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. What is most common lung injury after blunt chest trauma?
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
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Subphrenic abscess or other abdominal abscesses; order US or CT
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

2. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Urethral stricture; pelvic of urethral trauma
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Progressive fibrosis of palmar fascia. etiololgy not known;
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

3. aspiration of breast cyst is nonbloody
24-48 hours of supportive therapy followed by cholecystectomy
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
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

4. 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 mesenteric ishemia; most SMA occlusion secondary to an embolism
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Abd pain and tenderness; bloody diarrhoea or hematochezia

5. surgery for acute cholecystities
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Nonunion and avascular necrosis; fx can block blood supply;
24-48 hours of supportive therapy followed by cholecystectomy

6. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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
ACL injury

7. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
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)
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;

8. cremasteric reflex test?
Tendons more likely
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Seminomas

9. ct scan; cystic lesion in head of pancreas; next step
Abd pain and tenderness; bloody diarrhoea or hematochezia
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Next best step surgery; not ultrasound
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

10. Why right varicocele is more concerning?

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

11. cremasteric reflex
SAH due to post communicating artery aneurysm;
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
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

12. What are the common injuries from lightning?
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Elderly and critically ill patients
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

13. painless testicular mass in young male
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Malignancy until proven otherwise
Cystic scrotal fluid collection between parietal and visceral layers of testis

14. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
SAH due to post communicating artery aneurysm;
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

15. conservative Tx of varicose veins
Malignancy until proven otherwise
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
L5 to S2
Compression stocking - weight reduction - leg elevation

16. pregnant patient with asymptomatic gall stones
Klinefelter syndrome; 50 fold increase;
S2-S4
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction

17. prostate enlarged - nontender - no nodularity - elevated PSA
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Carpal tunnel syndrom
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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

18. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dm neuropathy; stocking glove pattern
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Progressive fibrosis of palmar fascia. etiololgy not known;
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

19. inhalation of hot air - steam - smoke in burn victim
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Supraglottic edema; low threshold for intubation
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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

20. contraindication of urethral catheterization
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
Supraglottic edema; low threshold for intubation
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

21. How to evaluate painless testicular swelling suspicious for cancer
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Pure motor stroke; limited neurological dysfunction

22. How to dx ACL tear?
Compression stocking - weight reduction - leg elevation
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
Pure motor stroke; limited neurological dysfunction
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

23. DD of acute scrotal pain
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Brardycardia - HTN - resp depression

24. Indication for bariatric surgery in obese patients
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;
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
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
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

25. What is the contraindication of hyperventilation in inc ICP
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Strok and traumatic brain injury
Malignancy until proven otherwise
Dumping syndrome; small and frequent meals; no simple sugar

26. stress fx
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Dm neuropathy; stocking glove pattern
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Nonunion and avascular necrosis; fx can block blood supply;

27. dumping syndrome after gastrectomy
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
If patient ambulatory - surgery and pain control; if not nonop mx
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
50%; tunneling between rectum or kin

28. most common complication of acute cholecystitis
Elderly and critically ill patients
Nonunion and avascular necrosis; fx can block blood supply;
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;

29. Why ruq calcificaion is concerning
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
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

30. managment of animal bite in hands
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
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;
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

31. 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
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx

32. xray finding of stress fx after 3-4w
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Saline and silicone

33. Dupuytren contracture
Brardycardia - HTN - resp depression
Seminomas
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Progressive fibrosis of palmar fascia. etiololgy not known;

34. How to manage a patient with asystole
Epi and chest compressio for prolong period of time; atropine is given after epi;
Retrograde ejaculation
If any compressive symptoms eg. dysphagia
Ispilateral hypoglossal nerve injury

35. What time frame required for bone remodeling
If any compressive symptoms eg. dysphagia
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Ispilateral hypoglossal nerve injury
10-12 months

36. What types of breast implants are available
Ispilateral hypoglossal nerve injury
Cystic scrotal fluid collection between parietal and visceral layers of testis
Saline and silicone
If patient ambulatory - surgery and pain control; if not nonop mx

37. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Subphrenic abscess or other abdominal abscesses; order US or CT
ACL injury
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
10-12 months

38. How to perform lachman test
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

39. What is terrible triad
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
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;
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

40. midline neck swelling moves with protrusion of tongue
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
When urethral catherization is unsuccessful
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Pure motor stroke; limited neurological dysfunction

41. beta hcg and AFP
Elevated non seminomas
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
When urethral catherization is unsuccessful

42. sudden onset of postoperative hyperglycemia when patient on TPN
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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
ACL injury
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

43. Tx of pulmonary contusion
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
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

44. SOB - confusion - petechial rash after trauma - fracture
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Check ET tube placement if correct needle decompresion
Displaced ORIF ; nondisplaced sling immobilization

45. perioral numbness after parathyroidectomy
Fx displace >1mm - nonunion during followup - osteonecrosis
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
When urethral catherization is unsuccessful
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

46. what size of ureteral stone for non op mx
Less than 5mm
Displaced ORIF ; nondisplaced sling immobilization
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

47. 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
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

48. when scaphoid fx patient needs to be referred to orthopedic
Dm neuropathy; stocking glove pattern
Fx displace >1mm - nonunion during followup - osteonecrosis
Mammogram
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy

49. common complication of inadequate mx of scaphoid fx
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Nonunion and avascular necrosis; fx can block blood supply;
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

50. Incidence of AF in CABG patient

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

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