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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. What is hydrocele?
Carpal tunnel syndrom
Cystic scrotal fluid collection between parietal and visceral layers of testis
Dumping syndrome; small and frequent meals; no simple sugar
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

2. aspiration of breast cyst is bloody
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Progressive fibrosis of palmar fascia. etiololgy not known;
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Mammogram

3. most common fx when falling on outsretched hand
Study showed no adverse effect; but they are contraindicated for PVD
Nonunion and avascular necrosis; fx can block blood supply;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

4. antibiotics of acute cholecystitis
4-6 weeks for noncontact sports and longer time for contact sports
24-48 hours of supportive therapy followed by cholecystectomy
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Ampicillin sublactum - pipercillin - ceftriaxone and metro

5. midline neck swelling moves with protrusion of tongue
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Check ET tube placement if correct needle decompresion
24-48 hours of supportive therapy followed by cholecystectomy
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;

6. When to stop raloxifene before surgery
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Retrograde ejaculation

7. beta hcg and AFP
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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Elevated non seminomas
Cystic scrotal fluid collection between parietal and visceral layers of testis

8. severe pain in leg after MVC
S2-S4
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
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
10-12 months

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

10. 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
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Study showed no adverse effect; but they are contraindicated for PVD
Urethral stricture; pelvic of urethral trauma

11. menisci injury
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Twisting force with the foot fixed on the ground seen in football and basketball games;
Klinefelter syndrome; 50 fold increase;

12. Valgus and Varus tests
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Less than 5mm
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line

13. sudden onset of postoperative hyperglycemia when patient on TPN
Next best step surgery; not ultrasound
Less than 5mm
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

14. transrectal prostate biopsy
Carpal tunnel syndrom
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Ispilateral hypoglossal nerve injury
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

15. Why varicocele more common in the left side
Unilateral vocal cord paralysis
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
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

16. complication displaced or communited distal radial fx
Patellar tendon tear; difficulty in extension
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Less than 5mm
Carpal tunnel syndrom

17. diarrhoea 4-5 days after cholecystectomy
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Abd pain and tenderness; bloody diarrhoea or hematochezia
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury

18. management of stone 8-10mm
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
If any compressive symptoms eg. dysphagia
Unilateral vocal cord paralysis
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

19. suddent turning while running; twisting injury to the knee with one foot fixed to the ground
Meniscus injury; medial most common; pain/swelling; popping sensation
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

20. How mcmurray manuver perform
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Ispilateral hypoglossal nerve injury
Check ET tube placement if correct needle decompresion

21. When patient can go back to sports after clavicle fx
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
4-6 weeks for noncontact sports and longer time for contact sports
Displaced ORIF ; nondisplaced sling immobilization
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea

22. indication of ursodeoxycholic acid
Amoxicillin-clavulanate
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
Meniscus injury; medial most common; pain/swelling; popping sensation

23. recurrent laryngeal nerve injury
SAH due to post communicating artery aneurysm;
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Unilateral vocal cord paralysis
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

24. pregnant patient with asymptomatic gall stones
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Dm neuropathy; stocking glove pattern
Elevated non seminomas
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;

25. Tx of proximal non metastatic rectal ca
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
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Low anterior resection and radio; add chemo if node positive
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

26. inhalation of hot air - steam - smoke in burn victim
50%; tunneling between rectum or kin
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;
Supraglottic edema; low threshold for intubation
MAT; medial meniscus injury; ACL and Tibial colateral ligament

27. What are the common injuries from lightning?
Urethral stricture; pelvic of urethral trauma
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Even after ochiopexy risk of ochiopexy higher then general population
Tendons more likely

28. suprapubic catheterization
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;
Abd pain and tenderness; bloody diarrhoea or hematochezia
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
When urethral catherization is unsuccessful

29. 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
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
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
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

30. When do we see complications due to hypophosphatemia
Subphrenic abscess or other abdominal abscesses; order US or CT
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;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

31. ct scan; cystic lesion in head of pancreas; next step
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Dumping syndrome; small and frequent meals; no simple sugar
Check ET tube placement if correct needle decompresion

32. popping sensation; rapid onset of knee effusion. athelet
ACL injury
Progressive fibrosis of palmar fascia. etiololgy not known;
Klinefelter syndrome; 50 fold increase;
Compression stocking - weight reduction - leg elevation

33. 3 mo with groin bulge; bulge appears when child cries
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

34. Can we use beta blocker for pvd?
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Study showed no adverse effect; but they are contraindicated for PVD
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Sphincter sparing surgery (local resection) - abdomnio perineal resection

35. diarrhoea after gastric bypass
Dumping syndrome; small and frequent meals; no simple sugar
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Ispilateral hypoglossal nerve injury
10-12 months

36. tx distal rectal ca
Retrograde ejaculation
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

37. managment of animal bite in hands
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;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Amoxicillin-clavulanate
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

38. Complications of breast impant
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Study showed no adverse effect; but they are contraindicated for PVD
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

39. How to confirm dx of compartment syndrom
Displaced ORIF ; nondisplaced sling immobilization
Pure motor stroke; limited neurological dysfunction
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

40. management of hip fracture
Progressive fibrosis of palmar fascia. etiololgy not known;
If patient ambulatory - surgery and pain control; if not nonop mx
Amoxicillin-clavulanate
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;

41. Dupuytren contracture
Progressive fibrosis of palmar fascia. etiololgy not known;
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
If patient ambulatory - surgery and pain control; if not nonop mx
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

42. What is most common lung injury after blunt chest trauma?
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
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Displaced ORIF ; nondisplaced sling immobilization
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

43. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
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
Nonunion and avascular necrosis; fx can block blood supply;
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

44. Incidence of AF in CABG patient

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45. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
CRPS
Strok and traumatic brain injury
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea

46. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Carpal tunnel syndrom
Epi and chest compressio for prolong period of time; atropine is given after epi;
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

47. varicocele
Cystic scrotal fluid collection between parietal and visceral layers of testis
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
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
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy

48. first line of management of PVD
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

49. When goiter needs surgery
If any compressive symptoms eg. dysphagia
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Study showed no adverse effect; but they are contraindicated for PVD
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

50. conservative Tx of varicose veins
CRPS
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Compression stocking - weight reduction - leg elevation
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