USMLE Sugery (Number)

During a radiological meeting at your local hospital, the Consultant Radiologist is commenting on the intra-abdominal structures found at the level of the transpyloric plane of Addison on a CT scan. At what vertebral level does this plane pass through?

A 45-year-old man undergoes emergency laparotomy for suspected intraabdominal trauma. A large liver laceration is detected during laparotomy and the bleeding is difficult to control. The Consultant locates the free edge of the lesser omentum and performs Pringle's manoeuvre to control the haemorrhage. From the list below, which structures are found within the free edge of the lesser omen tum?

You see a 60-year-old female presenting with haematemesis. An upper gastrointestinal endoscopy reveals bleeding oesophageal varices. From the list below, select the answer that corresponds to the correct number of areas of portosystemic anastomoses present in the abdomen?

A 25-year-old male sustains a right tibia and fibula fracture. He is unable to dorsiflex his right foot and has lost sensation to the dorsum of his right foot. From the list below, select the nerve that is likely to have been damaged?

You are examining a patient and looking for the second intercostal place by finding the manubriosternal junction (also known as the 'angle of Louis'). From the list below, choose the vertebral level that corresponds to the manubriosternal junction?

You are observing a 45-year-old female being prepared for induction of anaesthesia for a laparoscopic cholecystectomy. You discuss the stages of anaesthesia with the Consultant anaesthetist. From the list below, select the answer corresponding to the correct number of stages of anaesthesia?

A 25-year-old lady, weighing 65 Kg, is having a sebaceous cyst excised from her mid back. You are asked to initltrate local anaesthetic around the area before the sebaceous cyst can be removed. Which of the following is the maximum safe dose of lidocaine that can be used before it reaches toxic levels?

As part of the peripheral vascular examination, you are asked to record the ankle-brachial pressure index of the patient. Which one of the following values reflects a normal ankle-brachial pressure index?

During a ward round you are asked about the conditions that must be met in order to qualify a patient for elective abdominal aortic aneurysm repair. From the list below, select the most likely abdominal aortic aneurysm size that warrants elective repair providing the patient is fit for surgery?

A 41-year-old man presents to the emergency department with a severe headache that started suddenly following a weight-training session. He is treated appropriately and further examination some days later reveals a palpable lump in the left loin. An ultrasound scan confirms multiple kidney cysts and hepatomegaly, suggestive of adult poly cystic kidney disease. On further questioning, he reports that his father died of a brain haemorrhage at the age of 35. Adult poly cystic kidney disease is most commonly inherited by which one of the following modalities?

A 55-year-old solicitor presents to the urology outpatients department with a 6-month history of abnormal angulated penis on erection. This has made sexual intercourse particularly difficult and painful and has been affecting his relationship with his wife. After further questioning, a diagnosis of Peyronie's disease is offered. All of the following statements regarding Peyronie's disease are true, except?

A patient is being prepared for treatment of a fistula in the operating theatre. The consultant asks you to examine the patient and from your findings predict the course the tract is likely to have taken. You note a sinus in the 8 o'clock position with the patient in the lithotomy position. Where is the most likely point at which you may find the corresponding internal opening within the anal canal?

A 19-year-old girl presents with a recent history of stumbling gait associated with frequent falls and increasing difficulty with her vision, requiring frequent prescription changes. She reports that her grandfather was approximately 40 years old when he died of heart failure, but she and the remainder of her family are otherwise well. Examination reveals bilateral clubbed feet, upward going plantar reflexes, scoliosis and a prominent fourth heart sound. A genetic test is performed, which shows that she is suffering from Friedrich's ataxia. This condition is the result of a defective gene on which chromosome?

A 35-year-old man is admitted after severing his arm on industrial machinery. His airway is patent and there is no identifiable hindrance to breathing. His pulse is 110 beats/min, blood pressure is 130/105 mmHg, and respiratory rate is 25 breaths/min. Which stage of shock is this patient in?

A 35-year-old butcher is admitted after stabbing himself with a knife inadvertently. His airway is patent and there are no identifiable hindrances to breathing. His pulse is 110 beats/min, BP is 130/105 mmHg, and respiratory rate is 25 breaths/min. Assuming a body mass of 70 kg, what is the best estimated volume of blood lost?

A patient is admitted to the emergency department with a reduced level of consciousness, smelling of alcohol. A boggy haematoma is noted on the posterior aspect of his skull. The patient's eyes open to voice, but he makes no attempt to vocalize. A sternal rub causes the patient to open his eyes, moan and extend his arms and legs. His Glasgow Coma Scale score is?

A patient is admitted into the emergency department following a head injury at work. He is resuscitated and stabilized, but a computed tomography scan shows significant brain contusion. He is intubated and cared for on the intensive care unit. You attempt to evaluate his Glasgow Coma Scale score; there is no response to voice, but pressing a pen into his fmgernail causes the patient to open his eyes and attempt to withdraw his hand from you. His Glasgow Coma Scale score is therefore?

46. What is the least number of factors that must be present from the modified Glasgow criteria for acute pancreatitis to be classified as severe within 48 hours of admission?

A young girl presents to her GP with a 2-day history of fever and swelling on the left side of her abdomen. Examination confirms a raised temperature and left loin swelling extending into the mid-line. In addition, microscopic haematuria is found on a urine dipstick test. She is referred to the local hospital where an ultrasound scan of the abdomen and biopsy confirm Wilm's tumour (nephroblastoma). Which one of the following statements regarding Wilm's tumour is true?

A patient is being investigated for sciatica. On detailed neurological examination you elicit the following signs: sensory loss over the outer calf and dorsum of foot, weakness in dorsiflexion of toes, normal ankle reflexes, normal knee reflexes, painful straight leg raise, normal fem oral nerve stretch test. At which level is the disc protrusion?

A 28-year-old male motorcyclist is brought into the emergency department where you, as the doctor on call, are asked to assess his consciousness as part of the primary survey. He is unresponsive when you speak to him, but, on rubbing his sternum, opens his eyes and tries to push your hand away. During your assessment he also mutters something that you are unable to understand. His Glasgow Coma Scale score is?

A 21-year-old female student presents to the emergency department following a fall from a ledge approximately 1.5 m high while walking home. She has been drinking heavily and her friends report that she is now drowsier following her fall. She opens her eyes when her name is mentioned and is talking about her studies tomorrow. She also winces when you press her nail bed. Her score according to the Glasgow Coma Scale will be?

A healthy 34-year-old builder presents to his general practitioner having fallen 4.5 m from a ladder 4 days previously, while working at a construction site. Although no major injuries were sustained, since his accident, he has been having near constant lower backache, which radiates down his right leg and is worse on coughing. On examination, the pain is noted to be particularly worse on the outer aspect of the right leg. In addition, there is reduced sensation over this area and the dorsum of the foot. Ankle and big toe dorsiflexion also appear to be weak in comparison to the left side. The patient is referred to the local hospital for an MRI scan, which shows a lateral disc protrusion in the lumbar spine. Which nerve root is likely to be affected in this individual?

Systemic inflammatory response syndrome is a term used to describe the disseminated response to an inflammatory insult such as sepsis, pancreatitis or severe trauma. Which one of the following is not a manifestation of systemic inflammatory response syndrome?

A biopsy of a suspected malignant melanoma shows inva.sion of the reticular dermis. According to Clark's classification, what level is this lesion?

A patient is admitted in haemorrhagic shock following a road traffic accident. A final year medical student places an intravenous cannula; they have inserted a pink (20 G) cannula in the antecubital fossa. What rate of flow into the patient will this allow?

You assess a patient with a plantar ulcer who has poorly controlled diabetes. From the list of options below, select the most likely management plan?

You are in the vascular surgery outpatient clinic explaining the indications forbundergoing carotid endarterectomy to a patient. From the list below, select the most likely scenario where carotid endarterectomy is likely to be indicated?

You see a 26-year-old woman in clinic presenting with lower limb lymphoedema. Which of the following conditions is associated with lymphoedema?

A 62-year-old Caucasian man presents to clinic complaining of a recent change in his voice. He has noticed that it is much more hoarse than normal. The symptoms have persisted for more than 4 weeks. He also describes a history of persistent dry cough lasting several months. He is a smoker of 60 cigarettes per day. ENT evaluation reveals an irregular swelling of the left vocal cord which is biopsied. Which one of the following is the best statement regarding laryngeal carcinoma?

A 6-month-old boy presents with his parents to the paediatric outpatient clinic. The infant's parents have recently become aware that his scrotum appears to be small and underftlled. He was born prematurely at 30 weeks gestation. On examination, the scrotum appears small and hypoplastic, but there is no palpable abnormality within the inguinal regions. An ultrasound scan reports that two ovoid objects lie in the posterior abdominal wall and are consistent with the appearance of bilateral truly undescended testes. The infant's parents are advised that an orchidopexy is indicated to fix the testes in the scrotum. In which age range should this procedure ideally be undertaken to prevent irreparable testicular damage?

A 69-year-old retired canal engineer who has previously worked in North Africa presents to the urology outpatients department with a 2-month history of intermittent painless haematuria. A cystoscopy is performed showing a sessile mass on the posterior bladder wall. A biopsy is taken of this mass, which confirms transitional cell carcinoma invading the bladder muscle, but no local nodes are involved. A further staging computed tomography scan shows no distant metastases. According to the TNM classification, the tumour stage in this individual is?

A 75-year-old man presents to the urology outpatient clinic with a 6-month history of urinary frequency associated with difficulty initiating micturition, dribbling on reaching the end of his stream and nocturia. A digital rectal examination reveals a hard prostate gland. Core biopsy is performed on the gland and the pathology report indicates the presence of a tumour involving most of the right lobe. According to the TNM classification, the tumour stage is?

As the emergency department doctor on call, you are asked to perform a lumbar puncture. The mid-point at the level of the iliac crests is identified as your point of insertion of the puncture needle. Which intervertebral space does this represent?