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Test your basic knowledge |
USMLE Step3 Surgery
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Study First
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. How to confirm dx of compartment syndrom
Study showed no adverse effect; but they are contraindicated for PVD
Twisting force with the foot fixed on the ground seen in football and basketball games;
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
2. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
SAH due to post communicating artery aneurysm;
Study showed no adverse effect; but they are contraindicated for PVD
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Check ET tube placement if correct needle decompresion
3. Can we use beta blocker for pvd?
Next best step surgery; not ultrasound
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
Strok and traumatic brain injury
Study showed no adverse effect; but they are contraindicated for PVD
4. Most common of sudden death due to steering wheel injury
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
CRPS
Less than 5mm
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
5. acute colonic ischemia
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Dumping syndrome; small and frequent meals; no simple sugar
Ampicillin sublactum - pipercillin - ceftriaxone and metro
Abd pain and tenderness; bloody diarrhoea or hematochezia
6. beta HCG
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Fx displace >1mm - nonunion during followup - osteonecrosis
Even after ochiopexy risk of ochiopexy higher then general population
Seminomas
7. aspiration of breast cyst is bloody
Mammogram
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
Progressive fibrosis of palmar fascia. etiololgy not known;
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
8. When patient can go back to sports after clavicle fx
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
4-6 weeks for noncontact sports and longer time for contact sports
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
9. conservative Tx of varicose veins
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
Epi and chest compressio for prolong period of time; atropine is given after epi;
Compression stocking - weight reduction - leg elevation
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
10. management of hip fracture
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
If patient ambulatory - surgery and pain control; if not nonop mx
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
11. suprapubic catheterization
Dumping syndrome; small and frequent meals; no simple sugar
When urethral catherization is unsuccessful
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
12. MVC - unresponsive - bleeding from head - decr RR - unilat pupilary dilation - seizure
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Abd pain and tenderness; bloody diarrhoea or hematochezia
Carpal tunnel syndrom
Seminomas
13. Tx of proximal non metastatic rectal ca
Low anterior resection and radio; add chemo if node positive
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Colicky; waxing and waning; upper ureteral stone-pain in flank; lower ureteral stone pain radiates to ipsilateral groin area
14. common complication of inadequate mx of scaphoid fx
15-40%; self limiting;doesn't require tx
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy
Nonunion and avascular necrosis; fx can block blood supply;
15. How to dx ACL tear?
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
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
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
4-6 weeks for noncontact sports and longer time for contact sports
16. ct scan; cystic lesion in head of pancreas; next step
Epi and chest compressio for prolong period of time; atropine is given after epi;
Mammogram
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
17. severe pain in leg after MVC
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
Atrial myxoma; look for suden onset of symptoms which most likely an embolus; myxoma frequently embolize to systemic circu
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
18. What types of breast implants are available
Saline and silicone
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Seminomas
Pure motor stroke; limited neurological dysfunction
19. diarrhoea 4-5 days after cholecystectomy
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
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
20. dumping syndrome after gastrectomy
When urethral catherization is unsuccessful
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
21. How to perform lachman test
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
Klinefelter syndrome; 50 fold increase;
Headache - ataxia - bulbar dysfunction
Next best step surgery; not ultrasound
22. cremasteric reflex test?
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
ACL injury
Ispilateral hypoglossal nerve injury
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
23. antibiotics of acute cholecystitis
Ampicillin sublactum - pipercillin - ceftriaxone and metro
ACL injury
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Less than 5mm
24. differential of ultrasound finding of breast mass
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
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
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
25. Why right varicocele is more concerning?
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26. prostate enlarged - nontender - no nodularity - elevated PSA
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Epi and chest compressio for prolong period of time; atropine is given after epi;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Rechechek PSA in 2-4 weeks; BPH can have elevated PSA
27. varicocele
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Increased size during the day and valsalva means it is communicated with peritoneal cavity
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
28. tx distal rectal ca
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
29. most common fx when falling on outsretched hand
Less than 5mm
Progressive fibrosis of palmar fascia. etiololgy not known;
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Ampicillin sublactum - pipercillin - ceftriaxone and metro
30. What is the contraindication of hyperventilation in inc ICP
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Strok and traumatic brain injury
Brardycardia - HTN - resp depression
31. lacunar stroke
Pure motor stroke; limited neurological dysfunction
Urethral stricture; pelvic of urethral trauma
Elevated non seminomas
Epi and chest compressio for prolong period of time; atropine is given after epi;
32. What is terrible triad
50%; tunneling between rectum or kin
MAT; medial meniscus injury; ACL and Tibial colateral ligament
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)
33. 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
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Low anterior resection and radio; add chemo if node positive
Mammogram
34. Why initial xrays are negative in scaphoid fx
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
If patient ambulatory - surgery and pain control; if not nonop mx
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
When urethral catherization is unsuccessful
35. What is the strongest risk factor for male breast cancer
MAT; medial meniscus injury; ACL and Tibial colateral ligament
Klinefelter syndrome; 50 fold increase;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
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;
36. When to stop raloxifene before surgery
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Sphincter sparing surgery (local resection) - abdomnio perineal resection
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
37. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
4-6 weeks for noncontact sports and longer time for contact sports
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Cystic scrotal fluid collection between parietal and visceral layers of testis
Dm neuropathy; stocking glove pattern
38. xray finding of stress fx after 3-4w
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
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;
39. scrotal trauma
Headache - ataxia - bulbar dysfunction
Next best step surgery; not ultrasound
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
40. acalculus cholecystitis
Elderly and critically ill patients
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Low anterior resection and radio; add chemo if node positive
41. SAH due to posterior inferior cerebellar aneurysm
Brardycardia - HTN - resp depression
10-12 months
Even after ochiopexy risk of ochiopexy higher then general population
Headache - ataxia - bulbar dysfunction
42. transrectal prostate biopsy
Amoxicillin-clavulanate
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
If patient ambulatory - surgery and pain control; if not nonop mx
43. surgery for acute cholecystities
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
24-48 hours of supportive therapy followed by cholecystectomy
Unilateral vocal cord paralysis
Saline and silicone
44. How varicocele causes testicular atrophy
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Pure motor stroke; limited neurological dysfunction
45. recurrent laryngeal nerve injury
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
15-40%; self limiting;doesn't require tx
Unilateral vocal cord paralysis
Dumping syndrome; small and frequent meals; no simple sugar
46. popping sensation; rapid onset of knee effusion. athelet
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
ACL injury
Nonunion and avascular necrosis; fx can block blood supply;
47. When goiter needs surgery
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
If any compressive symptoms eg. dysphagia
50%; tunneling between rectum or kin
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
48. mx of stress fx
Complete cessation of all physical activity for 4-6 weeks and gradual return to activity; NSAID and crutches
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Pure motor stroke; limited neurological dysfunction
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
49. sudden onset of postoperative hyperglycemia when patient on TPN
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
15-40%; self limiting;doesn't require tx
Nonunion and avascular necrosis; fx can block blood supply;
50. SOB - confusion - petechial rash after trauma - fracture
Progressive fibrosis of palmar fascia. etiololgy not known;
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
24-48 hours of supportive therapy followed by cholecystectomy
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy