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. most common complication of acute cholecystitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
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

2. painless testicular mass in young male
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
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;
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
Malignancy until proven otherwise

3. antibiotics of acute cholecystitis
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Abd pain and tenderness; bloody diarrhoea or hematochezia
Nonunion and avascular necrosis; fx can block blood supply;

4. diarrhoea after gastric bypass
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Even after ochiopexy risk of ochiopexy higher then general population
Dumping syndrome; small and frequent meals; no simple sugar

5. prostate enlarged - nontender - no nodularity - elevated PSA
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
Brardycardia - HTN - resp depression
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
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

6. Most common of sudden death due to steering wheel injury
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
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Ispilateral hypoglossal nerve injury
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

7. Why right varicocele is more concerning?

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

8. surgery for acute cholecystities
24-48 hours of supportive therapy followed by cholecystectomy
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;
50%; tunneling between rectum or kin

9. Can we use beta blocker for pvd?
Headache - ataxia - bulbar dysfunction
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Study showed no adverse effect; but they are contraindicated for PVD
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

10. How varicocele causes testicular atrophy
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

11. stress fx
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Carpal tunnel syndrom

12. 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
Nonunion and avascular necrosis; fx can block blood supply;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

13. managment of animal bite in hands
Ampicillin sublactum - pipercillin - ceftriaxone and metro
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;
Amoxicillin-clavulanate
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

14. What is the contraindication of hyperventilation in inc ICP
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
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Strok and traumatic brain injury
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

15. dumping syndrome after gastrectomy
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Progressive fibrosis of palmar fascia. etiololgy not known;
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

16. How to confirm dx of compartment syndrom
Dm neuropathy; stocking glove pattern
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
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

17. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Patellar tendon tear; difficulty in extension
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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

18. how hyperventilation lowers ICP
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

19. conservative Tx of varicose veins
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
Supraglottic edema; low threshold for intubation
Compression stocking - weight reduction - leg elevation
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

20. What is prehn sign?
S2-S4
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
15-40%; self limiting;doesn't require tx

21. swelling and tenderness in anterior part of knee
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Carpal tunnel syndrom
Patellar tendon tear; difficulty in extension

22. management of nondisplaced scaphoid fx
S2-S4
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Brardycardia - HTN - resp depression
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg

23. What is cushing's triad
Carpal tunnel syndrom
Brardycardia - HTN - resp depression
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

24. What are the common injuries from lightning?
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
24-48 hours of supportive therapy followed by cholecystectomy
L5 to S2

25. How to evaluate painless testicular swelling suspicious for cancer
Carpal tunnel syndrom
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

26. first line of management of PVD
Low anterior resection and radio; add chemo if node positive
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Nonunion and avascular necrosis; fx can block blood supply;

27. When to do surgery in undesceneded testis?
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Less than 5mm
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Subphrenic abscess or other abdominal abscesses; order US or CT

28. aspiration of breast cyst is bloody
Mammogram
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

29. most common fx when falling on outsretched hand
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Headache - ataxia - bulbar dysfunction

30. indication of ursodeoxycholic acid
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
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
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

31. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Displaced ORIF ; nondisplaced sling immobilization
If any compressive symptoms eg. dysphagia
L5 to S2

32. How to differentiate communicative and non-communicative hydrocele
Carpal tunnel syndrom
50%; tunneling between rectum or kin
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
Increased size during the day and valsalva means it is communicated with peritoneal cavity

33. 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
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches

34. 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
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
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
10-12 months

35. aspiration of breast cyst is nonbloody
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
Elevated non seminomas
24-48 hours of supportive therapy followed by cholecystectomy

36. How to manage a patient with asystole
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
Dumping syndrome; small and frequent meals; no simple sugar
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Epi and chest compressio for prolong period of time; atropine is given after epi;

37. transrectal prostate biopsy
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
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 could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

38. Why ruq calcificaion is concerning
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
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Klinefelter syndrome; 50 fold increase;
Displaced ORIF ; nondisplaced sling immobilization

39. ipsilateral deviation of tongue upon protrusion
Progressive fibrosis of palmar fascia. etiololgy not known;
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Ispilateral hypoglossal nerve injury
Compression stocking - weight reduction - leg elevation

40. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Check ET tube placement if correct needle decompresion
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx

41. varicocele
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
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;
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position

42. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Progressive fibrosis of palmar fascia. etiololgy not known;
Headache - ataxia - bulbar dysfunction
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

43. pregnant patient with asymptomatic gall stones
Next best step surgery; not ultrasound
Mammogram
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole

44. cat/dog bites
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Klinefelter syndrome; 50 fold increase;
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Amoxicillin-clavulanate

45. lacerated wound in palmer surface of hand. what structure is injured?
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Tendons more likely
If patient ambulatory - surgery and pain control; if not nonop mx
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

46. cremasteric reflex test?
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Ampicillin sublactum - pipercillin - ceftriaxone and metro
MAT; medial meniscus injury; ACL and Tibial colateral ligament

47. What types of breast implants are available
4-6 weeks for noncontact sports and longer time for contact sports
Saline and silicone
Headache - ataxia - bulbar dysfunction
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

48. acalculus cholecystitis
4-6 weeks for noncontact sports and longer time for contact sports
Elderly and critically ill patients
Mammogram
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole

49. diarrhoea 4-5 days after cholecystectomy
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;
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Epi and chest compressio for prolong period of time; atropine is given after epi;
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

50. when patient with severe lung disease have C02 retention
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
When urethral catherization is unsuccessful
Ampicillin sublactum - pipercillin - ceftriaxone and metro
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

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