,USMLE Step 2 – Surgery Questions and
Correct Answers High-Yield Compilation
| 1000+ Clinical Cases & Explanations.
2025/2026.
Q001. assessing the airway
A001. patient conscious and speaking --> airway present; neck hematoma or emphysema -->
patient will loose airway and should be secured; patient unconscious or noisy breathing --> need to
secure airway
Q002. airway procedures
A002. in the field --> cricothyroidotomy; in the ER --> orotracheal intubation with pulse oximetry;
cervical spine injury --> orotracheal or nasotracheal intubation; maxillofacial injuries -->
cricothyroidotomy or percutaneous tracheostomy
Q003. signs of shock
A003. systolic pressure < 90mmHg; fast feeble pulse; low urinary output in patient who is cold, pale,
shivering, sweating, thirsty
Q004. traumatic causes of shock
A004. bleeding; pericardial tamponade; tension pneumothorax; hypovolemic shock cannot happen from
intracranial bleeding
Q005. hemorrhagic shock Vs. pericardial tamponade Vs. tension pneumothorax
A005. hemorrhage --> CVP is low (empty veins); cardiac tamponade and tension pneumothorax -->
CVP high (distended neck veins); pericardial tamponade --> no respiratory distress; tension
pneumothorax --> severe respiratory distress, unilateral loss of breath sounds, hyperresonance and
mediastinum/tracheal deviation
Q006. hemorrhagic shock in penetrating injuries management
A006. surgical intervention first to stop the bleeding then volume replacement
Q007. non-hemorrhagic shock management
A007. fluid replacement first with 2L of Ringer followed by packed red cells until urine is 0.5-2ml/kg/h
and CVP does not exceed 15mmHg
Q008. pericardial tamponade shock management
,A008. clinical diagnosis, don't order x-rays, if unclear order sonogram; prompt evacuation of pericardial
sac by pericardiocentesis, tube, pericardial window or open thoracotomy; fluids and red cells while
evacuation is being done
Q009. tension pneumothorax shock management
A009. clinical diagnosis, don't order x-rays or wait blood gases;; big needle or IV catheter into pleural
space;; follow with chest tube connected to underwater seal
Q010. preferred route of fluid resuscitation in shock
A010. 2 16-gauge peripheral IV lines; if not --> percutaneous femoral vein catheter or saphenous vein
cut-down
Q011. types of head trauma
A011. penetrating; linear skull fracture; base of skull fracture; acute epidural and subdural hematoma;
diffuse axonal injury; chronic subdural hematoma
Q012. head trauma + loss of consciousness
A012. CT of head required to rule out hematoma; if negative CT --> send home and wake up
frequently in next 24 hours
Q013. base of skull fracture
A013. signs are raccoon eyes, rhinorrhea, otorrhea, ecchymosis behind ear; no antibiotics indicated;
cervical spine CT to assess integrity; if has loss consciousness --> head CT; if signs of base fracture --
> neck CT also
Q014. neurologic damage from trauma
A014. from initial blow, or later hematoma or increased intracranial pressure; treat hematoma with
surgery; treat pressure with drugs (diuretics)
Q015. acute epidural hematoma
A015. sequence of trauma, unconsciousness, lucid interval, gradual coma, fixed dilated pupil,
contralateral hemiparesis; CT shows biconvex, lens-shaped hematoma; cure is emergency craniotomy
Q016. acute subdural hematoma
A016. sequence of trauma, unconsciousness, lucid interval, gradual coma mcuh more severe; CT shows
semilunar hematoma; if midline deviated --> craniotomy; else --> treat increased intracranial
pressure
Q017. diffuse axonal injury from head trauma
A017. CT shows blurring of gray-white matter interface and small punctuate hemorrhages; if no
hematoma, no surgery; decrease ICP
Q018. chronic subdural hematoma
, A018. in elderly or severe alcoholics; a tear in venous sinuses with hematoma over days or weeks; CT
and surgical evacuation is cure
Q019. penetrating neck trauma exploration indications
A019. expanding hematoma; deteriorating vital signs; esophageal or tracheal injury (coughing,
hemoptysis); gunshot to middle neck
Q020. neck gunshot wounds
A020. middle zone --> exploration; upper zone --> arteriogram; base of neck --> arteriogram,
esophagogram (barium), esophagoscopy, and bronchoscopy before surgery
Q021. neck stab wounds
A021. if upper and middle zones in asymptomatic patients --> observation
Q022. blunt neck trauma
A022. if neurologic deficits or pain to local palpation of cervical spine --> cervical spine CT
Q023. types of chest trauma
A023. rib fracture; pneumothorax; hemothorax; blunt trauma; sucking chest wounds; flail chest;
pulmonary contusion; myocardial contusion; traumatic rupture of diaphragm, aorta, trachea or
bronchus; air and fat embolism
Q024. rib fracture
A024. can be deadly in elderly; progression of pain --> hypoventilation --> atelectasis -->
pneumonia; treat with nerve block
Q025. plain pneumothorax
A025. penetrating trauma due to broken rib or weapon; moderate shortness of breath, unilateral
absence of breath sounds and hyperresonance; do chest x-ray, place chest tube, connect to underwater
seal
Q026. hemothorax
A026. penetrating trauma due to broken rib or weapon; moderate shortness of breath; unilateral
absence of breath sounds and dullness to percussion; do chest x-ray and evacuate blood by chest tube;
surgery indicated if --> recover 1.5L of blood with insertion of chest tube or 600ml in tube drainage
over 6 hours
Q027. blunt chest trauma
A027. monitor hidden injuries; blood gases,; chest x-ray,; cardiac enzymes,; ECG
Q028. sucking chest wound
A028. flap sucks air in with inspiration and closes in expiration; treat with occlusive dressing to allow air
out but not in
Correct Answers High-Yield Compilation
| 1000+ Clinical Cases & Explanations.
2025/2026.
Q001. assessing the airway
A001. patient conscious and speaking --> airway present; neck hematoma or emphysema -->
patient will loose airway and should be secured; patient unconscious or noisy breathing --> need to
secure airway
Q002. airway procedures
A002. in the field --> cricothyroidotomy; in the ER --> orotracheal intubation with pulse oximetry;
cervical spine injury --> orotracheal or nasotracheal intubation; maxillofacial injuries -->
cricothyroidotomy or percutaneous tracheostomy
Q003. signs of shock
A003. systolic pressure < 90mmHg; fast feeble pulse; low urinary output in patient who is cold, pale,
shivering, sweating, thirsty
Q004. traumatic causes of shock
A004. bleeding; pericardial tamponade; tension pneumothorax; hypovolemic shock cannot happen from
intracranial bleeding
Q005. hemorrhagic shock Vs. pericardial tamponade Vs. tension pneumothorax
A005. hemorrhage --> CVP is low (empty veins); cardiac tamponade and tension pneumothorax -->
CVP high (distended neck veins); pericardial tamponade --> no respiratory distress; tension
pneumothorax --> severe respiratory distress, unilateral loss of breath sounds, hyperresonance and
mediastinum/tracheal deviation
Q006. hemorrhagic shock in penetrating injuries management
A006. surgical intervention first to stop the bleeding then volume replacement
Q007. non-hemorrhagic shock management
A007. fluid replacement first with 2L of Ringer followed by packed red cells until urine is 0.5-2ml/kg/h
and CVP does not exceed 15mmHg
Q008. pericardial tamponade shock management
,A008. clinical diagnosis, don't order x-rays, if unclear order sonogram; prompt evacuation of pericardial
sac by pericardiocentesis, tube, pericardial window or open thoracotomy; fluids and red cells while
evacuation is being done
Q009. tension pneumothorax shock management
A009. clinical diagnosis, don't order x-rays or wait blood gases;; big needle or IV catheter into pleural
space;; follow with chest tube connected to underwater seal
Q010. preferred route of fluid resuscitation in shock
A010. 2 16-gauge peripheral IV lines; if not --> percutaneous femoral vein catheter or saphenous vein
cut-down
Q011. types of head trauma
A011. penetrating; linear skull fracture; base of skull fracture; acute epidural and subdural hematoma;
diffuse axonal injury; chronic subdural hematoma
Q012. head trauma + loss of consciousness
A012. CT of head required to rule out hematoma; if negative CT --> send home and wake up
frequently in next 24 hours
Q013. base of skull fracture
A013. signs are raccoon eyes, rhinorrhea, otorrhea, ecchymosis behind ear; no antibiotics indicated;
cervical spine CT to assess integrity; if has loss consciousness --> head CT; if signs of base fracture --
> neck CT also
Q014. neurologic damage from trauma
A014. from initial blow, or later hematoma or increased intracranial pressure; treat hematoma with
surgery; treat pressure with drugs (diuretics)
Q015. acute epidural hematoma
A015. sequence of trauma, unconsciousness, lucid interval, gradual coma, fixed dilated pupil,
contralateral hemiparesis; CT shows biconvex, lens-shaped hematoma; cure is emergency craniotomy
Q016. acute subdural hematoma
A016. sequence of trauma, unconsciousness, lucid interval, gradual coma mcuh more severe; CT shows
semilunar hematoma; if midline deviated --> craniotomy; else --> treat increased intracranial
pressure
Q017. diffuse axonal injury from head trauma
A017. CT shows blurring of gray-white matter interface and small punctuate hemorrhages; if no
hematoma, no surgery; decrease ICP
Q018. chronic subdural hematoma
, A018. in elderly or severe alcoholics; a tear in venous sinuses with hematoma over days or weeks; CT
and surgical evacuation is cure
Q019. penetrating neck trauma exploration indications
A019. expanding hematoma; deteriorating vital signs; esophageal or tracheal injury (coughing,
hemoptysis); gunshot to middle neck
Q020. neck gunshot wounds
A020. middle zone --> exploration; upper zone --> arteriogram; base of neck --> arteriogram,
esophagogram (barium), esophagoscopy, and bronchoscopy before surgery
Q021. neck stab wounds
A021. if upper and middle zones in asymptomatic patients --> observation
Q022. blunt neck trauma
A022. if neurologic deficits or pain to local palpation of cervical spine --> cervical spine CT
Q023. types of chest trauma
A023. rib fracture; pneumothorax; hemothorax; blunt trauma; sucking chest wounds; flail chest;
pulmonary contusion; myocardial contusion; traumatic rupture of diaphragm, aorta, trachea or
bronchus; air and fat embolism
Q024. rib fracture
A024. can be deadly in elderly; progression of pain --> hypoventilation --> atelectasis -->
pneumonia; treat with nerve block
Q025. plain pneumothorax
A025. penetrating trauma due to broken rib or weapon; moderate shortness of breath, unilateral
absence of breath sounds and hyperresonance; do chest x-ray, place chest tube, connect to underwater
seal
Q026. hemothorax
A026. penetrating trauma due to broken rib or weapon; moderate shortness of breath; unilateral
absence of breath sounds and dullness to percussion; do chest x-ray and evacuate blood by chest tube;
surgery indicated if --> recover 1.5L of blood with insertion of chest tube or 600ml in tube drainage
over 6 hours
Q027. blunt chest trauma
A027. monitor hidden injuries; blood gases,; chest x-ray,; cardiac enzymes,; ECG
Q028. sucking chest wound
A028. flap sucks air in with inspiration and closes in expiration; treat with occlusive dressing to allow air
out but not in
