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. Tx of pulmonary contusion
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Ispilateral hypoglossal nerve injury
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury

2. most common fx when falling on outsretched hand
S2-S4
Cystic scrotal fluid collection between parietal and visceral layers of testis
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

3. Why initial xrays are negative in scaphoid fx
Amoxicillin-clavulanate
50%; tunneling between rectum or kin
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
Next best step surgery; not ultrasound

4. management of gunshot wound
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
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction

5. when scaphoid fx patient needs to be referred to orthopedic
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Fx displace >1mm - nonunion during followup - osteonecrosis
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

6. anal sphincter tone
S2-S4
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
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

7. severe pain in leg after MVC
Malignancy until proven otherwise
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
Compression stocking - weight reduction - leg elevation
15-40%; self limiting;doesn't require tx

8. when patient with severe lung disease have C02 retention
10-12 months
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
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Epi and chest compressio for prolong period of time; atropine is given after epi;

9. Most common of sudden death due to steering wheel injury
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
4-6 weeks for noncontact sports and longer time for contact sports
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

10. management of nondisplaced scaphoid fx
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Dumping syndrome; small and frequent meals; no simple sugar
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
24-48 hours of supportive therapy followed by cholecystectomy

11. Complications of breast impant
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Check ET tube placement if correct needle decompresion
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

12. 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
Cystic scrotal fluid collection between parietal and visceral layers of testis
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;
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

13. clavicle fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Displaced ORIF ; nondisplaced sling immobilization
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Retrograde ejaculation

14. How to evaluate painless testicular swelling suspicious for cancer
Next best step surgery; not ultrasound
15-40%; self limiting;doesn't require tx
S2-S4
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

15. 3 mo with groin bulge; bulge appears when child cries
Progressive fibrosis of palmar fascia. etiololgy not known;
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

16. most common complication of acute cholecystitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Abd pain and tenderness; bloody diarrhoea or hematochezia
Elevated non seminomas
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

17. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Twisting force with the foot fixed on the ground seen in football and basketball games;
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;
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Nonunion and avascular necrosis; fx can block blood supply;

18. cremasteric reflex test?
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
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
ACL injury
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

19. common complication of inadequate mx of scaphoid fx
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Less than 5mm
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Nonunion and avascular necrosis; fx can block blood supply;

20. ipsilateral deviation of tongue upon protrusion
Ispilateral hypoglossal nerve injury
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
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

21. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Check ET tube placement if correct needle decompresion
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
CRPS
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

22. What is hydrocele?
Cystic scrotal fluid collection between parietal and visceral layers of testis
Mammogram
If patient ambulatory - surgery and pain control; if not nonop mx
50%; tunneling between rectum or kin

23. lacunar stroke
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Strok and traumatic brain injury
Pure motor stroke; limited neurological dysfunction

24. 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
10-12 months
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Dumping syndrome; small and frequent meals; no simple sugar

25. What is hungry bone syndrome?
Meniscus injury; medial most common; pain/swelling; popping sensation
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
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;

26. How to differentiate communicative and non-communicative hydrocele
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
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

27. SOB - confusion - petechial rash after trauma - fracture
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
L5 to S2

28. aspiration of breast cyst is bloody
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
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
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

29. Can we use beta blocker for pvd?
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Study showed no adverse effect; but they are contraindicated for PVD
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

30. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Low anterior resection and radio; add chemo if node positive
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

31. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
CRPS
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

32. How to confirm dx of compartment syndrom
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
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Compression stocking - weight reduction - leg elevation
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

33. how ABI help dx of PVD
Next best step surgery; not ultrasound
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.

34. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
Subphrenic abscess or other abdominal abscesses; order US or CT
50%; tunneling between rectum or kin
Urethral stricture; pelvic of urethral trauma
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

35. differential of ultrasound finding of breast mass
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;
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
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

36. management of stone 8-10mm
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;
24-48 hours of supportive therapy followed by cholecystectomy
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

37. acalculus cholecystitis
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Cystic scrotal fluid collection between parietal and visceral layers of testis
Elderly and critically ill patients
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

38. what size of ureteral stone for non op mx
Less than 5mm
CRPS
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;
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

39. What types of breast implants are available
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Saline and silicone
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
Urethral stricture; pelvic of urethral trauma

40. Why ruq calcificaion is concerning
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Tendons more likely
Mammogram

41. beta HCG
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
Seminomas
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

42. pregnant patient with asymptomatic gall stones
Elderly and critically ill patients
If patient ambulatory - surgery and pain control; if not nonop mx
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole

43. DD of acute scrotal pain
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
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
When urethral catherization is unsuccessful

44. When to do surgery in undesceneded testis?
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Klinefelter syndrome; 50 fold increase;
Amoxicillin-clavulanate
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

45. Indication for bariatric surgery in obese patients
4-6 weeks for noncontact sports and longer time for contact sports
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
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;

46. When to stop raloxifene before surgery
Low anterior resection and radio; add chemo if node positive
Increased size during the day and valsalva means it is communicated with peritoneal cavity
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Abd pain and tenderness; bloody diarrhoea or hematochezia

47. characteristics of ureteral stone?
CRPS
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

48. management of hip fracture
Low anterior resection and radio; add chemo if node positive
Fx displace >1mm - nonunion during followup - osteonecrosis
Cystic scrotal fluid collection between parietal and visceral layers of testis
If patient ambulatory - surgery and pain control; if not nonop mx

49. How to confirm achiles tendon rupture
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
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

50. dumping syndrome after gastrectomy
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Klinefelter syndrome; 50 fold increase;

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