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. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dumping syndrome; small and frequent meals; no simple sugar
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Dm neuropathy; stocking glove pattern
Klinefelter syndrome; 50 fold increase;

2. 3 mo with groin bulge; bulge appears when child cries
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
CRPS
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Low anterior resection and radio; add chemo if node positive

3. sudden onset of postoperative hyperglycemia when patient on TPN
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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

4. most frequent complication of TURP
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Retrograde ejaculation
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

5. acute colonic ischemia
Abd pain and tenderness; bloody diarrhoea or hematochezia
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

6. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Subphrenic abscess or other abdominal abscesses; order US or CT
CRPS

7. SAH due to posterior inferior cerebellar aneurysm
Headache - ataxia - bulbar dysfunction
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;
Tendons more likely
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins

8. What is prehn sign?
Less than 5mm
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
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
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

9. management of gunshot wound
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Klinefelter syndrome; 50 fold increase;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
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

10. clavicle fx
Mammogram
Fx displace >1mm - nonunion during followup - osteonecrosis
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
Displaced ORIF ; nondisplaced sling immobilization

11. pregnant patient with asymptomatic gall stones
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

12. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
Urethral stricture; pelvic of urethral trauma
Epi and chest compressio for prolong period of time; atropine is given after epi;
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

13. first step for evaluation of testicular swelling
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
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Low anterior resection and radio; add chemo if node positive
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

14. what size of ureteral stone for non op mx
Less than 5mm
Mammogram
Klinefelter syndrome; 50 fold increase;
Elevated non seminomas

15. anal sphincter tone
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
S2-S4
Dumping syndrome; small and frequent meals; no simple sugar

16. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Abd pain and tenderness; bloody diarrhoea or hematochezia

17. how hyperventilation lowers ICP
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
Compression stocking - weight reduction - leg elevation
Displaced ORIF ; nondisplaced sling immobilization
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

18. most common fx when falling on outsretched hand
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

19. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
ACL injury
Meniscus injury; medial most common; pain/swelling; popping sensation
Study showed no adverse effect; but they are contraindicated for PVD
Brardycardia - HTN - resp depression

20. What are the common injuries from lightning?
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Unilateral vocal cord paralysis
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

21. cat/dog bites
Amoxicillin-clavulanate
4-6 weeks for noncontact sports and longer time for contact sports
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

22. types of hip fracture
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Pure motor stroke; limited neurological dysfunction

23. aspiration of breast cyst is bloody
Mammogram
Progressive fibrosis of palmar fascia. etiololgy not known;
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
If any compressive symptoms eg. dysphagia

24. What percent of anal abscess deveolop fisutula
Malignancy until proven otherwise
Headache - ataxia - bulbar dysfunction
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
50%; tunneling between rectum or kin

25. management of stone 8-10mm
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
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
24-48 hours of supportive therapy followed by cholecystectomy
Tendons more likely

26. contraindication of urethral catheterization
CRPS
Urethral stricture; pelvic of urethral trauma
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
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

27. menisci injury
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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
Twisting force with the foot fixed on the ground seen in football and basketball games;
Dumping syndrome; small and frequent meals; no simple sugar

28. how ABI help dx of PVD
Ispilateral hypoglossal nerve injury
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
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

29. How to differentiate communicative and non-communicative hydrocele
Increased size during the day and valsalva means it is communicated with peritoneal cavity
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
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
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

30. aspiration of breast cyst is nonbloody
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Elderly and critically ill patients
Nonunion and avascular necrosis; fx can block blood supply;
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury

31. How to manage obesity
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
Nonunion and avascular necrosis; fx can block blood supply;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
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

32. When to stop raloxifene before surgery
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

33. varicose veins with ulcer - bleeding and thrombophlebitits
Unilateral vocal cord paralysis
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins

34. common complication of inadequate mx of scaphoid fx
Nonunion and avascular necrosis; fx can block blood supply;
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

35. swelling and tenderness in anterior part of knee
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Patellar tendon tear; difficulty in extension
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

36. What is the complications of undescended testis
Even after ochiopexy risk of ochiopexy higher then general population
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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

37. 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;
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Supraglottic edema; low threshold for intubation
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

38. severe pain in leg after MVC
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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
Mammogram

39. varicocele
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Epi and chest compressio for prolong period of time; atropine is given after epi;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Sphincter sparing surgery (local resection) - abdomnio perineal resection

40. complications of TPN
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
10-12 months
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

41. diarrhoea 4-5 days after cholecystectomy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Strok and traumatic brain injury
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

42. acalculus cholecystitis
Elderly and critically ill patients
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
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
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

43. Tx of pulmonary contusion
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
15-40%; self limiting;doesn't require tx
10-12 months
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

44. when patient with severe lung disease have C02 retention
Patellar tendon tear; difficulty in extension
Pure motor stroke; limited neurological dysfunction
Elderly and critically ill patients
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

45. ct scan; cystic lesion in head of pancreas; next step
Malignancy until proven otherwise
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

46. How varicocele causes testicular atrophy
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Dumping syndrome; small and frequent meals; no simple sugar

47. beta hcg and AFP
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
Elevated non seminomas
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

48. When to do surgery in undesceneded testis?
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
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.

49. How mcmurray manuver perform
Twisting force with the foot fixed on the ground seen in football and basketball games;
Elderly and critically ill patients
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
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

50. prostate enlarged - nontender - no nodularity - elevated PSA
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Fx displace >1mm - nonunion during followup - osteonecrosis
Abd pain and tenderness; bloody diarrhoea or hematochezia
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

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