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. beta HCG
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Seminomas
Compression stocking - weight reduction - leg elevation
Malignancy until proven otherwise

2. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Cystic scrotal fluid collection between parietal and visceral layers of testis
Abd pain and tenderness; bloody diarrhoea or hematochezia
Malignancy until proven otherwise

3. common complication of inadequate mx of scaphoid fx
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Nonunion and avascular necrosis; fx can block blood supply;
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Displaced ORIF ; nondisplaced sling immobilization

4. management of nondisplaced scaphoid fx
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
If patient ambulatory - surgery and pain control; if not nonop mx
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

5. pregnant patient with asymptomatic gall stones
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Patellar tendon tear; difficulty in extension
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
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

6. What is the contraindication of hyperventilation in inc ICP
Strok and traumatic brain injury
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Pure motor stroke; limited neurological dysfunction

7. Why ruq calcificaion is concerning
Check ET tube placement if correct needle decompresion
Less than 5mm
When urethral catherization is unsuccessful
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy

8. DD of acute scrotal pain
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Progressive fibrosis of palmar fascia. etiololgy not known;
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

9. complication displaced or communited distal radial fx
L5 to S2
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Carpal tunnel syndrom

10. when patient with severe lung disease have C02 retention
Meniscus injury; medial most common; pain/swelling; popping sensation
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
24-48 hours of supportive therapy followed by cholecystectomy

11. What are the common injuries from lightning?
Abd pain and tenderness; bloody diarrhoea or hematochezia
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

12. diarrhoea 4-5 days after cholecystectomy
24-48 hours of supportive therapy followed by cholecystectomy
Headache - ataxia - bulbar dysfunction
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

13. acute colonic ischemia
S2-S4
Amoxicillin-clavulanate
Abd pain and tenderness; bloody diarrhoea or hematochezia
Check ET tube placement if correct needle decompresion

14. What is prehn sign?
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Klinefelter syndrome; 50 fold increase;

15. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
S2-S4
Dumping syndrome; small and frequent meals; no simple sugar
Less than 5mm

16. How to differentiate communicative and non-communicative hydrocele
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Abd pain and tenderness; bloody diarrhoea or hematochezia
Cystic scrotal fluid collection between parietal and visceral layers of testis

17. Incidence of AF in CABG patient

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

18. Valgus and Varus tests
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
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Less than 5mm
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

19. several knee pain after being tackled in football game
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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
Unilateral vocal cord paralysis

20. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Subphrenic abscess or other abdominal abscesses; order US or CT
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Abd pain and tenderness; bloody diarrhoea or hematochezia

21. first step for evaluation of testicular swelling
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
S2-S4
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

22. aspiration of breast cyst is nonbloody
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
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
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

23. How to manage a patient with asystole
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
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;
Epi and chest compressio for prolong period of time; atropine is given after epi;
Ispilateral hypoglossal nerve injury

24. scrotal trauma
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
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;
Next best step surgery; not ultrasound

25. conservative Tx of varicose veins
Compression stocking - weight reduction - leg elevation
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 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
Less than 5mm

26. 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
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Fx displace >1mm - nonunion during followup - osteonecrosis
Brardycardia - HTN - resp depression

27. How to manage obesity
Retrograde ejaculation
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
ACL injury

28. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
ACL injury

29. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
S2-S4
SAH due to post communicating artery aneurysm;
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
CRPS

30. surgery for acute cholecystities
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
24-48 hours of supportive therapy followed by cholecystectomy

31. xray finding of stress fx after 3-4w
Nonunion and avascular necrosis; fx can block blood supply;
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
15-40%; self limiting;doesn't require tx
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

32. 27 yo with scrotal mass; warm tender testes feel like bag of worms
Pure motor stroke; limited neurological dysfunction
Tendons more likely
If patient ambulatory - surgery and pain control; if not nonop mx
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration

33. varicocele
If patient ambulatory - surgery and pain control; if not nonop mx
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Elderly and critically ill patients
CRPS

34. 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
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Abd pain and tenderness; bloody diarrhoea or hematochezia
Unilateral vocal cord paralysis

35. When patient can go back to sports after clavicle fx
4-6 weeks for noncontact sports and longer time for contact sports
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

36. antibiotics of acute cholecystitis
Klinefelter syndrome; 50 fold increase;
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Ampicillin sublactum - pipercillin - ceftriaxone and metro
CRPS

37. aspiration of breast cyst is bloody
Mammogram
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Retrograde ejaculation
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

38. What percent of anal abscess deveolop fisutula
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
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Patellar tendon tear; difficulty in extension
50%; tunneling between rectum or kin

39. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
CRPS
SAH due to post communicating artery aneurysm;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

40. swelling and tenderness in anterior part of knee
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Patellar tendon tear; difficulty in extension
Elderly and critically ill patients

41. Tx of pulmonary contusion
Retrograde ejaculation
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Mammogram
Tendons more likely

42. what size of ureteral stone for non op mx
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
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
Less than 5mm
Mammogram

43. severe pain in leg after MVC
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
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
Brardycardia - HTN - resp depression
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

44. Why varicocele more common in the left side
10-12 months
Pure motor stroke; limited neurological dysfunction
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea

45. contraindication of urethral catheterization
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Mammogram
Abd pain and tenderness; bloody diarrhoea or hematochezia
Urethral stricture; pelvic of urethral trauma

46. What is hungry bone syndrome?
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 full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
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
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

47. What types of breast implants are available
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Ispilateral hypoglossal nerve injury
Saline and silicone
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

48. stress fx
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Strok and traumatic brain injury
Progressive fibrosis of palmar fascia. etiololgy not known;
Even after ochiopexy risk of ochiopexy higher then general population

49. midline neck swelling moves with protrusion of tongue
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

50. Indication for bariatric surgery in obese patients
50%; tunneling between rectum or kin
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
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;
When urethral catherization is unsuccessful

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

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