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. What is cushing's triad
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
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
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Brardycardia - HTN - resp depression

2. How to confirm achiles tendon rupture
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Pure motor stroke; limited neurological dysfunction
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
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

3. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
SAH due to post communicating artery aneurysm;
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
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
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

4. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Tendons more likely
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;

5. Why right varicocele is more concerning?

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

6. What is hydrocele?
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Cystic scrotal fluid collection between parietal and visceral layers of testis
Twisting force with the foot fixed on the ground seen in football and basketball games;

7. How to manage a patient with asystole
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;
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
Epi and chest compressio for prolong period of time; atropine is given after epi;
Twisting force with the foot fixed on the ground seen in football and basketball games;

8. How to perform lachman test
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Nonunion and avascular necrosis; fx can block blood supply;

9. scrotal trauma
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Next best step surgery; not ultrasound
Study showed no adverse effect; but they are contraindicated for PVD

10. differential of ultrasound finding of breast mass
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
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
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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. diarrhoea 4-5 days after cholecystectomy
Seminomas
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

12. How to dx ACL tear?
Brardycardia - HTN - resp depression
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
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
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial

13. xray finding of stress fx after 3-4w
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Headache - ataxia - bulbar dysfunction

14. 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.
Saline and silicone
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
Tendons more likely

15. when scaphoid fx patient needs to be referred to orthopedic
Displaced ORIF ; nondisplaced sling immobilization
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Fx displace >1mm - nonunion during followup - osteonecrosis
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

16. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Compression stocking - weight reduction - leg elevation
50%; tunneling between rectum or kin
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

17. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
Dm neuropathy; stocking glove pattern
Displaced ORIF ; nondisplaced sling immobilization
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA

18. stress fx
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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

19. Why initial xrays are negative in scaphoid fx
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 lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Dm neuropathy; stocking glove pattern
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

20. perioral numbness after parathyroidectomy
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
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
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
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

21. lacerated wound in palmer surface of hand. what structure is injured?
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Abd pain and tenderness; bloody diarrhoea or hematochezia
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
Tendons more likely

22. mx of stress fx
Compression stocking - weight reduction - leg elevation
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
Malignancy until proven otherwise
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile

23. Why varicocele more common in the left side
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Study showed no adverse effect; but they are contraindicated for PVD
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

24. contraindication of urethral catheterization
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Urethral stricture; pelvic of urethral trauma
Saline and silicone
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

25. When goiter needs surgery
If any compressive symptoms eg. dysphagia
Pure motor stroke; limited neurological dysfunction
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
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

26. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
CRPS
When urethral catherization is unsuccessful
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area

27. What is the complications of undescended testis
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Even after ochiopexy risk of ochiopexy higher then general population

28. young patient with s/s mitral valve obstruction - now p/w diminished unitlateral pulses - foot pain and cold extremity
Seminomas
Saline and silicone
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;
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu

29. Tx of pulmonary contusion
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

30. severe pain in leg after MVC
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
Headache - ataxia - bulbar dysfunction
CRPS

31. management of nondisplaced scaphoid fx
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
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;
10-12 months
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

32. anal sphincter tone
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
S2-S4
When urethral catherization is unsuccessful

33. swelling and tenderness in anterior part of knee
Patellar tendon tear; difficulty in extension
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
Amoxicillin-clavulanate
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

34. most frequent complication of TURP
Retrograde ejaculation
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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

35. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Malignancy until proven otherwise
Subphrenic abscess or other abdominal abscesses; order US or CT

36. 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
Meniscus injury; medial most common; pain/swelling; popping sensation
Less than 5mm
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum

37. How to evaluate painless testicular swelling suspicious for cancer
Brardycardia - HTN - resp depression
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Increased size during the day and valsalva means it is communicated with peritoneal cavity

38. surgery for acute cholecystities
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
Abd pain and tenderness; bloody diarrhoea or hematochezia
24-48 hours of supportive therapy followed by cholecystectomy
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

39. suprapubic catheterization
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
When urethral catherization is unsuccessful
If any compressive symptoms eg. dysphagia
Epi and chest compressio for prolong period of time; atropine is given after epi;

40. 27 yo with scrotal mass; warm tender testes feel like bag of worms
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
MAT; medial meniscus injury; ACL and Tibial colateral ligament

41. indication of ursodeoxycholic acid
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
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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

42. midline neck swelling moves with protrusion of tongue
CRPS
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
If any compressive symptoms eg. dysphagia
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis

43. types of hip fracture
SAH due to post communicating artery aneurysm;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

44. popping sensation; rapid onset of knee effusion. athelet
CRPS
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
ACL injury

45. first line of management of PVD
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
When urethral catherization is unsuccessful

46. how hyperventilation lowers ICP
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
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
Elevated non seminomas
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

47. Patient underwent CABG; postoperatively drowsy. most likely cause?
Next best step surgery; not ultrasound
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
Epi and chest compressio for prolong period of time; atropine is given after epi;
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

48. How mcmurray manuver perform
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
S2-S4
Displaced ORIF ; nondisplaced sling immobilization

49. What is terrible triad
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
If large surgical ligation and stipping. if small - try conservation tx if fails after 3-6m - inject sclerosing agent into veins
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Cystic scrotal fluid collection between parietal and visceral layers of testis

50. clavicle fx
When urethral catherization is unsuccessful
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Carpal tunnel syndrom
Displaced ORIF ; nondisplaced sling immobilization

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