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. desatig plus decreasesd breath sound in one side of chest in patient with ET tube
Check ET tube placement if correct needle decompresion
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Twisting force with the foot fixed on the ground seen in football and basketball games;
Mammogram

2. types of hip fracture
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
L5 to S2
Ispilateral hypoglossal nerve injury
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line

3. complication of distal radial fx and wrist fx splinted with palmar flexion at 15
CRPS
Meniscus injury; medial most common; pain/swelling; popping sensation
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

4. contraindication of urethral catheterization
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;
Meniscus injury; medial most common; pain/swelling; popping sensation
Urethral stricture; pelvic of urethral trauma
Check ET tube placement if correct needle decompresion

5. dorsiflexion and planter flexion
Elevated non seminomas
L5 to S2
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;

6. management of stone 8-10mm
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
15-40%; self limiting;doesn't require tx
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

7. SAH due to posterior inferior cerebellar aneurysm
Headache - ataxia - bulbar dysfunction
SAH due to post communicating artery aneurysm;
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
Dm neuropathy; stocking glove pattern

8. 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.
Seminomas
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
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

9. How to perform lachman test
SAH due to post communicating artery aneurysm;
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur

10. diarrhoea 4-5 days after cholecystectomy
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles
Abd pain and tenderness; bloody diarrhoea or hematochezia
Unilateral vocal cord paralysis
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

11. 27 yo with scrotal mass; warm tender testes feel like bag of worms
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Tendons more likely
Ispilateral hypoglossal nerve injury

12. common complication of inadequate mx of scaphoid fx
When urethral catherization is unsuccessful
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
Nonunion and avascular necrosis; fx can block blood supply;

13. SOB - confusion - petechial rash after trauma - fracture
When urethral catherization is unsuccessful
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
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
Fat embolism; they develop petechia coz dermal capillaries are occluded by fat particles

14. conservative Tx of varicose veins
Urethral stricture; pelvic of urethral trauma
Tendons more likely
Compression stocking - weight reduction - leg elevation
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

15. painless testicular mass in young male
<10mm and proximal: ESWL (extracorporeal shockwave lithotripsy) and >10 mm proximal and all distal: flexible ureterscopy and laser lithotripsy; dial
Amoxicillin-clavulanate
S2-S4
Malignancy until proven otherwise

16. 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
Even after ochiopexy risk of ochiopexy higher then general population
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
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

17. How to manage obesity
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
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;
15-40%; self limiting;doesn't require tx
Seminomas

18. Why ruq calcificaion is concerning
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
EUS and aspiration; most effective for biopsying LN - lesion in pancreas - liver - adrenal gland - bile duct - peritoneal and pleural fluid.
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;

19. How to differentiate communicative and non-communicative hydrocele
Low anterior resection and radio; add chemo if node positive
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Supraglottic edema; low threshold for intubation

20. first step for evaluation of testicular swelling
Subphrenic abscess or other abdominal abscesses; order US or CT
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Study showed no adverse effect; but they are contraindicated for PVD

21. What is prehn sign?
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Saline and silicone
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Unilateral vocal cord paralysis

22. When goiter needs surgery
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
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
If any compressive symptoms eg. dysphagia

23. Tx of proximal non metastatic rectal ca
Urethral stricture; pelvic of urethral trauma
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein
Varicocele; due to failure of obliteration of processus vaginalis; tx surgey asap to avoid incarceration
Low anterior resection and radio; add chemo if node positive

24. transrectal prostate biopsy
Seminomas
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA

25. popping sensation; rapid onset of knee effusion. athelet
ACL injury
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
Progressive fibrosis of palmar fascia. etiololgy not known;
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

26. What is terrible triad
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Ispilateral hypoglossal nerve injury
MAT; medial meniscus injury; ACL and Tibial colateral ligament
10-12 months

27. Indication for bariatric surgery in obese patients
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;
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
It lowers PCO2 to 25-30 mm hg and constricts cerebral vessels;
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

28. 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
Ispilateral hypoglossal nerve injury
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
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

29. lacunar stroke
Carpal tunnel syndrom
15-40%; self limiting;doesn't require tx
Pure motor stroke; limited neurological dysfunction
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal

30. pregnant patient with asymptomatic gall stones
If gall stones are asymptomatic - no tx; symptomatic patient- lap chole
50%; tunneling between rectum or kin
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
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

31. aspiration of breast cyst is bloody
Mammogram
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Unilateral vocal cord paralysis
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis

32. severe abd pain; ct scan neg and cardiac history; metabolic acidosis
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
Dm neuropathy; stocking glove pattern
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

33. sudden onset of postoperative hyperglycemia when patient on TPN
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;
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Urethral stricture; pelvic of urethral trauma

34. What is hungry bone syndrome?
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
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
Scrotal ultrasound; cystic and fluid filled collections are noncancerous

35. Most common of sudden death due to steering wheel injury
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus
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;
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism

36. anal sphincter tone
S2-S4
If there is any residual mass present mammogram; if not f/you in 4-6 weeks; if mass came back mammogram
Progressive fibrosis of palmar fascia. etiololgy not known;
Nonunion and avascular necrosis; fx can block blood supply;

37. How to manage a patient with asystole
Epi and chest compressio for prolong period of time; atropine is given after epi;
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Mammogram
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

38. cat/dog bites
Amoxicillin-clavulanate
Dumping syndrome; small and frequent meals; no simple sugar
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

39. What percent of anal abscess deveolop fisutula
50%; tunneling between rectum or kin
Compression stocking - weight reduction - leg elevation
Sphincter sparing surgery (local resection) - abdomnio perineal resection
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

40. Why right varicocele is more concerning?

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

41. Complications of breast impant
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Nonunion and avascular necrosis; fx can block blood supply;
Cystic scrotal fluid collection between parietal and visceral layers of testis
Elevated non seminomas

42. most common fx when falling on outsretched hand
Retrograde ejaculation
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI
Nonunion and avascular necrosis; fx can block blood supply;
Elderly and critically ill patients

43. Valgus and Varus tests
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
Twisting force with the foot fixed on the ground seen in football and basketball games;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation

44. Can we use beta blocker for pvd?
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa
Study showed no adverse effect; but they are contraindicated for PVD
4 weeks before; increases risk of in thromembolism in perioperative period when patient is immobile
Ispilateral hypoglossal nerve injury

45. How to evaluate painless testicular swelling suspicious for cancer
Urethral stricture; pelvic of urethral trauma
Nonunion and avascular necrosis; fx can block blood supply;
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

46. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele
Strok and traumatic brain injury
SAH due to post communicating artery aneurysm;
CRPS; type 1 no nerve lesion - 90% of cases; type 2 with nerve lesion; tx nerve block or intravensou regional anesthesa

47. Incidence of AF in CABG patient

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

48. What is the strongest risk factor for male breast cancer
Twisting force with the foot fixed on the ground seen in football and basketball games;
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Klinefelter syndrome; 50 fold increase;
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

49. stress fx
Supraglottic edema; low threshold for intubation
24-48 hours of supportive therapy followed by cholecystectomy
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Check ET tube placement if correct needle decompresion

50. xray finding of stress fx after 3-4w
Within 6 moths and definitely before 1 yrs; after 6 months - chances of spontaneous descent is rare
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Ispilateral hypoglossal nerve injury
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line