy followed by cholecystectomy

25. mangement of localized lymphadenopathy
50%; tunneling between rectum or kin
Amoxicillin-clavulanate
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Meniscus injury; medial most common; pain/swelling; popping sensation

26. Dupuytren contracture
Progressive fibrosis of palmar fascia. etiololgy not known;
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
Displaced ORIF ; nondisplaced sling immobilization
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;

27. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
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
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Abd pain and tenderness; bloody diarrhoea or hematochezia

28. What is prehn sign?
Malignancy until proven otherwise
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
10-12 months
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;

29. How to differentiate ACL and meniscus injury
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
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
Elevated non seminomas
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

30. What is hydrocele?
Nonunion and avascular necrosis; fx can block blood supply;
Cystic scrotal fluid collection between parietal and visceral layers of testis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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

31. managment of animal bite in hands
4-6 weeks for noncontact sports and longer time for contact sports
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
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

32. cat/dog bites
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Amoxicillin-clavulanate
50%; tunneling between rectum or kin
Supraglottic edema; low threshold for intubation

33. 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
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
Saline and silicone
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

34. cremasteric reflex test?
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Sphincter sparing surgery (local resection) - abdomnio perineal resection
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration

35. Indication for bariatric surgery in obese patients
Pure motor stroke; limited neurological dysfunction
Compression stocking - weight reduction - leg elevation
Brardycardia - HTN - resp depression
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;

36. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Check ET tube placement if correct needle decompresion
Study showed no adverse effect; but they are contraindicated for PVD

37. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Study showed no adverse effect; but they are contraindicated for PVD

38. tx distal rectal ca
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy

39. beta HCG
Seminomas
Fx displace >1mm - nonunion during followup - osteonecrosis
Brardycardia - HTN - resp depression
50%; tunneling between rectum or kin

40. Patient underwent CABG; postoperatively drowsy. most likely cause?
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Unilateral vocal cord paralysis
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
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

41. most common fx when falling on outsretched hand
Even after ochiopexy risk of ochiopexy higher then general population
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
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

42. Why right varicocele is more concerning?

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

43. When do we see complications due to hypophosphatemia
CRPS
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Dm neuropathy; stocking glove pattern
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;

44. when scaphoid fx patient needs to be referred to orthopedic
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Fx displace >1mm - nonunion during followup - osteonecrosis
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

45. aspiration of breast cyst is nonbloody
Check ET tube placement if correct needle decompresion
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Abd pain and tenderness; bloody diarrhoea or hematochezia
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

46. midline neck swelling moves with protrusion of tongue
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Compression stocking - weight reduction - leg elevation
Tendons more likely
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

47. most common complication of acute cholecystitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Unilateral vocal cord paralysis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

48. dumping syndrome after gastrectomy
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Subphrenic abscess or other abdominal abscesses; order US or CT
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
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

49. What is the strongest risk factor for male breast cancer
10-12 months
Klinefelter syndrome; 50 fold increase;
CRPS
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

50. DD of acute scrotal pain
Dm neuropathy; stocking glove pattern
If any compressive symptoms eg. dysphagia
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole