USMLE 3

Question 1

GCS Score breakdown: Eyes.

Answer 1

4 - opens spontaneously.
3 - opens to verbal command.
2 - opens to pain.
1 - does not open.

Question 2

GCS Score breakdown: Verbal.

Answer 2

5 - oriented.
4 - confused.
3 - inappropriate words.
2 - sounds.
1 - no sounds.

Question 3

GCS Score breakdown: Motor.

Answer 3

6 - obeys commands.
5 - localizes to pain.
4 - withdraws from pain.
3 - flexion (decorticate).
2 - extension (decerebrate).
1 - no movement.

Question 4

Non bleeding esophageal varices are managed by?

Answer 4

Beta adrenergic antagonists - propranolol.

Question 5

An elderly man presents with bone pain, the only remarkable finding is elevated Alkaline phosphatase and increased uptake in bone scans? Complications?

Answer 5

Paget disease of the bone. Fractures, arthritis, HEARING LOSS.

Question 6

A patient presents after a MVC and looks SHOCKY. FAST and DPL find no abdominal bleeding. They have a pelvic fracture, how do you assess retroperitoneal bleeding?

Answer 6

Angiogram.

Question 7

How does Nursemaid elbow happen? How do you fix it?

Answer 7

Pulling on a child’s arm causes subluxation of radial head at elbow joint. Flex the elbow and supinate the forearm (the very thing they don’t want you to do).

Question 8

In hypovolemic shock, what are the first physiological changes to occur.

Answer 8

Tachycardia (increased pulse rate) and peripheral vascular constriction.

Question 9

Abdominal complications from AAA surgery? Presentation? What will CT elicit?

Answer 9

Ischemic colitis. Dull abdominal pain and bloody diarrhea. Thickening of the bowel wall.

Question 10

You note edema, stasis, dermatitis and venous ulcerations on the medial leg that stretches from the ankle to the knee. What is the cause? First physical sign?

Answer 10

Venous valvular incompetence. Xerosis (dry skin).

Question 11

A man presents flank pain, hematuria, and vomiting. How does a PMH of Chrohns make the diagnosis?

Answer 11

Nephrolithiasis. Poor absorption of fats leads to excessive absorption of oxalate, which contributes to stone formation.

Question 12

A patient has an edematous lower extremity that gets more swollen throughout the day. Cause? First complication noticed on PE?

Answer 12

Venous valve incompetence. Xerosis.

Question 13

In a post-op recovery room, a patient becomes hypoglycemic, hypotensive, with vomiting, nausea, and abdominal pain. Main cause?

Answer 13

Acute adrenal insufficiency. Preoperative steroid use.

Question 14

An asian adult patient presents with epistaxis. You note a mass in the posterior nasal cavity? Most important risk factor?

Answer 14

Nasopharyngeal carcinoma. EBV.

Question 15

An elderly patient suffers a displaced femoral neck fracture. Treatment?

Answer 15

Primary arthoplasty.

Question 16

Baby has a scalded bottom. What should you do?

Answer 16

Admit the baby and do a full skeletal survey. This child is being abused.

Question 17

Treatment of duodenal hematoma?

Answer 17

NG tube and parenteral nutrition.

Question 18

A patient presents several days after the signs of appendicitis with abdominal tenderness? Treatment?

Answer 18

Perforated appendicitis. Antibiotics, IV fluids, bowel rest.

Question 19

Best test to confirm the diagnosis of retroperitoneal air?

Answer 19

CT w/ contrast.

Question 20

A patient after MVC who already receives a chest tube develops subcutaneous emphysema and pneumomediastinum?

Answer 20

Trachea or Bronchi rupture.

Question 21

Deviated mediastinum with a mass in the lower left chest on CXR?

Answer 21

Diaphragmatic hernia.

Question 22

A patient with widened mediastinum, fever, chest pain, and leukocytosis. AAA has been ruled out? Treatment?

Answer 22

Acute mediastinitis. Thoracotomy for debridement, drainage. Antibiotics.

Question 23

A patient suffers severe head trauma, grows drowsy, weak on the right side of the body. What nerve is most likely to be damaged?

Answer 23

Oculomotor - from transtentorial herniation.

Question 24

Two years after a whiplash injury, a patient develops decreased strength and loss of temperature/pain sensation? Cause? Diagnostic test?

Answer 24

Syringomelia. CSF retention. MRI.

Question 25

A patient presents with non bilious vomiting of partially digested food, weight loss, early satiety, and a history of GERD? What if he ingested acid as part of a suicide attempt?

Answer 25

Gastric outlet obstruction. Pyloric stricture.

Question 26

What blood loss is required to necessitate blood transfusion?

Answer 26

1500 ml

Question 27

One week after open heart surgery, a patient develops fever, substernal chest pain, and mediastinal widening on CXR. AAA is ruled out? Treatment?

Answer 27

Acute mediastinits. Surgical debridement, drainage, and antibiotics.

Question 28

Septic knee joint within 3 months of surgery. What is the offending agent? What is the offending agent if has been more than 3 months.

Answer 28

Staph Aureus. Staph Epidermidis.

Question 29

A patient presents with right anterior thigh pain that is worse with walking. PE shows a small pulsatile mass in the right groin area?

Answer 29

Femoral artery aneurysm.

Question 30

A man is actively bleeding from esophageal varices. What do you do first? Then what do you do?

Answer 30

Establish vascular access and fluid resuscitation. Control the bleeding.

Question 31

Retropharyngeal abscess can lead to what complication?

Answer 31

Infection to the mediastinum, acute necrotizing mediastinitis.

Question 32

An elderly patient post op day 7 presents with swollen and painful parotid gland? What could have prevented this complication? What is the offending agent?

Answer 32

Acute bacterial parotitis. Fluid hydration and oral hygiene. Staph Aureus.