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Test your basic knowledge |
USMLE Step3 Surgery
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Study First
Subjects
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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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. Incidence of AF in CABG patient
2. Dupuytren contracture
If any compressive symptoms eg. dysphagia
Progressive fibrosis of palmar fascia. etiololgy not known;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Dm neuropathy; stocking glove pattern
3. conservative Tx of varicose veins
Compression stocking - weight reduction - leg elevation
Mammogram
Strok and traumatic brain injury
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
4. management of gunshot wound
15-40%; self limiting;doesn't require tx
Urethral stricture; pelvic of urethral trauma
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
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
5. first line of management of PVD
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Patellar tendon tear; difficulty in extension
6. mx of stress fx
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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%; tunneling between rectum or kin
7. several knee pain after being tackled in football game
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Cystic scrotal fluid collection between parietal and visceral layers of testis
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
8. Indication for bariatric surgery in obese patients
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
Seminomas
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;
If any compressive symptoms eg. dysphagia
9. How to evaluate painless testicular swelling suspicious for cancer
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
L5 to S2
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
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
10. cat/dog bites
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Amoxicillin-clavulanate
11. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
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
Dm neuropathy; stocking glove pattern
Less than 5mm
12. varicocele
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
13. diarrhoea after gastric bypass
Dumping syndrome; small and frequent meals; no simple sugar
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
Seminomas
Study showed no adverse effect; but they are contraindicated for PVD
14. What is the contraindication of hyperventilation in inc ICP
Ispilateral hypoglossal nerve injury
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Strok and traumatic brain injury
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
15. How varicocele causes testicular atrophy
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Epi and chest compressio for prolong period of time; atropine is given after epi;
16. clavicle fx
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
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Displaced ORIF ; nondisplaced sling immobilization
L5 to S2
17. When to stop raloxifene before surgery
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
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
18. What is the complications of undescended testis
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Even after ochiopexy risk of ochiopexy higher then general population
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Headache - ataxia - bulbar dysfunction
19. surgery for acute cholecystities
Headache - ataxia - bulbar dysfunction
Strok and traumatic brain injury
24-48 hours of supportive therapy followed by cholecystectomy
10-12 months
20. management of stone 8-10mm
Displaced ORIF ; nondisplaced sling immobilization
Dumping syndrome; small and frequent meals; no simple sugar
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
21. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
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
22. management of hip fracture
If patient ambulatory - surgery and pain control; if not nonop mx
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
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
23. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
CRPS
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Amoxicillin-clavulanate
Supraglottic edema; low threshold for intubation
24. xray finding of stress fx after 3-4w
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Low anterior resection and radio; add chemo if node positive
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
25. Why initial xrays are negative in scaphoid fx
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
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
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
26. cremasteric reflex
SAH due to post communicating artery aneurysm;
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
CRPS
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
27. How to manage obesity
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Unilateral vocal cord paralysis
Low anterior resection and radio; add chemo if node positive
28. how hyperventilation lowers ICP
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;
Strok and traumatic brain injury
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
29. indication of ursodeoxycholic acid
Check ET tube placement if correct needle decompresion
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
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
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
30. beta HCG
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Seminomas
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
31. How to perform lachman test
Twisting force with the foot fixed on the ground seen in football and basketball games;
Elderly and critically ill patients
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
32. mangement of localized lymphadenopathy
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
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Ispilateral hypoglossal nerve injury
33. stress fx
Check ET tube placement if correct needle decompresion
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
34. DD of acute scrotal pain
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Subphrenic abscess or other abdominal abscesses; order US or CT
Mammogram
35. differential of ultrasound finding of breast mass
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
4-6 weeks for noncontact sports and longer time for contact sports
Meniscus injury; medial most common; pain/swelling; popping sensation
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
36. ipsilateral deviation of tongue upon protrusion
Mammogram
Twisting force with the foot fixed on the ground seen in football and basketball games;
Ispilateral hypoglossal nerve injury
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
37. lacunar stroke
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
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
Pure motor stroke; limited neurological dysfunction
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
38. first step for evaluation of testicular swelling
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Saline and silicone
MAT; medial meniscus injury; ACL and Tibial colateral ligament
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
39. transrectal prostate biopsy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
40. 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
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Check ET tube placement if correct needle decompresion
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
41. acalculus cholecystitis
Elderly and critically ill patients
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
42. managment of animal bite in hands
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
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;
Carpal tunnel syndrom
43. 3 mo with groin bulge; bulge appears when child cries
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
Less than 5mm
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
44. anal sphincter tone
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
Klinefelter syndrome; 50 fold increase;
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
45. perioral numbness after parathyroidectomy
Retrograde ejaculation
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Nonunion and avascular necrosis; fx can block blood supply;
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. When do we see complications due to hypophosphatemia
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
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 phosphate levels fall below 1.0; 30% of patient on TPN has this prob; patient develop respiratory weakness - hemolysis - impaired oxygen release from Hb;
Low anterior resection and radio; add chemo if node positive
47. What is the strongest risk factor for male breast cancer
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;
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Klinefelter syndrome; 50 fold increase;
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
48. most common complication of acute cholecystitis
Elevated non seminomas
Urethral stricture; pelvic of urethral trauma
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
49. Tx of proximal non metastatic rectal ca
Low anterior resection and radio; add chemo if node positive
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
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
Increased size during the day and valsalva means it is communicated with peritoneal cavity
50. What is cushing's triad
Progressive fibrosis of palmar fascia. etiololgy not known;
Brardycardia - HTN - resp depression
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins