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 manage obesity
24-48 hours of supportive therapy followed by cholecystectomy
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
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

2. How to confirm dx of compartment syndrom
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Low anterior resection and radio; add chemo if node positive
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

3. How to manage a patient with asystole
Elevated non seminomas
Epi and chest compressio for prolong period of time; atropine is given after epi;
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare

4. lacerated wound in palmer surface of hand. what structure is injured?
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Meniscus injury; medial most common; pain/swelling; popping sensation
Study showed no adverse effect; but they are contraindicated for PVD
Tendons more likely

5. What is most common lung injury after blunt chest trauma?
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

6. ct scan; cystic lesion in head of pancreas; next step
Check ET tube placement if correct needle decompresion
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Malignancy until proven otherwise

7. painless testicular mass in young male
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Elderly and critically ill patients
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Malignancy until proven otherwise

8. characteristics of ureteral stone?
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
ACL injury
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis

9. Dupuytren contracture
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Progressive fibrosis of palmar fascia. etiololgy not known;

10. How varicocele causes testicular atrophy
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Check ET tube placement if correct needle decompresion
If patient ambulatory - surgery and pain control; if not nonop mx
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

11. Tx of pulmonary contusion
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Progressive fibrosis of palmar fascia. etiololgy not known;

12. What time frame required for bone remodeling
Less than 5mm
15-40%; self limiting;doesn't require tx
10-12 months
Pure motor stroke; limited neurological dysfunction

13. popping sensation; rapid onset of knee effusion. athelet
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
ACL injury
Increased size during the day and valsalva means it is communicated with peritoneal cavity
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

14. Why right varicocele is more concerning?

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

15. Tx of proximal non metastatic rectal ca
Low anterior resection and radio; add chemo if node positive
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

16. What is hungry bone syndrome?
50%; tunneling between rectum or kin
Nonunion and avascular necrosis; fx can block blood supply;
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
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

17. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
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
Dm neuropathy; stocking glove pattern
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
Subphrenic abscess or other abdominal abscesses; order US or CT

18. most common complication of acute cholecystitis
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;

19. Patient underwent CABG; postoperatively drowsy. most likely cause?
L5 to S2
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
Pure motor stroke; limited neurological dysfunction
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

20. Why ruq calcificaion is concerning
10-12 months
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Low anterior resection and radio; add chemo if node positive
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy

21. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
Twisting force with the foot fixed on the ground seen in football and basketball games;
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
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
Meniscus injury; medial most common; pain/swelling; popping sensation

22. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
SAH due to post communicating artery aneurysm;
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

23. How mcmurray manuver perform
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

24. What is terrible triad
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Nonunion and avascular necrosis; fx can block blood supply;
Klinefelter syndrome; 50 fold increase;
Unilateral vocal cord paralysis

25. recurrent laryngeal nerve injury
Tendons more likely
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Unilateral vocal cord paralysis

26. first line of management of PVD
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;

27. management of stone 8-10mm
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
Nonunion and avascular necrosis; fx can block blood supply;
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

28. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Meniscus injury; medial most common; pain/swelling; popping sensation
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

29. dorsiflexion and planter flexion
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
15-40%; self limiting;doesn't require tx
L5 to S2
Pure motor stroke; limited neurological dysfunction

30. What is prehn sign?
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Even after ochiopexy risk of ochiopexy higher then general population
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
S2-S4

31. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
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
Displaced ORIF ; nondisplaced sling immobilization
Dm neuropathy; stocking glove pattern

32. how hyperventilation lowers ICP
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Abd pain and tenderness; bloody diarrhoea or hematochezia

33. when scaphoid fx patient needs to be referred to orthopedic
Fx displace >1mm - nonunion during followup - osteonecrosis
Tendons more likely
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

34. complication displaced or communited distal radial fx
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Carpal tunnel syndrom
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx

35. When to stop raloxifene before surgery
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
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
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

36. most frequent complication of TURP
Ispilateral hypoglossal nerve injury
15-40%; self limiting;doesn't require tx
Retrograde ejaculation
Dm neuropathy; stocking glove pattern

37. suprapubic catheterization
Meniscus injury; medial most common; pain/swelling; popping sensation
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Cystic scrotal fluid collection between parietal and visceral layers of testis
When urethral catherization is unsuccessful

38. How to differentiate ACL and meniscus injury
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

39. acute colonic ischemia
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Elderly and critically ill patients
Abd pain and tenderness; bloody diarrhoea or hematochezia
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

40. how ABI help dx of PVD
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 drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

41. most common fx when falling on outsretched hand
Compression stocking - weight reduction - leg elevation
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

42. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Urethral stricture; pelvic of urethral trauma
Pure motor stroke; limited neurological dysfunction
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

43. What are the common injuries from lightning?
Dumping syndrome; small and frequent meals; no simple sugar
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

44. How to differentiate communicative and non-communicative hydrocele
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Sphincter sparing surgery (local resection) - abdomnio perineal resection

45. types of hip fracture
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
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

46. cremasteric reflex
If patient ambulatory - surgery and pain control; if not nonop mx
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Subphrenic abscess or other abdominal abscesses; order US or CT
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction

47. Incidence of AF in CABG patient

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

48. swelling and tenderness in anterior part of knee
Patellar tendon tear; difficulty in extension
If patient ambulatory - surgery and pain control; if not nonop mx
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

49. What is hydrocele?
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Cystic scrotal fluid collection between parietal and visceral layers of testis

50. sudden onset of postoperative hyperglycemia when patient on TPN
Carpal tunnel syndrom
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
10-12 months
Malignancy until proven otherwise