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. How to confirm achiles tendon rupture
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
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Even after ochiopexy risk of ochiopexy higher then general population

2. When do we see complications due to hypophosphatemia
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
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;

3. How to manage a patient with asystole
Dumping syndrome; small and frequent meals; no simple sugar
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
Klinefelter syndrome; 50 fold increase;
Epi and chest compressio for prolong period of time; atropine is given after epi;

4. How mcmurray manuver perform
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
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. Tx of pulmonary contusion
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
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Next best step surgery; not ultrasound

6. How to confirm dx of compartment syndrom
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
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
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

7. When to do surgery in undesceneded testis?
Amoxicillin-clavulanate
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Strok and traumatic brain injury
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare

8. popping sensation; rapid onset of knee effusion. athelet
Progressive fibrosis of palmar fascia. etiololgy not known;
ACL 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
Headache - ataxia - bulbar dysfunction

9. suprapubic catheterization
When urethral catherization is unsuccessful
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Mammogram

10. diarrhoea 4-5 days after cholecystectomy
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
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
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

11. 3 mo with groin bulge; bulge appears when child cries
50%; tunneling between rectum or kin
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

12. types of hip fracture
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
CRPS
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

13. midline neck swelling moves with protrusion of tongue
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Headache - ataxia - bulbar dysfunction
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

14. diarrhoea after gastric bypass
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Dumping syndrome; small and frequent meals; no simple sugar
Nonunion and avascular necrosis; fx can block blood supply;
Supraglottic edema; low threshold for intubation

15. how ABI help dx of PVD
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Retrograde ejaculation
Patellar tendon tear; difficulty in extension
If any compressive symptoms eg. dysphagia

16. what size of ureteral stone for non op mx
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Less than 5mm
Displaced ORIF ; nondisplaced sling immobilization
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

17. varicose veins with ulcer - bleeding and thrombophlebitits
Supraglottic edema; low threshold for intubation
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
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
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins

18. when patient with severe lung disease have C02 retention
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
Dm neuropathy; stocking glove pattern
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
Compression stocking - weight reduction - leg elevation

19. first line of management of PVD
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Pure motor stroke; limited neurological dysfunction
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;

20. What is the strongest risk factor for male breast cancer
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Klinefelter syndrome; 50 fold increase;
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
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

21. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dm neuropathy; stocking glove pattern
L5 to S2
Urethral stricture; pelvic of urethral trauma
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

22. recurrent laryngeal nerve injury
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;
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Unilateral vocal cord paralysis

23. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
L5 to S2
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Retrograde ejaculation

24. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
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
Carpal tunnel syndrom

25. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Subphrenic abscess or other abdominal abscesses; order US or CT
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Displaced ORIF ; nondisplaced sling immobilization
If any compressive symptoms eg. dysphagia

26. Complications of breast impant
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
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
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

27. How to dx ACL tear?
Compression stocking - weight reduction - leg elevation
Malignancy until proven otherwise
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
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

28. painless testicular mass in young male
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Malignancy until proven otherwise
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
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

29. What is hungry bone syndrome?
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
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Dumping syndrome; small and frequent meals; no simple sugar

30. most common complication of acute cholecystitis
Retrograde ejaculation
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

31. characteristics of ureteral stone?
Pure motor stroke; limited neurological dysfunction
24-48 hours of supportive therapy followed by cholecystectomy
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

32. most frequent complication of TURP
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Retrograde ejaculation
Study showed no adverse effect; but they are contraindicated for PVD

33. xray finding of stress fx after 3-4w
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
If patient ambulatory - surgery and pain control; if not nonop mx
Meniscus injury; medial most common; pain/swelling; popping sensation
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

34. Can we use beta blocker for pvd?
CRPS
Study showed no adverse effect; but they are contraindicated for PVD
SAH due to post communicating artery aneurysm;
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

35. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Compression stocking - weight reduction - leg elevation
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
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

36. prostate enlarged - nontender - no nodularity - elevated PSA
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
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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

37. 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
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
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

38. stress fx
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
If patient ambulatory - surgery and pain control; if not nonop mx
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

39. 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
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;
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion

40. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
Pure motor stroke; limited neurological dysfunction
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
CRPS

41. perioral numbness after parathyroidectomy
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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
Dm neuropathy; stocking glove pattern
Patellar tendon tear; difficulty in extension

42. How to evaluate painless testicular swelling suspicious for cancer
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Pure motor stroke; limited neurological dysfunction

43. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
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;
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Supraglottic edema; low threshold for intubation
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

44. tx distal rectal ca
Low anterior resection and radio; add chemo if node positive
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Seminomas

45. anal sphincter tone
50%; tunneling between rectum or kin
S2-S4
Klinefelter syndrome; 50 fold increase;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

46. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
Pure motor stroke; limited neurological dysfunction
SAH due to post communicating artery aneurysm;
Meniscus injury; medial most common; pain/swelling; popping sensation
Low anterior resection and radio; add chemo if node positive

47. 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
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Malignancy until proven otherwise

48. dumping syndrome after gastrectomy
Epi and chest compressio for prolong period of time; atropine is given after epi;
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea

49. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
Headache - ataxia - bulbar dysfunction
Meniscus injury; medial most common; pain/swelling; popping sensation
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

50. lacerated wound in palmer surface of hand. what structure is injured?
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Tendons more likely

Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?

Major Subjects
Tests & Exams AP CLEP DSST GRE SAT GMAT	Certifications CISSP go to https://www.isc2.org/ PMP ITIL RHCE MCTS More...	IT Skills Android Programming Data Modeling Objective C Programming Basic Python Programming Adobe Illustrator More...	Business Skills Advertising Techniques Business Accounting Basics Business Strategy Human Resource Management Marketing Basics More...
Soft Skills Body Language People Skills Public Speaking Persuasion Job Hunting And Resumes More...	Vocabulary GRE Vocab SAT Vocab TOEFL Essential Vocab Basic English Words For All Global Words You Should Know Business English More...	Languages AP German Vocab AP Latin Vocab SAT Subject Test: French Italian Survival Norwegian Survival More...	Engineering Audio Engineering Computer Science Engineering Aerospace Engineering Chemical Engineering Structural Engineering More...
Health Sciences Basic Nursing Skills Health Science Language Fundamentals Veterinary Technology Medical Language Cardiology Clinical Surgery More...	English Grammar Fundamentals Literary And Rhetorical Vocab Elements Of Style Vocab Introduction To English Major Complete Advanced Sentences Literature Homonyms More...	Math Algebra Formulas Basic Arithmetic: Measurements Metric Conversions Geometric Properties Important Math Facts Number Sense Vocab Business Math More...	Other Major Subjects Science Economics History Law Performing-arts Cooking Logic & Reasoning Trivia

Test your basic knowledge |

USMLE Step3 Surgery

Sorry!:) No result found.

Can you answer 50 questions in 15 minutes?

Let me suggest you:

Browse all subjects

Browse all tests

Most popular tests

Major Subjects

Tests & Exams

Certifications

IT Skills

Business Skills

Soft Skills

Vocabulary

Languages

Engineering

Health Sciences

English

Math

Other Major Subjects

Browse all subjects

Browse all tests

Most popular tests