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. When do we see complications due to hypophosphatemia
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;
Progressive fibrosis of palmar fascia. etiololgy not known;
It can take up to 2 weeks to show fx; if high clinical suspicion MRI is ideal test when xray neg - which differentiate ligament injury vs bone fx
Headache - ataxia - bulbar dysfunction

2. aspiration of breast cyst is nonbloody
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Elevated non seminomas
Less than 5mm
SAH due to post communicating artery aneurysm;

3. 27 yo with scrotal mass; warm tender testes feel like bag of worms
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Klinefelter syndrome; 50 fold increase;
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

4. How to manage a patient with asystole
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Amoxicillin-clavulanate
Epi and chest compressio for prolong period of time; atropine is given after epi;

5. What types of breast implants are available
Saline and silicone
S2-S4
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
When urethral catherization is unsuccessful

6. MVC - unrestrained driver - chest bruises - peripheral cyanosis - tachycardia and tahypnoea
Progressive fibrosis of palmar fascia. etiololgy not known;
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Tendons more likely

7. When patient can go back to sports after clavicle fx
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
4-6 weeks for noncontact sports and longer time for contact sports
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

8. Dupuytren contracture
Fx displace >1mm - nonunion during followup - osteonecrosis
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
Progressive fibrosis of palmar fascia. etiololgy not known;
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;

9. painless testicular mass in young male
Malignancy until proven otherwise
Cystic scrotal fluid collection between parietal and visceral layers of testis
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
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

10. Can we use beta blocker for pvd?
Study showed no adverse effect; but they are contraindicated for PVD
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
MAT; medial meniscus injury; ACL and Tibial colateral ligament
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram

11. Tx of pulmonary contusion
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
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;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Progressive fibrosis of palmar fascia. etiololgy not known;

12. management of gunshot wound
Urethral stricture; pelvic of urethral trauma
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
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
10-12 months

13. ipsilateral deviation of tongue upon protrusion
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Unilateral vocal cord paralysis
Urethral stricture; pelvic of urethral trauma
Ispilateral hypoglossal nerve injury

14. management of hip fracture
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
Urethral stricture; pelvic of urethral trauma
If patient ambulatory - surgery and pain control; if not nonop mx
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

15. aspiration of breast cyst is bloody
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
Mammogram
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;
15-40%; self limiting;doesn't require tx

16. 3 weeks after trauma - intense pain - swelling - dec ROM - skin changes
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
Supraglottic edema; low threshold for intubation
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
15-40%; self limiting;doesn't require tx

17. How to perform lachman test
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Malignancy until proven otherwise

18. common complication of inadequate mx of scaphoid fx
L5 to S2
Nonunion and avascular necrosis; fx can block blood supply;
Even after ochiopexy risk of ochiopexy higher then general population
Klinefelter syndrome; 50 fold increase;

19. diarrhoea after gastric bypass
Dumping syndrome; small and frequent meals; no simple sugar
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Elevated non seminomas
Carpal tunnel syndrom

20. transrectal prostate biopsy
Ant drawer test; foot placed on exam table; both hand behind knee to push it anteriorly; a difference of 1 cm compared with the opposite side suggests complete ACL tear
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

21. Patient underwent CABG; postoperatively drowsy. most likely cause?
15-40%; self limiting;doesn't require tx
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
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
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

22. acute colonic ischemia
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Abd pain and tenderness; bloody diarrhoea or hematochezia
50%; tunneling between rectum or kin
Carpal tunnel syndrom

23. 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
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
Strok and traumatic brain injury
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

24. sudden onset of severe periumbilical pain/n/v; AF; hx of MI
If patient ambulatory - surgery and pain control; if not nonop mx
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
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

25. ct scan; cystic lesion in head of pancreas; next step
Headache - ataxia - bulbar dysfunction
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
Ispilateral hypoglossal nerve injury

26. mangement of localized lymphadenopathy
Patellar tendon tear; difficulty in extension
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx

27. What is the strongest risk factor for male breast cancer
Klinefelter syndrome; 50 fold increase;
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
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;

28. varicocele
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;
50%; tunneling between rectum or kin
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
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

29. managment of animal bite in hands
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
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;

30. How to dx ACL tear?
Elderly and critically ill patients
Abd pain and tenderness; bloody diarrhoea or hematochezia
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

31. beta hcg and AFP
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Elevated non seminomas
Elderly and critically ill patients
Strok and traumatic brain injury

32. popping sensation; rapid onset of knee effusion. athelet
ACL injury
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;
10-12 months
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

33. menisci injury
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Twisting force with the foot fixed on the ground seen in football and basketball games;
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
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

34. scrotal trauma
Nonunion and avascular necrosis; fx can block blood supply;
Next best step surgery; not ultrasound
Twisting force with the foot fixed on the ground seen in football and basketball games;
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

35. How to confirm dx of compartment syndrom
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Pure motor stroke; limited neurological dysfunction

36. When goiter needs surgery
If any compressive symptoms eg. dysphagia
Less than 5mm
15-40%; self limiting;doesn't require tx
Subphrenic abscess or other abdominal abscesses; order US or CT

37. types of hip fracture
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
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
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Carpal tunnel syndrom

38. cat/dog bites
Amoxicillin-clavulanate
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
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

39. what size of ureteral stone for non op mx
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
Ispilateral hypoglossal nerve injury
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Less than 5mm

40. 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
MAT; medial meniscus injury; ACL and Tibial colateral ligament
If patient ambulatory - surgery and pain control; if not nonop mx
Increased size during the day and valsalva means it is communicated with peritoneal cavity

41. management of nondisplaced scaphoid fx
Retrograde ejaculation
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Even after ochiopexy risk of ochiopexy higher then general population

42. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
50%; tunneling between rectum or kin
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Malignancy until proven otherwise

43. lacerated wound in palmer surface of hand. what structure is injured?
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Tendons more likely
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
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

44. most common fx when falling on outsretched hand
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Even after ochiopexy risk of ochiopexy higher then general population
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

45. most common complication of acute cholecystitis
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Study showed no adverse effect; but they are contraindicated for PVD
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
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

46. SOB - confusion - petechial rash after trauma - fracture
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Carpal tunnel syndrom

47. stress fx
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Klinefelter syndrome; 50 fold increase;
Fx displace >1mm - nonunion during followup - osteonecrosis
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset

48. Why right varicocele is more concerning?

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

49. sudden onset of postoperative hyperglycemia when patient on TPN
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
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

50. how ABI help dx of PVD
Check ET tube placement if correct needle decompresion
S2-S4
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

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