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. anal sphincter tone
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
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
S2-S4

2. Valgus and Varus tests
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Pure motor stroke; limited neurological dysfunction
S2-S4
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

3. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Meniscus injury; medial most common; pain/swelling; popping sensation
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Malignancy until proven otherwise

4. Patient underwent CABG; postoperatively drowsy. most likely cause?
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
If patient ambulatory - surgery and pain control; if not nonop mx
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
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

5. Why right varicocele is more concerning?

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

6. What are the common injuries from lightning?
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

7. conservative Tx of varicose veins
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Compression stocking - weight reduction - leg elevation
50%; tunneling between rectum or kin
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

8. 27 yo with scrotal mass; warm tender testes feel like bag of worms
Compression stocking - weight reduction - leg elevation
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
CRPS
Progressive fibrosis of palmar fascia. etiololgy not known;

9. management of hip fracture
If patient ambulatory - surgery and pain control; if not nonop mx
Cystic scrotal fluid collection between parietal and visceral layers of testis
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

10. How to perform lachman test
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Low anterior resection and radio; add chemo if node positive
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

11. common complication of inadequate mx of scaphoid fx
Nonunion and avascular necrosis; fx can block blood supply;
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Ampicillin sublactum - pipercillin - ceftriaxone and metro

12. most common complication of acute cholecystitis
Nonunion and avascular necrosis; fx can block blood supply;
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Fx displace >1mm - nonunion during followup - osteonecrosis

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

14. ipsilateral deviation of tongue upon protrusion
Ispilateral hypoglossal nerve injury
Epi and chest compressio for prolong period of time; atropine is given after epi;
Even after ochiopexy risk of ochiopexy higher then general population
Nonunion and avascular necrosis; fx can block blood supply;

15. Most common of sudden death due to steering wheel injury
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
Even after ochiopexy risk of ochiopexy higher then general population
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

16. swelling and tenderness in anterior part of knee
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;
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Patellar tendon tear; difficulty in extension
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

17. What time frame required for bone remodeling
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;
CRPS
10-12 months
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

18. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

19. How to confirm dx of compartment syndrom
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
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
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

20. Complications of breast impant
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Twisting force with the foot fixed on the ground seen in football and basketball games;
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

21. popping sensation; rapid onset of knee effusion. athelet
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Next best step surgery; not ultrasound
ACL injury
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury

22. Why varicocele more common in the left side
Fx displace >1mm - nonunion during followup - osteonecrosis
Increased size during the day and valsalva means it is communicated with peritoneal cavity
ACL injury
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

23. midline neck swelling moves with protrusion of tongue
10-12 months
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
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;
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

24. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dm neuropathy; stocking glove pattern
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Urethral stricture; pelvic of urethral trauma
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

25. when patient with severe lung disease have C02 retention
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
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

26. management of stone 8-10mm
Ispilateral hypoglossal nerve injury
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
When urethral catherization is unsuccessful

27. What is most common lung injury after blunt chest trauma?
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

28. Indication for bariatric surgery in obese patients
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Klinefelter syndrome; 50 fold increase;
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;
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;

29. When patient can go back to sports after clavicle fx
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
4-6 weeks for noncontact sports and longer time for contact sports
Dumping syndrome; small and frequent meals; no simple sugar

30. recurrent laryngeal nerve injury
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
SAH due to post communicating artery aneurysm;
Unilateral vocal cord paralysis
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

31. What is the complications of undescended testis
Even after ochiopexy risk of ochiopexy higher then general population
Nonunion and avascular necrosis; fx can block blood supply;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

32. management of gunshot wound
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Less than 5mm
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

33. When do we see complications due to hypophosphatemia
Elderly and critically ill patients
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;
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

34. What is the strongest risk factor for male breast cancer
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
Klinefelter syndrome; 50 fold increase;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Pure motor stroke; limited neurological dysfunction

35. How varicocele causes testicular atrophy
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
Urethral stricture; pelvic of urethral trauma
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

36. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
Compression stocking - weight reduction - leg elevation
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
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

37. painless testicular mass in young male
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Malignancy until proven otherwise
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

38. What is hungry bone syndrome?
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
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Study showed no adverse effect; but they are contraindicated for PVD
Patellar tendon tear; difficulty in extension

39. What is prehn sign?
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
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;
Increased size during the day and valsalva means it is communicated with peritoneal cavity

40. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
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
CRPS
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis

41. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Retrograde ejaculation
Even after ochiopexy risk of ochiopexy higher then general population
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

42. varicose veins with ulcer - bleeding and thrombophlebitits
24-48 hours of supportive therapy followed by cholecystectomy
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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
S2-S4

43. contraindication of urethral catheterization
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
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Urethral stricture; pelvic of urethral trauma
Increased size during the day and valsalva means it is communicated with peritoneal cavity

44. acalculus cholecystitis
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;
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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
Elderly and critically ill patients

45. 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
Check ET tube placement if correct needle decompresion
Unilateral vocal cord paralysis
Mammogram

46. 3 mo with groin bulge; bulge appears when child cries
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
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
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
Less than 5mm

47. xray finding of stress fx after 3-4w
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

48. 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
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

49. aspiration of breast cyst is bloody
Supraglottic edema; low threshold for intubation
Pure motor stroke; limited neurological dysfunction
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;
Mammogram

50. lacunar stroke
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Pure motor stroke; limited neurological dysfunction
S2-S4
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

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