Surgery NBME 115 Exam (This was written 1 month after the exam, so many details are lost)

Exam was easy in general.

(Author: Dark Side Leader)

1) Recurrent pressure ulcers, next step? Myocutaneous flap.(it’s not practical to bring edges together,
other options include ishcioectomy but this is invasive)

2) Retro cardiac density, vomiting. Dx? Paraesophagial hernia

3)Palpable pulses +1 bilaterally. Next step? Ankle brachial index

4)Venous ulcer patient was put on compression stockings. Next step? No further management

5) Suspected basal skull fracture. Next step? CT of head

6)PE case. ABGs findings? Respiratory alkalosis

7)Epigastric pain after hernia repair.Next step? Cardiac stress scintigraphy

8)RUQ pain after trip to Mexico. Rx? IV Metronidazole

9)Multiple transfusions, bleeding continues. What's deficient? Platelets. Cuz we didn't give him platelets
with FFP, blood

10)Lesion present since birth? Blue Nevus

11)Coffee bean appearance with vomiting. Dx? Sigmoid volvulus

12)Best way of feeding after CNS lesion? jejunal feeding(enteral feeding is better than parenteral in
general)
13)Trauma to brain. Sodium high. Dx? Central DI(Answer was decreased ADH release)

14)Flank pain after transfusion. Has been crossmatched. Dx? ABO incompatibility

15)Bleeding cuz of warfarin intake. Give? FFP(given in acute bleeding episodes)

16)ARDS after pancreatitis. Mechanism? SIRS

17) pulmonary edema after trauma. Mechanism? SIRS

18)C.defficile case. Rx? oral Vancomycin

19)Tension pneumothorax case after CVC insertion. Rx? Needle decompression

20)Stable patient after abdominal trauma? CT with contrast

21)MC complication after urethral injury? Urethral stricture

22)Pearly shaped mass on nose with telengiectasias? BCC. Picture was shown

23) Mechanism of hidradenitis suppurativa? Apocrine gland occlusion

24)Lesion on face? Melanoma(easy). Picture shown

25)Anal fissure picture (easy). Asked for Dx

26)Diarrhea after bowel resection. Cause? Bile salts

27)Diarrhea in Crohn's disease. Most likely cause is? Bile salts

28)Presentation of MEN-2A. Next step? Urine Metanephrine

29)Case of Pheochromocytoma(easy. Dx?)

30)Renal failure. PTH is sky high. Cause is? Hyperplasia of the four parathyroids

31) Recurrent cholecystitis. Ultrasound clear. Next step? HIDA scan

32)RUQ pain that comes and goes. Dx? Biliary colic

33) Typical presentation of duodenal ulcer. Next step? Endoscopy

34)Colonoscopy for man with suspected liver mets from colon CA(presentation of RUQ pain, weight
loss,…)

35) Colonoscopy for anemic old man

36)Orotracheal intubation for mentally depressed patient after trauma

37)IV ringer lactate for hypotensive traumatized patient

38)Furesemide for maybe pulmonary edema??

39)Hemorrhigic shock case. Easy

40)Case of Vipoma typical. Asked for Dx

41)Case of Oglivie syndrome in ICU patient

42)Case of Diverticulitis vs ovarian torsion. Age 35, female, 2 days duration. Mostly diverticulitis

43)Case on inconsulable crying. Next step? enema(intususseption)

44)case of vomiting, abdominal pain after years of surgery. Cause is? Adhesions

45) Epigastric pain, hypotension, fever,... Dx? Cholangitis

46)Pancreatic CA case(easy)

47) Recurrent kidney stones. Next step? Measurments of Ca+2 in urine

48)Intraductal papilloma(easy)

49) inflammatory breast cancer(easy, age was >65)

50) Young girl. Suspected breast mass(fibroadenoma) on exam. Next step? U/S of breast

51) Symptomatic breast cyst(painful). Next step? Aspiration

52)Breast tenderness and warmth of breastfeeding woman. Dx? Mastitis

53,54) 2 ethics qustions i forgot. But in general (if you did surgery on a patient and during the surgery
you found non life-threatening lesion, don't resect it because the patient didn't give consent for it. But if
it's life-threatening, resect it).

*Note 2: Evaluate for patient competency in questionable cases

*Note 3: abide by patient wishes if he/she refuses a life-saving procedure (provided she’s competent)
55) Abdominal distension with Regurgitation of food. Dx? Tracheoesphageal fistula

56)Thigh mass after exercise. Painless. Dx? Osteosarcoma. Other options include Quadreceps muscle
strain

57)Explatory laparotomy for gunshot

58)DVT invloving femoral artery. Patient on prophylactic dose of heparin. Next step? Theraputic heparin
dose. Other options include thrombectomy

59)Feared complication of untreated SBO? intestinal infarction

60)CBD stricture case(u/s shows dilated CBD)

61)Lung nodule resection, suspicious for malignancy (age, calcifications,...)

62)Loss of gastric acid. Don't remember

63)Epidural hematoma case. Easy

64)Fournier gangrene case. Next step? debridement. Other options include antibiotics

65)case of Prerenal azotemia. Patient was hypotensive. Cause? Hypovolemia

66)What do you expect after immediately revascularizing ischemic bowel. EtCO2 - base deficits, pH,...
and other parameters. (In general think of reperfusion injury)
67MI case. Easy

68)Ribs fractures multiple. Patient is hypoxix. Cause is? Pulmonary contusion

69Pneumocystis jirovici case. I don't think the answer was this one. He was an HIV patient who
developed bilateral lung opacities after surgery. Maybe the answer is ARDS

70)BMI 42 - obesity hypoventilation syndrome

71)Parasympathetic injury of bladder(overflow incontinence)

72)Case of recurrent amurosis fugax. Source of lesion? Carotid bifurcation

73)Afib case developed abdominal pain. Next step? CT angio of abdomen

74)Aspiration?? Maybe the cause of hypoxia in Parkinson patient

75)Metronidazol for trichomoniasis

76)Foot drop after leg casting. Injured nerve? Peroneal nerve( it gets compressed against bone)

77)High PT PTT. cause? DIC

78)Peripancreatic fat necrosis(easy)

79) Abdominal pain, mass after pancreatitis. Next step? CT abdomen (pseudocyst)

80)Duplex u/s for leg(venous incompetence)

81)Testicular torsion case- operate immediately

82)You operate on an old man. Found AAA of 7 cm. What to do? Recommend resection

83) Massive PE case. Patient BP very low. Next step? Echocardiogram not CT angio

84)Case of PE. Acute onset chest pain

85)ECG for Epigastric pain in old female

86)Esophageal cancer case(dysphagia to solids but not liquids)

87) Blood pressure of 180/100 after surgery. Cause is? Pheochromocytoma. Other options include pain

88)Case of pilonidal sinus. Mechanism? Embedded hair

89) Atelectasis after surgery. What could have prevented this? Incentive spirometry

90) Patient with BUN of 119. He’s bleeding. Cause? Platelet dysfunction

91) Patient on heparin, developed thrombosis. Cause? HIT. Note: PT was elevated in this case because
he was on warfarin not because of DIC

92)Case of ischemic colitis. Patient was hypotensive

93)Pre-operative stress testing(revise scheme in Uworld)

94) Soon after insertion of chest tube, a patient developed hypotension, cardiac sounds are distant. Dx?
Cardiac tamponade

95)Case with leukocytosis, mid-upper abdominal pain, WBCs in urine,… Dx? Pyelonephritis. I actually
chose diverticulitis because the pain description was vague. Some say it was mentioned flank pain.

96) Traumatized face, jaw pain,… Next step? Cricothyroidotomy

97) Suspected kidney injury after trauma. Next step? CT with contrast

98)Case of mass on face. It’s erythematous, fluctuating,… Next step? Incision and drainage

99)Ascites and hypotension after pancreatitis. Cause? Pancreatic fluid sequestration

100)6 weeks old infant. Non-biliary emesis. Cause? Pyloric stenosis

101)Thrill and palpable mass at site on dialysis catheter insertion. Cause? AV fistula

102)Case of compartment syndrome (pain with stretching). What to do? 4-compartment fasciotomy

103) Diarrhea, weight loss, abdominal pain,…long case. Dx? Gastrinoma

104)case giving labs values of calcium, PTH, phosphorus before and after surgery. Cause is?
Immobilization (calcium, phosphorus rise slightly, PTH drops slightly)

105)long case describing urine retention. Best way to provide long-term benefits? Intermittent
catheterization

106)Case of neck hematoma after carotid endarterectomy. Voice was raspy?? Next step? Surgery
107) Patient on CVC developed sepsis. Cath is clean. Cause? Catheter infection (even if clean)