Surgery — USMLE Step 3 Practice
Surgery on USMLE Step 3 covers perioperative management, acute abdominal emergencies, trauma, wound care, and surgical complications. Recognizing when surgical intervention is required versus medical management is consistently tested.
Frequently Asked Questions
What is the classic presentation of appendicitis on USMLE Step 3?
Appendicitis: periumbilical pain migrating to RLQ (McBurney point), nausea/vomiting, anorexia, low-grade fever, and leukocytosis. CT abdomen/pelvis (with contrast) is the preferred imaging in adults. Alvarado score helps risk stratify. Treatment: laparoscopic appendectomy. Uncomplicated appendicitis may be managed with antibiotics alone in selected patients.
How do you manage an acute small bowel obstruction on Step 3?
SBO management: NPO, NG decompression, IV fluids, Foley for urine output monitoring. Most adhesive SBOs (most common cause) resolve with conservative management. Indications for surgery: complete obstruction, closed loop obstruction, signs of strangulation (fever, leukocytosis, peritoneal signs, CT showing wall enhancement loss).
What is the perioperative beta-blocker rule on USMLE Step 3?
Continue beta-blockers in patients already on them perioperatively — abrupt discontinuation increases cardiac risk. Initiating new beta-blockers preoperatively: only indicated for high-cardiac-risk surgery in patients with elevated RCRI score AND multiple active cardiac conditions. Do NOT routinely start beta-blockers just before surgery (increased stroke risk).
How do you evaluate acute abdominal pain in a trauma patient?
Primary survey (ABCDE) first. FAST exam (Focused Assessment with Sonography in Trauma) at the bedside to detect hemoperitoneum. Unstable patient with positive FAST → immediate exploratory laparotomy. Stable patient → CT abdomen/pelvis for full evaluation. Peritoneal signs (guarding, rigidity, rebound) = presumptive perforation → surgery.
What is Virchow's triad and its relevance to DVT/PE prevention in surgery?
Virchow's triad: stasis (immobility, prolonged surgery), hypercoagulability (malignancy, inherited thrombophilia, OCP), endothelial damage (trauma, surgical injury). VTE prophylaxis: early ambulation + sequential compression devices (SCDs) for all surgical patients; add pharmacological prophylaxis (LMWH or UFH) for moderate-high risk patients. Continue for 4 weeks after major abdominal/pelvic cancer surgery.
Related Articles
- High-Yield Emergency Medicine for USMLE Step 3: Toxidromes, ATLS, and Resuscitation
Master emergency medicine for USMLE Step 3 — toxidrome recognition and antidotes, ATLS primary survey, and anaphylaxis management.
- High-Yield Surgery for USMLE Step 3: Acute Abdomen, Perioperative Care, and Trauma
Master surgery for USMLE Step 3 — appendicitis management, small bowel obstruction, perioperative beta-blocker rules, trauma ATLS, and VTE prophylaxis.
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