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. 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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
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
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

2. Why right varicocele is more concerning?

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

3. scrotal trauma
Next best step surgery; not ultrasound
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Progressive fibrosis of palmar fascia. etiololgy not known;
Sphincter sparing surgery (local resection) - abdomnio perineal resection

4. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Even after ochiopexy risk of ochiopexy higher then general population
Subphrenic abscess or other abdominal abscesses; order US or CT
Klinefelter syndrome; 50 fold increase;
Displaced ORIF ; nondisplaced sling immobilization

5. What is terrible triad
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Nonunion and avascular necrosis; fx can block blood supply;
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

6. acalculus cholecystitis
Elderly and critically ill patients
Nonunion and avascular necrosis; fx can block blood supply;
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Malignancy until proven otherwise

7. How to manage obesity
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
10-12 months
S2-S4

8. pregnant patient with asymptomatic gall stones
Saline and silicone
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Epi and chest compressio for prolong period of time; atropine is given after epi;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole

9. mangement of localized lymphadenopathy
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele

10. Why ruq calcificaion is concerning
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Retrograde ejaculation
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration

11. sudden onset of postoperative hyperglycemia when patient on TPN
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

12. surgery for acute cholecystities
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Urethral stricture; pelvic of urethral trauma
24-48 hours of supportive therapy followed by cholecystectomy
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

13. ipsilateral deviation of tongue upon protrusion
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Ispilateral hypoglossal nerve injury
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

14. What is prehn sign?
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Epi and chest compressio for prolong period of time; atropine is given after epi;
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;

15. Complications of breast impant
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
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

16. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
SAH due to post communicating artery aneurysm;
Dm neuropathy; stocking glove pattern
Strok and traumatic brain injury
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

17. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
Headache - ataxia - bulbar dysfunction
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Meniscus injury; medial most common; pain/swelling; popping sensation

18. When patient can go back to sports after clavicle fx
Nonunion and avascular necrosis; fx can block blood supply;
4-6 weeks for noncontact sports and longer time for contact sports
Subphrenic abscess or other abdominal abscesses; order US or CT
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;

19. How to evaluate painless testicular swelling suspicious for cancer
Dumping syndrome; small and frequent meals; no simple sugar
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
24-48 hours of supportive therapy followed by cholecystectomy
SAH due to post communicating artery aneurysm;

20. Patient underwent CABG; postoperatively drowsy. most likely cause?
Strok and traumatic brain injury
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Headache - ataxia - bulbar dysfunction
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

21. Incidence of AF in CABG patient

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

22. What is the strongest risk factor for male breast cancer
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Klinefelter syndrome; 50 fold increase;
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

23. antibiotics of acute cholecystitis
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Ampicillin sublactum - pipercillin - ceftriaxone and metro

24. ct scan; cystic lesion in head of pancreas; next step
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

25. What time frame required for bone remodeling
SAH due to post communicating artery aneurysm;
10-12 months
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Strok and traumatic brain injury

26. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Meniscus injury; medial most common; pain/swelling; popping sensation

27. transrectal prostate biopsy
Malignancy until proven otherwise
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
SAH due to post communicating artery aneurysm;
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

28. several knee pain after being tackled in football game
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

29. swelling and tenderness in anterior part of knee
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Carpal tunnel syndrom
Compression stocking - weight reduction - leg elevation
Patellar tendon tear; difficulty in extension

30. when patient with severe lung disease have C02 retention
L5 to S2
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
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
Supraglottic edema; low threshold for intubation

31. popping sensation; rapid onset of knee effusion. athelet
ACL injury
When urethral catherization is unsuccessful
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Study showed no adverse effect; but they are contraindicated for PVD

32. Valgus and Varus tests
Headache - ataxia - bulbar dysfunction
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

33. Why varicocele more common in the left side
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
Dm neuropathy; stocking glove pattern
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

34. types of hip fracture
Less than 5mm
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

35. cremasteric reflex test?
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

36. When to do surgery in undesceneded testis?
Amoxicillin-clavulanate
Klinefelter syndrome; 50 fold increase;
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Elderly and critically ill patients

37. differential of ultrasound finding of breast mass
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
4-6 weeks for noncontact sports and longer time for contact sports
Strok and traumatic brain injury
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

38. xray finding of stress fx after 3-4w
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Amoxicillin-clavulanate
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective 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

39. When to stop raloxifene before surgery
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Meniscus injury; medial most common; pain/swelling; popping sensation
Pure motor stroke; limited neurological dysfunction

40. How to confirm dx of compartment syndrom
Mammogram
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
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;
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

41. Dupuytren contracture
Nonunion and avascular necrosis; fx can block blood supply;
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
Progressive fibrosis of palmar fascia. etiololgy not known;
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare

42. management of nondisplaced scaphoid fx
Carpal tunnel syndrom
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
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

43. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Ispilateral hypoglossal nerve injury
SAH due to post communicating artery aneurysm;

44. How to differentiate ACL and meniscus injury
Klinefelter syndrome; 50 fold increase;
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
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

45. inhalation of hot air - steam - smoke in burn victim
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;
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
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
Supraglottic edema; low threshold for intubation

46. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
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
Dumping syndrome; small and frequent meals; no simple sugar
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;

47. What is the complications of undescended testis
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Even after ochiopexy risk of ochiopexy higher then general population
24-48 hours of supportive therapy followed by cholecystectomy

48. most frequent complication of TURP
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Retrograde ejaculation
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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

49. management of gunshot wound
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
MAT; medial meniscus injury; ACL and Tibial colateral ligament
If any compressive symptoms eg. dysphagia
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

50. common complication of inadequate mx of scaphoid fx
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Nonunion and avascular necrosis; fx can block blood supply;
SAH due to post communicating artery aneurysm;
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