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Test your basic knowledge |
USMLE Step3 Surgery
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Study First
Subjects
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health-sciences
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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. What is terrible triad
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Next best step surgery; not ultrasound
50%; tunneling between rectum or kin
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
2. management of nondisplaced scaphoid fx
Supraglottic edema; low threshold for intubation
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Fx displace >1mm - nonunion during followup - osteonecrosis
3. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Fx displace >1mm - nonunion during followup - osteonecrosis
Carpal tunnel syndrom
4. management of hip fracture
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
4-6 weeks for noncontact sports and longer time for contact sports
If patient ambulatory - surgery and pain control; if not nonop mx
5. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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
Cystic scrotal fluid collection between parietal and visceral layers of testis
Low anterior resection and radio; add chemo if node positive
6. anal sphincter tone
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
S2-S4
7. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Retrograde ejaculation
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Urethral stricture; pelvic of urethral trauma
8. when patient with severe lung disease have C02 retention
L5 to S2
Klinefelter syndrome; 50 fold increase;
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
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
9. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
10. clavicle fx
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
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
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
Displaced ORIF ; nondisplaced sling immobilization
11. Tx of pulmonary contusion
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Abd pain and tenderness; bloody diarrhoea or hematochezia
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
12. mangement of localized lymphadenopathy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Headache - ataxia - bulbar dysfunction
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
13. Tx of proximal non metastatic rectal ca
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Retrograde ejaculation
4-6 weeks for noncontact sports and longer time for contact sports
Low anterior resection and radio; add chemo if node positive
14. How to differentiate communicative and non-communicative hydrocele
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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
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
15. menisci injury
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Twisting force with the foot fixed on the ground seen in football and basketball games;
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
16. midline neck swelling moves with protrusion of tongue
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
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
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
17. complications of TPN
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
L5 to S2
Dm neuropathy; stocking glove pattern
18. Complications of breast impant
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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;
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
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
19. sudden onset of postoperative hyperglycemia when patient on TPN
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
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
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
20. first line of management of PVD
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Ispilateral hypoglossal nerve injury
Tendons more likely
When urethral catherization is unsuccessful
21. What is hungry bone syndrome?
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
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
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
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
22. surgery for acute cholecystities
Carpal tunnel syndrom
24-48 hours of supportive therapy followed by cholecystectomy
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Elderly and critically ill patients
23. Patient underwent CABG; postoperatively drowsy. most likely cause?
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
Progressive fibrosis of palmar fascia. etiololgy not known;
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Brardycardia - HTN - resp depression
24. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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
Retrograde ejaculation
Check ET tube placement if correct needle decompresion
25. 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
Displaced ORIF ; nondisplaced sling immobilization
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Even after ochiopexy risk of ochiopexy higher then general population
26. How to evaluate painless testicular swelling suspicious for cancer
Subphrenic abscess or other abdominal abscesses; order US or CT
Next best step surgery; not ultrasound
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
27. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
Less than 5mm
SAH due to post communicating artery aneurysm;
MAT; medial meniscus injury; ACL and Tibial colateral ligament
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
28. What is most common lung injury after blunt chest trauma?
S2-S4
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;
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
Retrograde ejaculation
29. How to confirm achiles tendon rupture
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
SAH due to post communicating artery aneurysm;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
30. How mcmurray manuver perform
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Next best step surgery; not ultrasound
31. dorsiflexion and planter flexion
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
L5 to S2
Displaced ORIF ; nondisplaced sling immobilization
S2-S4
32. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
33. What are the common injuries from lightning?
L5 to S2
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
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
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
34. painless testicular mass in young male
Compression stocking - weight reduction - leg elevation
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Malignancy until proven otherwise
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
35. recurrent laryngeal nerve injury
Unilateral vocal cord paralysis
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
36. Why ruq calcificaion is concerning
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Pure motor stroke; limited neurological dysfunction
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
37. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Pure motor stroke; limited neurological dysfunction
Saline and silicone
Progressive fibrosis of palmar fascia. etiololgy not known;
38. contraindication of urethral catheterization
Urethral stricture; pelvic of urethral trauma
Twisting force with the foot fixed on the ground seen in football and basketball games;
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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
39. first step for evaluation of testicular swelling
SAH due to post communicating artery aneurysm;
Amoxicillin-clavulanate
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
40. What is prehn sign?
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Mammogram
41. most frequent complication of TURP
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
If patient ambulatory - surgery and pain control; if not nonop mx
Retrograde ejaculation
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
42. acalculus cholecystitis
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Elderly and critically ill patients
Fx displace >1mm - nonunion during followup - osteonecrosis
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
43. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Compression stocking - weight reduction - leg elevation
Retrograde ejaculation
Nonunion and avascular necrosis; fx can block blood supply;
44. types of hip fracture
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Epi and chest compressio for prolong period of time; atropine is given after epi;
Seminomas
Unilateral vocal cord paralysis
45. What types of breast implants are available
Epi and chest compressio for prolong period of time; atropine is given after epi;
Study showed no adverse effect; but they are contraindicated for PVD
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Saline and silicone
46. cremasteric reflex test?
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
When urethral catherization is unsuccessful
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
47. how hyperventilation lowers ICP
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
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
Meniscus injury; medial most common; pain/swelling; popping sensation
48. characteristics of ureteral stone?
Nonunion and avascular necrosis; fx can block blood supply;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
15-40%; self limiting;doesn't require tx
49. cremasteric reflex
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Mammogram
Carpal tunnel syndrom
50. several knee pain after being tackled in football game
Seminomas
CRPS
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)