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
4-6 weeks for noncontact sports and longer time for contact sports
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
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
Elderly and critically ill patients

2. Incidence of AF in CABG patient

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

3. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
10-12 months

4. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
When urethral catherization is unsuccessful
Abd pain and tenderness; bloody diarrhoea or hematochezia

5. popping sensation; rapid onset of knee effusion. athelet
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
ACL injury

6. severe pain in leg after MVC
Dumping syndrome; small and frequent meals; no simple sugar
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
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

7. prostate enlarged - nontender - no nodularity - elevated PSA
24-48 hours of supportive therapy followed by cholecystectomy
4-6 weeks for noncontact sports and longer time for contact sports
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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

8. What percent of anal abscess deveolop fisutula
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
24-48 hours of supportive therapy followed by cholecystectomy
50%; tunneling between rectum or kin

9. SOB - confusion - petechial rash after trauma - fracture
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Abd pain and tenderness; bloody diarrhoea or hematochezia

10. cat/dog bites
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Amoxicillin-clavulanate
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;

11. complication displaced or communited distal radial fx
Carpal tunnel syndrom
24-48 hours of supportive therapy followed by cholecystectomy
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Fx displace >1mm - nonunion during followup - osteonecrosis

12. Why varicocele more common in the left side
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
Subphrenic abscess or other abdominal abscesses; order US or CT
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

13. contraindication of urethral catheterization
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Urethral stricture; pelvic of urethral trauma
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

14. mangement of localized lymphadenopathy
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
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
SAH due to post communicating artery aneurysm;
4-6 weeks for noncontact sports and longer time for contact sports

15. Why initial xrays are negative in scaphoid fx
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
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
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration

16. when scaphoid fx patient needs to be referred to orthopedic
When urethral catherization is unsuccessful
S2-S4
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;
Fx displace >1mm - nonunion during followup - osteonecrosis

17. What is the complications of undescended testis
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
Ispilateral hypoglossal nerve injury
Even after ochiopexy risk of ochiopexy higher then general population
Klinefelter syndrome; 50 fold increase;

18. How to differentiate communicative and non-communicative hydrocele
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Malignancy until proven otherwise
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury

19. cremasteric reflex
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Amoxicillin-clavulanate
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction

20. what size of ureteral stone for non op mx
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
Less than 5mm
Unilateral vocal cord paralysis
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal

21. complications of TPN
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
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

22. differential of ultrasound finding of breast mass
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
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
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

23. tx distal rectal ca
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Tendons more likely
Sphincter sparing surgery (local resection) - abdomnio perineal resection
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

24. swelling and tenderness in anterior part of knee
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
Patellar tendon tear; difficulty in extension
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

25. diarrhoea 4-5 days after cholecystectomy
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
Fx displace >1mm - nonunion during followup - osteonecrosis
If patient ambulatory - surgery and pain control; if not nonop mx

26. transrectal prostate biopsy
Low anterior resection and radio; add chemo if node positive
Abd pain and tenderness; bloody diarrhoea or hematochezia
Brardycardia - HTN - resp depression
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

27. lacerated wound in palmer surface of hand. what structure is injured?
Twisting force with the foot fixed on the ground seen in football and basketball games;
Tendons more likely
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
CRPS

28. most common fx when falling on outsretched hand
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Elderly and critically ill patients
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

29. stress fx
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Sphincter sparing surgery (local resection) - abdomnio perineal resection
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

30. common complication of inadequate mx of scaphoid fx
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Carpal tunnel syndrom
Nonunion and avascular necrosis; fx can block blood supply;

31. menisci injury
Compression stocking - weight reduction - leg elevation
Twisting force with the foot fixed on the ground seen in football and basketball games;
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
Retrograde ejaculation

32. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Elderly and critically ill patients
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Subphrenic abscess or other abdominal abscesses; order US or CT

33. cremasteric reflex test?
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Epi and chest compressio for prolong period of time; atropine is given after epi;
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

34. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
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
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

35. Dupuytren contracture
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Saline and silicone
Progressive fibrosis of palmar fascia. etiololgy not known;
Amoxicillin-clavulanate

36. When patient can go back to sports after clavicle fx
4-6 weeks for noncontact sports and longer time for contact sports
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Elevated non seminomas
Supraglottic edema; low threshold for intubation

37. beta hcg and AFP
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Elevated non seminomas
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
L5 to S2

38. Valgus and Varus tests
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
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Compression stocking - weight reduction - leg elevation

39. How to differentiate ACL and meniscus injury
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
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Ampicillin sublactum - pipercillin - ceftriaxone and metro
15-40%; self limiting;doesn't require tx

40. conservative Tx of varicose veins
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Compression stocking - weight reduction - leg elevation
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Unilateral vocal cord paralysis

41. 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
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
Epi and chest compressio for prolong period of time; atropine is given after epi;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

42. pregnant patient with asymptomatic gall stones
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
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
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Tendons more likely

43. SAH due to posterior inferior cerebellar aneurysm
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Headache - ataxia - bulbar dysfunction

44. How to evaluate painless testicular swelling suspicious for cancer
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Seminomas
Ampicillin sublactum - pipercillin - ceftriaxone and metro

45. 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.
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

46. Tx of pulmonary contusion
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
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
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Study showed no adverse effect; but they are contraindicated for PVD

47. What is hydrocele?
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
Cystic scrotal fluid collection between parietal and visceral layers of testis
Fx displace >1mm - nonunion during followup - osteonecrosis
Saline and silicone

48. What types of breast implants are available
Urethral stricture; pelvic of urethral trauma
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Saline and silicone

49. When to do surgery in undesceneded testis?
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
10-12 months
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

50. 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
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Ispilateral hypoglossal nerve injury
Pure motor stroke; limited neurological dysfunction