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. lacunar stroke
Strok and traumatic brain injury
Pure motor stroke; limited neurological dysfunction
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

2. what size of ureteral stone for non op mx
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Less than 5mm

3. SOB - confusion - petechial rash after trauma - fracture
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
4-6 weeks for noncontact sports and longer time for contact sports

4. management of gunshot wound
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
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
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
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

5. How to perform lachman test
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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;

6. cremasteric reflex
Amoxicillin-clavulanate
Brardycardia - HTN - resp depression
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Seminomas

7. dorsiflexion and planter flexion
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
L5 to S2
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
S2-S4

8. antibiotics of acute cholecystitis
Abd pain and tenderness; bloody diarrhoea or hematochezia
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Ampicillin sublactum - pipercillin - ceftriaxone and metro

9. 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
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Retrograde ejaculation
Headache - ataxia - bulbar dysfunction

10. What is the strongest risk factor for male breast cancer
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Klinefelter syndrome; 50 fold increase;
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Pure motor stroke; limited neurological dysfunction

11. Why right varicocele is more concerning?

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

12. most frequent complication of TURP
If patient ambulatory - surgery and pain control; if not nonop mx
Fx displace >1mm - nonunion during followup - osteonecrosis
Retrograde ejaculation
SAH due to post communicating artery aneurysm;

13. severe pain in leg after MVC
Seminomas
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
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

14. varicose veins with ulcer - bleeding and thrombophlebitits
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Displaced ORIF ; nondisplaced sling immobilization
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
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

15. What is hungry bone syndrome?
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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
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
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

16. management of hip fracture
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Meniscus injury; medial most common; pain/swelling; popping sensation
If any compressive symptoms eg. dysphagia
If patient ambulatory - surgery and pain control; if not nonop mx

17. midline neck swelling moves with protrusion of tongue
Brardycardia - HTN - resp depression
Unilateral vocal cord paralysis
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

18. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
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
Elderly and critically ill patients

19. DD of acute scrotal pain
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Subphrenic abscess or other abdominal abscesses; order US or CT
S2-S4

20. When do we see complications due to hypophosphatemia
Epi and chest compressio for prolong period of time; atropine is given after epi;
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;
Dm neuropathy; stocking glove pattern
15-40%; self limiting;doesn't require tx

21. varicocele
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
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Urethral stricture; pelvic of urethral trauma

22. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Dumping syndrome; small and frequent meals; no simple sugar
Study showed no adverse effect; but they are contraindicated for PVD
Check ET tube placement if correct needle decompresion
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

23. What is the contraindication of hyperventilation in inc ICP
Even after ochiopexy risk of ochiopexy higher then general population
Strok and traumatic brain injury
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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

24. common complication of inadequate mx of scaphoid fx
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Compression stocking - weight reduction - leg elevation
Nonunion and avascular necrosis; fx can block blood supply;

25. Indication for bariatric surgery in obese patients
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
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
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;

26. differential of ultrasound finding of breast mass
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
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
When urethral catherization is unsuccessful

27. What is most common lung injury after blunt chest trauma?
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
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
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

28. anal sphincter tone
S2-S4
24-48 hours of supportive therapy followed by cholecystectomy
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

29. When goiter needs surgery
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
If any compressive symptoms eg. dysphagia
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

30. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
SAH due to post communicating artery aneurysm;

31. mx of stress fx
SAH due to post communicating artery aneurysm;
Amoxicillin-clavulanate
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Klinefelter syndrome; 50 fold increase;

32. diarrhoea after gastric bypass
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Dumping syndrome; small and frequent meals; no simple sugar
SAH due to post communicating artery aneurysm;

33. How to differentiate ACL and meniscus injury
Tendons more likely
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
Mammogram
Retrograde ejaculation

34. Patient underwent CABG; postoperatively drowsy. most likely cause?
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
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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
Twisting force with the foot fixed on the ground seen in football and basketball games;

35. surgery for acute cholecystities
Subphrenic abscess or other abdominal abscesses; order US or CT
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Epi and chest compressio for prolong period of time; atropine is given after epi;
24-48 hours of supportive therapy followed by cholecystectomy

36. Dupuytren contracture
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Progressive fibrosis of palmar fascia. etiololgy not known;

37. SAH due to posterior inferior cerebellar aneurysm
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
Headache - ataxia - bulbar dysfunction
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Dumping syndrome; small and frequent meals; no simple sugar

38. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Dumping syndrome; small and frequent meals; no simple sugar
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

39. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Check ET tube placement if correct needle decompresion
Tendons more likely

40. pregnant patient with asymptomatic gall stones
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

41. stress fx
Subphrenic abscess or other abdominal abscesses; order US or CT
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

42. diarrhoea 4-5 days after cholecystectomy
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Check ET tube placement if correct needle decompresion
Malignancy until proven otherwise
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

43. tx distal rectal ca
Sphincter sparing surgery (local resection) - abdomnio perineal resection
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;
4-6 weeks for noncontact sports and longer time for contact sports

44. menisci injury
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Displaced ORIF ; nondisplaced sling immobilization
Twisting force with the foot fixed on the ground seen in football and basketball games;

45. What is cushing's triad
Klinefelter syndrome; 50 fold increase;
Supraglottic edema; low threshold for intubation
Brardycardia - HTN - resp depression
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

46. dumping syndrome after gastrectomy
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
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;

47. What is terrible triad
Mammogram
CRPS
MAT; medial meniscus injury; ACL and Tibial colateral ligament
SAH due to post communicating artery aneurysm;

48. What time frame required for bone remodeling
Amoxicillin-clavulanate
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
10-12 months
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

49. Valgus and Varus tests
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Mammogram
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

50. 27 yo with scrotal mass; warm tender testes feel like bag of worms
24-48 hours of supportive therapy followed by cholecystectomy
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea