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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. How to confirm dx of compartment syndrom
Study showed no adverse effect; but they are contraindicated for PVD
Twisting force with the foot fixed on the ground seen in football and basketball games;
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

2. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
SAH due to post communicating artery aneurysm;
Study showed no adverse effect; but they are contraindicated for PVD
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Check ET tube placement if correct needle decompresion

3. Can we use beta blocker for pvd?
Next best step surgery; not ultrasound
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Strok and traumatic brain injury
Study showed no adverse effect; but they are contraindicated for PVD

4. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
CRPS
Less than 5mm
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

5. acute colonic ischemia
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Dumping syndrome; small and frequent meals; no simple sugar
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Abd pain and tenderness; bloody diarrhoea or hematochezia

6. beta HCG
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Fx displace >1mm - nonunion during followup - osteonecrosis
Even after ochiopexy risk of ochiopexy higher then general population
Seminomas

7. aspiration of breast cyst is bloody
Mammogram
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Progressive fibrosis of palmar fascia. etiololgy not known;
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

8. When patient can go back to sports after 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
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
4-6 weeks for noncontact sports and longer time for contact sports
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration

9. conservative Tx of varicose veins
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
Epi and chest compressio for prolong period of time; atropine is given after epi;
Compression stocking - weight reduction - leg elevation
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

10. management of hip fracture
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
If patient ambulatory - surgery and pain control; if not nonop mx
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;

11. suprapubic catheterization
Dumping syndrome; small and frequent meals; no simple sugar
When urethral catherization is unsuccessful
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

12. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Abd pain and tenderness; bloody diarrhoea or hematochezia
Carpal tunnel syndrom
Seminomas

13. Tx of proximal non metastatic rectal ca
Low anterior resection and radio; add chemo if node positive
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

14. common complication of inadequate mx of scaphoid fx
15-40%; self limiting;doesn't require tx
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Nonunion and avascular necrosis; fx can block blood supply;

15. How to dx ACL tear?
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
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
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
4-6 weeks for noncontact sports and longer time for contact sports

16. ct scan; cystic lesion in head of pancreas; next step
Epi and chest compressio for prolong period of time; atropine is given after epi;
Mammogram
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

17. severe pain in leg after MVC
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
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

18. What types of breast implants are available
Saline and silicone
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Seminomas
Pure motor stroke; limited neurological dysfunction

19. diarrhoea 4-5 days after cholecystectomy
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

20. dumping syndrome after gastrectomy
When urethral catherization is unsuccessful
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

21. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Klinefelter syndrome; 50 fold increase;
Headache - ataxia - bulbar dysfunction
Next best step surgery; not ultrasound

22. cremasteric reflex test?
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
ACL injury
Ispilateral hypoglossal nerve injury
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

23. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
ACL injury
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Less than 5mm

24. differential of ultrasound finding of breast mass
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

25. Why right varicocele is more concerning?

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26. prostate enlarged - nontender - no nodularity - elevated PSA
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;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

27. varicocele
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Increased size during the day and valsalva means it is communicated with peritoneal cavity
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

28. tx distal rectal ca
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;

29. most common fx when falling on outsretched hand
Less than 5mm
Progressive fibrosis of palmar fascia. etiololgy not known;
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Ampicillin sublactum - pipercillin - ceftriaxone and metro

30. What is the contraindication of hyperventilation in inc ICP
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Strok and traumatic brain injury
Brardycardia - HTN - resp depression

31. lacunar stroke
Pure motor stroke; limited neurological dysfunction
Urethral stricture; pelvic of urethral trauma
Elevated non seminomas
Epi and chest compressio for prolong period of time; atropine is given after epi;

32. What is terrible triad
50%; tunneling between rectum or kin
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Patellar tendon tear; difficulty in extension
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

33. 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
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Low anterior resection and radio; add chemo if node positive
Mammogram

34. Why initial xrays are negative in scaphoid fx
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
If patient ambulatory - surgery and pain control; if not nonop mx
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
When urethral catherization is unsuccessful

35. What is the strongest risk factor for male breast cancer
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Klinefelter syndrome; 50 fold increase;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
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;

36. When to stop raloxifene before surgery
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Sphincter sparing surgery (local resection) - abdomnio perineal resection
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

37. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
4-6 weeks for noncontact sports and longer time for contact sports
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Cystic scrotal fluid collection between parietal and visceral layers of testis
Dm neuropathy; stocking glove pattern

38. xray finding of stress fx after 3-4w
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

39. scrotal trauma
Headache - ataxia - bulbar dysfunction
Next best step surgery; not ultrasound
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

40. acalculus cholecystitis
Elderly and critically ill patients
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Low anterior resection and radio; add chemo if node positive

41. SAH due to posterior inferior cerebellar aneurysm
Brardycardia - HTN - resp depression
10-12 months
Even after ochiopexy risk of ochiopexy higher then general population
Headache - ataxia - bulbar dysfunction

42. transrectal prostate biopsy
Amoxicillin-clavulanate
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
If patient ambulatory - surgery and pain control; if not nonop mx

43. surgery for acute cholecystities
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
24-48 hours of supportive therapy followed by cholecystectomy
Unilateral vocal cord paralysis
Saline and silicone

44. 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
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Pure motor stroke; limited neurological dysfunction

45. recurrent laryngeal nerve injury
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
15-40%; self limiting;doesn't require tx
Unilateral vocal cord paralysis
Dumping syndrome; small and frequent meals; no simple sugar

46. popping sensation; rapid onset of knee effusion. athelet
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
ACL injury
Nonunion and avascular necrosis; fx can block blood supply;

47. When goiter needs surgery
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
If any compressive symptoms eg. dysphagia
50%; tunneling between rectum or kin
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. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Pure motor stroke; limited neurological dysfunction
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

49. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
15-40%; self limiting;doesn't require tx
Nonunion and avascular necrosis; fx can block blood supply;

50. SOB - confusion - petechial rash after trauma - fracture
Progressive fibrosis of palmar fascia. etiololgy not known;
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
24-48 hours of supportive therapy followed by cholecystectomy
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy