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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. midline neck swelling moves with protrusion of tongue
Elevation of testis in response to stroking of upper thigh; absent in boys under 6m and testicular torsion
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Elderly and critically ill patients
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery

2. contraindication of urethral catheterization
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
10-12 months
Urethral stricture; pelvic of urethral trauma
Strok and traumatic brain injury

3. How to manage obesity
Right varicocele drains to inferior vena cava; unless patient has obstrction of inf vena cava by intra abdominal mass or big clot from DVT - varicocele doesn't occur; do ct scan to eval caUse of rt varicocele
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
Dm neuropathy; stocking glove pattern
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. severe pain in leg after MVC
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
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
Subphrenic abscess or other abdominal abscesses; order US or CT
Progressive fibrosis of palmar fascia. etiololgy not known;

5. Valgus and Varus tests
Flail chest; double rib fractures in more than one site; 10-20% of trauma admissions; increased work of breathing due to muscular spasms;
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
Increased size during the day and valsalva means it is communicated with peritoneal cavity
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

6. Incidence of AF in CABG patient

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7. What is hydrocele?
Cystic scrotal fluid collection between parietal and visceral layers of testis
Study showed no adverse effect; but they are contraindicated for PVD
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Supraglottic edema; low threshold for intubation

8. diarrhoea 4-5 days after cholecystectomy
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
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
To determine integrity of medial and lateral collateral ligament; also present tenderness along medial and lateral joint line
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid

9. first step for evaluation of testicular swelling
Klinefelter syndrome; 50 fold increase;
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
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
Increased size during the day and valsalva means it is communicated with peritoneal cavity

10. Tx of pulmonary contusion
Twisting force with the foot fixed on the ground seen in football and basketball games;
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
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Seminomas

11. several knee pain after being tackled in football game
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)
It could be porcelin GB which has high risk of devleoping Ca; Tx CT then elective cholecystectomy
Next best step surgery; not ultrasound
Compression stocking - weight reduction - leg elevation

12. Why varicocele more common in the left side
24-48 hours of supportive therapy followed by cholecystectomy
Scrotal ultrasound; cystic and fluid filled collections are noncancerous
4-6 weeks for noncontact sports and longer time for contact sports
It drains to left renal vein at a right angle; any renal mass/disease obstruct venous flow and casues varicocele

13. dorsiflexion and planter flexion
Severe pain; torsion or epididymis; if associated with swelling; hydrocele - varicocele - spermatocele
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Elderly and critically ill patients
L5 to S2

14. antibiotics of acute cholecystitis
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
Headache - ataxia - bulbar dysfunction
Ampicillin sublactum - pipercillin - ceftriaxone and metro

15. types of hip fracture
Epi and chest compressio for prolong period of time; atropine is given after epi;
Intracapsular involves femoral head and neck and extracapsular involves intertrochanteric and subtrochanteric; complication-avascular necrosis;
Less than 5mm
Patellar tendon tear; difficulty in extension

16. what size of ureteral stone for non op mx
Less than 5mm
Supraglottic edema; low threshold for intubation
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
24-48 hours of supportive therapy followed by cholecystectomy

17. varicocele
SAH due to post communicating artery aneurysm;
Meniscus injury; medial most common; pain/swelling; popping sensation
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

18. bilateral symmetric reduction in perception of vibration - pain and temperature; ED and absent cremastieric reflex
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Dm neuropathy; stocking glove pattern
If patient ambulatory - surgery and pain control; if not nonop mx
SAH due to post communicating artery aneurysm;

19. laparotomy 2 weeks ago - now pain in right shoulder tip; fever and tachycardia
If any compressive symptoms eg. dysphagia
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;
Subphrenic abscess or other abdominal abscesses; order US or CT
When urethral catherization is unsuccessful

20. management of nondisplaced scaphoid fx
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Progressive fibrosis of palmar fascia. etiololgy not known;
Study showed no adverse effect; but they are contraindicated for PVD
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal

21. management of hip fracture
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
If patient ambulatory - surgery and pain control; if not nonop mx
5-10% patient; increased bile acid flux caused diarrhea; tx cholestyramine which sequester excess bile acid
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp

22. acalculus cholecystitis
Elderly and critically ill patients
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Cystic scrotal fluid collection between parietal and visceral layers of testis
Strok and traumatic brain injury

23. What percent of anal abscess deveolop fisutula
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
ABI below 0.9 suggest pvd; below 0.4 severe ischemia
Cystic scrotal fluid collection between parietal and visceral layers of testis
50%; tunneling between rectum or kin

24. indication of ursodeoxycholic acid
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Next best step surgery; not ultrasound
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
Right varicocele drains to inferior vena cava; unless patient has obstrction of inf vena cava by intra abdominal mass or big clot from DVT - varicocele doesn't occur; do ct scan to eval caUse of rt varicocele

25. menisci injury
Twisting force with the foot fixed on the ground seen in football and basketball games;
Dm neuropathy; stocking glove pattern
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case

26. popping sensation; rapid onset of knee effusion. athelet
ACL injury
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
If patient ambulatory - surgery and pain control; if not nonop mx
Progressive fibrosis of palmar fascia. etiololgy not known;

27. swelling and tenderness in anterior part of knee
Patellar tendon tear; difficulty in extension
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased PSA
CRPS
Ispilateral hypoglossal nerve injury

28. stress fx
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
Ispilateral hypoglossal nerve injury
TTP and local swelling; plain xray mostly negative withn 2-3 weeks of symptom onset
Force applied from lateral to medial direction; likely injury to medial colaterl ligament; positve valgus test (L for lateral force)

29. What are the common injuries from lightning?
Dilatation of pampiniform plexus increase temperature inside scroum; cells in seminiferous tubule are very sensitive to temp and atrophies with inc temp
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
4-6 weeks for noncontact sports and longer time for contact sports
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

30. sudden onset of headache; right sided ptosis - anisocoria - nuchal rigidity
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;
SAH due to post communicating artery aneurysm;
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol

31. common complication of inadequate mx of scaphoid fx
Nonunion and avascular necrosis; fx can block blood supply;
Klinefelter syndrome; 50 fold increase;
Elderly and critically ill patients
Mammogram

32. What is the contraindication of hyperventilation in inc ICP
Strok and traumatic brain injury
Short arm thumb spica cast; f/you xray every 2weeks to monitor healing; rigid wrist protection for 2m after cast removal
Absent in L1 to L2 lesion; associated with decreased hip flexion and adduction
Amoxicillin-clavulanate

33. how ABI help dx of PVD
Mammogram
When urethral catherization is unsuccessful
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
ABI below 0.9 suggest pvd; below 0.4 severe ischemia

34. How to differentiate communicative and non-communicative hydrocele
Acute mesenteric ishemia; most SMA occlusion secondary to an embolism
4-6 weeks for noncontact sports and longer time for contact sports
Increased size during the day and valsalva means it is communicated with peritoneal cavity
Abdomen CT to evaluate lymph node metastasis; serum marker beta HCG and alpha feto protein

35. dumping syndrome after gastrectomy
Rapid passage of liquid and food into jejunum faster; leads to diarrhoea - nausea - vomiting - dizziness - sweating - dyspnoea
Pure motor stroke; limited neurological dysfunction
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Study showed no adverse effect; but they are contraindicated for PVD

36. How to perform lachman test
Sepsis; look for the source of infetion; line sepsis - pneumonia - wound infection;
Knee flexed at 20 degree; one hand pulls proximal tibia and other hand stabilizes femur
When urethral catherization is unsuccessful
If patient ambulatory - surgery and pain control; if not nonop mx

37. mangement of localized lymphadenopathy
Follow up 3-4 weeks for complete resolution; if not resolved do lymph node bx
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
4-6 weeks for noncontact sports and longer time for contact sports
Aortic rupture; most common site -ligamentum arteriosum - aortic root and diaphragmatic hiatus

38. first line of management of PVD
Right varicocele drains to inferior vena cava; unless patient has obstrction of inf vena cava by intra abdominal mass or big clot from DVT - varicocele doesn't occur; do ct scan to eval caUse of rt varicocele
CRPS
Cilostazol; phosphodiesterase inhibitor; inhibits platelet aggregation and arterial vasodilator; improve maximal walking distance;
Seminomas

39. inhalation of hot air - steam - smoke in burn victim
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;
Supraglottic edema; low threshold for intubation
Gall bladder gangrene and perforation; cholecystoenteric fistula; emphysematous cholecystitis;

40. Complications of breast impant
Capsular contracture resulting pain - distortion of shape - implant deflation - rupture; tx implant removal
Knee full flexed then externally rotated and extended slowly; audible click is positive for meniscal injury
Dull scrotal pain relieved by recumbency; soft scrotal mass disappears in recumbent position
Pain relief with testis elevation; not reliable absent in testicular torsion and present in epidymitis

41. How to dx ACL tear?
Unilateral vocal cord paralysis
Fx displace >1mm - nonunion during followup - osteonecrosis
If patient ambulatory - surgery and pain control; if not nonop mx
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

42. What is prehn sign?
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
Brardycardia - HTN - resp depression
Strok and traumatic brain injury

43. most frequent complication of TURP
Increased ICP; initially headcha - vomiting - blurry vision - papilledema; then AMS - ipsilateral pupil dilation - nerve palsy and hemiparesis; tx ABC intubate then mannitol
Retrograde ejaculation
Thyroglossal cyst; ectopic thryroid tissue may present - imaging CT/nuclear scan/US mandatory before surgery
Scaphoid fx; p/w dec ROM - radial wrist pain and swelling; TTP anatomical snuffbox; if xray neg - do MRI

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
Dm neuropathy; stocking glove pattern
Unilateral vocal cord paralysis
Check tissue pressure; above 30 mm Hg is diagnostic; tx emergent fasciotomy

45. transrectal prostate biopsy
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
Mesenteric ischemia; emboli form due to AF turbulence can occlude mesenteri artery causing mesenteric ischemia; abd exam normal
If prostate nodular - indurated and asymmetrical in digital rectal exam; with or without increased 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

46. 3 mo with groin bulge; bulge appears when child cries
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
Next best step surgery; not ultrasound
Infection most common; atrophy of bowel mucosa--disruption of normal mucosal barrier allow intestinal bacteria to enter systemic circulation
Indirect inguinal hernia most likely failure to obliteration of processus vaginalis; tx surgical repair asap to avoid risk of incarceration - no wait;

47. clavicle fx
Sudden cardiac arrest (asystole) - rhadomyolysis - autonomic dysfunction causing fixed dilated pupil; local burn - ruptured eardrum
Displaced ORIF ; nondisplaced sling immobilization
L5 to S2
Low anterior resection and radio; add chemo if node positive

48. 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
Calorie restriction - exercise - behavioral modification; if fails orlistat - if fails bariatric surg
S2-S4
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

49. aspiration of breast cyst is bloody
Pumonary toileting - pain control - restrict fluid to control edema - oxygen; intubation required in severe case
Mammogram
Cortical thickening - periosteal elevation - bone sclerosis - true fracture line
Saline and silicone

50. Why right varicocele is more concerning?

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