Surgery NBME Form 3 Exam Questions
and Answers
57 iiyo ii- ii3 iimonths iiof iicough ii
> iilast ii4 iiwks ii- iicough iiinc iiin iifreq ii
> iiblood-tinged iisputum iionce ii
no iiPMHx; iino iimeds
SHx: iismoked ii1 iipack iicigs iiqd iifor ii40 iiyrs
BMI: ii26 ii
PE: iicoarse iirhonchi ii- iiR.lung iibase
CXR: ii3 iicm iimass iinear iihilum iiof iiR.lung ii
biopsy: iinon-small iicell iiCA iiof iiR.main iistem iibronchus
mediastinoscopy iiand iiPET iiscan: iino iimets
pre-op iitesting: ii
> iiFEV1 ii- ii600 iimL
> iimax iivoluntary iivent ii(MVV) iiand iiDLCO ii- iiboth ii50% iiof iipredicted
> iiPCO2 ii- ii44 iimmHg
> iiPO2 ii- ii75 iimmHg
what iiparameter iiis iimost iiuseful iiin iiassessing iithis iipt's iipost-op iirisk iifor
iipneumonectomy? ii- iiAnswers ii-FEV1 ii
operability iiof iilung iicancer ii- iipredicted iion iiresidual iifxn iiafter iiresection ii
*minimum iiof iiFEV1 ii800 iimL iiis iirequired*
determine iifractions iithat iicomes iifrom iieach iilung ii(by iiVQ iiscan) ii- iiwhat iiwould iiremain
iiafter iipneumonectomy? ii
> iiif ii< ii800 iimL ii- iidon't iicont iiexpensive iitests iibc iipt iinot iisurg iicandidate
tx: iichemo iiand iiradiation ii
you iialso iineed iito iicheck iifor iimets iibc iihilar iiones iican iibe iiremoved iiw/
iipneumonectomy ii
> iinodal iimets iiat iicarina iior iimediastinum iican't ii
dx: iiCT iiand iiPET; iiendobronchial iiUS ii- iiinvasive iito iisample iimediastinal iinodes
26 iiyo ii- iiworsening, iiint iiabd iicramps
PMHx iiof iiint iidiarrhea ii+ ii11 iilb iiweight iiloss ii
PE: iimod iigen iiabd iitenderness, iihyperactive iibowel iisounds, iiand iino iiinvoluntary
iiguarding; iitenderness ii+ iimass iiin iiRLQ ii
barium iienema iishown ii
most iilikely iidx? ii- iiAnswers ii-Crohn iidisease
unpredictable iiflares iiand iiremissions ii
*hallmark iilocation: iiterminal iiileum*
transmural iithickening iiand iiinf ii(full-thickness iiinvolvement) ii> iinarrowing iiof iilumen
,features: iidiarrhea ii(usually iino iiblood); iimalabsorption iiand iiweight iiloss; iiabd iipain
ii(usually iiRLQ), iiN/V; iifever, iimalaise; iiextra-int iimanifestations ii
dx: iiendoscopy iiw/ iibiopsy ii(aphthous iiulcers, iicobblestone iiappearance, iipseudo
iipolyps, iipatchy/skip iilesions); iiBa iienema; iiupper iiGI iiw/ iismall iibowel iifollow-through
tx: iisulfasalazine ii(if iicolon iiinvolved); iimetro; iisys iicorticosteroids ii(for iiacute
iiexacerbations); iigo iisurgical iifor iicomplications
52 iiyo ii- iiF/U ii1 iimonth iiafter iidx iiof iiHTN
no iimeds
99.7 iiF
P: ii105/min
BP: ii165/95 iimmHg
PE: ii1 iicm iimass iiin iiR.lobe iiof iithyroid ii
US iiof iithyroid: iisolid iimass
radionuclide iiscan: iiinc iiuptake iiwhere iimass iiis
pt iiwill iihave iiwhich iifindings? ii- iiAnswers ii-deceased iiserum iithyroid-stimulating
iihormone ii(TSH) iiconcentration iiand iiincreased iitriiodothyronine ii(T3) iiand iithyroxine
ii(T4) iiconcentrations ii
1st iistep iiif iinodule iifound ii- iiFNA
thyroid iiscan ii- iiperformed iiif iiFNA iibiopsy iiindeterminate iior iipts iiw/ iilow iiTSH ii
> iidec ii("cold") iior iiinc ii("hot") iiaccumulation iiof iiradioactive iiI- iicompared iiw/ iinormal
iitissue ii
> iicold ii= iihypofunctioning ii
> iiwarm ii= iinormal ii
> iihot ii= iihyperfunctioning ii
so iisince iithis iinodule iilit iiup ii- iisuggests iiit iiis iihyperfunctioning
> iisecreting iimore iiT3 iiand iiT4 ii> iisuppressing iiTSH iirelease
52 iiyo ii- ii1 iiyr iiof iiprog iidifficulty iiswallowing, iiint iivomiting iiof iiundigested iifood, iiand
iicough iimore iisevere iiat iinight ii
> ii17 iilb iiweight iiloss
> iino iipain iiw/ iiswallowing iior iidifficulty iiswallowing ii
no iiPMHx; iino iimeds
inc iianxiety ii- iipast ii6 iimonths ii
SHx: iino iicigs/alcohol ii
vitals: iistable ii
PE: iino iipalp iineck iimasses; iitrachea iimidline; iino iithyromegaly ii
CXR: iiair-fluid iilevel iiin iipost iimediastinum iiat iilevel iiof iicardiac iisilhouette
manometry: iinormal iiLES iipressure; iiabsent iiLES iirelaxation iiw/ iiswallowing ii
most iilikely iidx? ii- iiAnswers ii-achalasia
LES iifails iito iicompletely iirelax iiw/ iiswallowing ii> iiabnormal iiperistalsis ii
features: iidysphasia ii- iiequal iidifficulty iiin iiswallowing iiliquids iiand iisolids ii(exacerbated
iiby iifast iieating iiand ii*emotional iistress*); iiregurgitation; iichest iipain; iiweight iiloss; iirec
iipulm iicomplications ii
dx: iiBa iiswallow ii("bird's iibeak"); iiupper iiGI iiendoscopy; iimanometry ii(confirms) ii- iifailure
iiof iiLES iirelaxation iiand iiaperistalsis iiof iiesophageal iibody ii
, post iimediastinum ii- iiwhere iiesophagus iiis iilocated ii
> iiair iifluid iilevels iipresent iiwhen iithere's iiblockage/obstruction ii
> iiair iirises iiwhile iifluid/food iisettles iiat iithe iibottom ii
tx: iiLSM; iiantimusc iiagents; iisublingual iiNTG, iilong-acting iinitrates, iiand iiCCB; iibotox;
iiforceful iidilatation ii(pneumatic iiballoon) ii- iithis iiis iicurrently iipreferred; ii"Heller
iimyotomy" ii
diffuse iiesophageal iispasm: iiinc iiLES, iiinc iiLEP
systemic iisclerosis: iidec iiLES, iidec iiLEP
67 iiyo ii- iif/u iiexam
PMHx: iiHTN; iiangina iipectoris; iimild iiCOPD
meds: iiNTG; iialbuterol iiinhaler
SHx: iismokes ii2 iipacks iiof iiits iiqd iifor ii48 iiyrs ii
BMI: ii21 ii
BP: ii165/105 iimmHg
labs: iiBUN ii36; iiCr ii1.9 ii
renal iiUS: ii14 iicm iiL.kidney, ii7 iicm iiR.kidney
most iilikely iicause iiof iiHTN iiand iirenal iiatrophy? ii- iiAnswers ii-renal iiartery iistenosis
activates iiRAAS ii> iiHTN ii
MC iicause iiof iisecondary iiHTN
*atherosclerosis ii- iiseen iiin iielderly iimen*; iismoking iiand iihigh iichol ii- iipredisposing
iifactors ii
fibromuscular iidysplasia ii- iiyoung iifemales ii
features: iisudden iionset iiof iiHTN iiw/o iiFHx; iidec iirenal iifxn; iiabd iibruit ii(RUQ, iiLUQ,
iiepigastrium; iimore iicommon iiin iithose iiw/ iidysplasia) ii
dx: iirenal iiarteriogram; iiMRA ii(for iithose iiw/ iirenal iifailure)
tx: iirevascularization iiw/ iiPRTA ii+/- iiconservative iimeds ii(ACEi, iiCCB)
28 iiyo ii- iifatigue, iiinc iibreast iisize/tenderness, iiand iiinc iiur iifreq ii- ii8 iiwks
> iislight iiint iicramping iiin iimidline ii
LMP: iiuncertain ii
BMI: ii37 ii
US: iipreg iihigh iiin iiuterus ii- ii8 iiwks iigest ii
2 iiwks iilater: iisevere iiR. iiabd iipain ii+ iiR. iishoulder iipain ii
US iiof iipelvis: iiviable iipreg iiin iiR.cornual iiarea iiof iiuterus
> iiimmediately iiafter: iivitals iiunstable ii
most iilikely iidx? ii- iiAnswers ii-ectopic iipregnancy ii
pt iipresents iiw/ iitypical iisigns iiof iipreg
> iiimaging iiconfirms
cornual iipreg ii= iiectopic iipregnancy iithat iidevelops iiin iithe iiinterstitial iiportion iiof iithe
iifallopian iitube iiinvading iithrough iithe iiuterine iiwall
> iiruptures iilater ii- iibc iimyometrium iimore iidistensible iithan iifallopian iitube ii
> iioften iimisdiagnosed iias iiintrauterine iipreg
HoTN, iipain, iiand iiperitoneal iiirritation ii> iipreg iihas iiruptured
52 iiyo ii- ii30 iilb iiweight iiloss ii- ii6 iimonths
and Answers
57 iiyo ii- ii3 iimonths iiof iicough ii
> iilast ii4 iiwks ii- iicough iiinc iiin iifreq ii
> iiblood-tinged iisputum iionce ii
no iiPMHx; iino iimeds
SHx: iismoked ii1 iipack iicigs iiqd iifor ii40 iiyrs
BMI: ii26 ii
PE: iicoarse iirhonchi ii- iiR.lung iibase
CXR: ii3 iicm iimass iinear iihilum iiof iiR.lung ii
biopsy: iinon-small iicell iiCA iiof iiR.main iistem iibronchus
mediastinoscopy iiand iiPET iiscan: iino iimets
pre-op iitesting: ii
> iiFEV1 ii- ii600 iimL
> iimax iivoluntary iivent ii(MVV) iiand iiDLCO ii- iiboth ii50% iiof iipredicted
> iiPCO2 ii- ii44 iimmHg
> iiPO2 ii- ii75 iimmHg
what iiparameter iiis iimost iiuseful iiin iiassessing iithis iipt's iipost-op iirisk iifor
iipneumonectomy? ii- iiAnswers ii-FEV1 ii
operability iiof iilung iicancer ii- iipredicted iion iiresidual iifxn iiafter iiresection ii
*minimum iiof iiFEV1 ii800 iimL iiis iirequired*
determine iifractions iithat iicomes iifrom iieach iilung ii(by iiVQ iiscan) ii- iiwhat iiwould iiremain
iiafter iipneumonectomy? ii
> iiif ii< ii800 iimL ii- iidon't iicont iiexpensive iitests iibc iipt iinot iisurg iicandidate
tx: iichemo iiand iiradiation ii
you iialso iineed iito iicheck iifor iimets iibc iihilar iiones iican iibe iiremoved iiw/
iipneumonectomy ii
> iinodal iimets iiat iicarina iior iimediastinum iican't ii
dx: iiCT iiand iiPET; iiendobronchial iiUS ii- iiinvasive iito iisample iimediastinal iinodes
26 iiyo ii- iiworsening, iiint iiabd iicramps
PMHx iiof iiint iidiarrhea ii+ ii11 iilb iiweight iiloss ii
PE: iimod iigen iiabd iitenderness, iihyperactive iibowel iisounds, iiand iino iiinvoluntary
iiguarding; iitenderness ii+ iimass iiin iiRLQ ii
barium iienema iishown ii
most iilikely iidx? ii- iiAnswers ii-Crohn iidisease
unpredictable iiflares iiand iiremissions ii
*hallmark iilocation: iiterminal iiileum*
transmural iithickening iiand iiinf ii(full-thickness iiinvolvement) ii> iinarrowing iiof iilumen
,features: iidiarrhea ii(usually iino iiblood); iimalabsorption iiand iiweight iiloss; iiabd iipain
ii(usually iiRLQ), iiN/V; iifever, iimalaise; iiextra-int iimanifestations ii
dx: iiendoscopy iiw/ iibiopsy ii(aphthous iiulcers, iicobblestone iiappearance, iipseudo
iipolyps, iipatchy/skip iilesions); iiBa iienema; iiupper iiGI iiw/ iismall iibowel iifollow-through
tx: iisulfasalazine ii(if iicolon iiinvolved); iimetro; iisys iicorticosteroids ii(for iiacute
iiexacerbations); iigo iisurgical iifor iicomplications
52 iiyo ii- iiF/U ii1 iimonth iiafter iidx iiof iiHTN
no iimeds
99.7 iiF
P: ii105/min
BP: ii165/95 iimmHg
PE: ii1 iicm iimass iiin iiR.lobe iiof iithyroid ii
US iiof iithyroid: iisolid iimass
radionuclide iiscan: iiinc iiuptake iiwhere iimass iiis
pt iiwill iihave iiwhich iifindings? ii- iiAnswers ii-deceased iiserum iithyroid-stimulating
iihormone ii(TSH) iiconcentration iiand iiincreased iitriiodothyronine ii(T3) iiand iithyroxine
ii(T4) iiconcentrations ii
1st iistep iiif iinodule iifound ii- iiFNA
thyroid iiscan ii- iiperformed iiif iiFNA iibiopsy iiindeterminate iior iipts iiw/ iilow iiTSH ii
> iidec ii("cold") iior iiinc ii("hot") iiaccumulation iiof iiradioactive iiI- iicompared iiw/ iinormal
iitissue ii
> iicold ii= iihypofunctioning ii
> iiwarm ii= iinormal ii
> iihot ii= iihyperfunctioning ii
so iisince iithis iinodule iilit iiup ii- iisuggests iiit iiis iihyperfunctioning
> iisecreting iimore iiT3 iiand iiT4 ii> iisuppressing iiTSH iirelease
52 iiyo ii- ii1 iiyr iiof iiprog iidifficulty iiswallowing, iiint iivomiting iiof iiundigested iifood, iiand
iicough iimore iisevere iiat iinight ii
> ii17 iilb iiweight iiloss
> iino iipain iiw/ iiswallowing iior iidifficulty iiswallowing ii
no iiPMHx; iino iimeds
inc iianxiety ii- iipast ii6 iimonths ii
SHx: iino iicigs/alcohol ii
vitals: iistable ii
PE: iino iipalp iineck iimasses; iitrachea iimidline; iino iithyromegaly ii
CXR: iiair-fluid iilevel iiin iipost iimediastinum iiat iilevel iiof iicardiac iisilhouette
manometry: iinormal iiLES iipressure; iiabsent iiLES iirelaxation iiw/ iiswallowing ii
most iilikely iidx? ii- iiAnswers ii-achalasia
LES iifails iito iicompletely iirelax iiw/ iiswallowing ii> iiabnormal iiperistalsis ii
features: iidysphasia ii- iiequal iidifficulty iiin iiswallowing iiliquids iiand iisolids ii(exacerbated
iiby iifast iieating iiand ii*emotional iistress*); iiregurgitation; iichest iipain; iiweight iiloss; iirec
iipulm iicomplications ii
dx: iiBa iiswallow ii("bird's iibeak"); iiupper iiGI iiendoscopy; iimanometry ii(confirms) ii- iifailure
iiof iiLES iirelaxation iiand iiaperistalsis iiof iiesophageal iibody ii
, post iimediastinum ii- iiwhere iiesophagus iiis iilocated ii
> iiair iifluid iilevels iipresent iiwhen iithere's iiblockage/obstruction ii
> iiair iirises iiwhile iifluid/food iisettles iiat iithe iibottom ii
tx: iiLSM; iiantimusc iiagents; iisublingual iiNTG, iilong-acting iinitrates, iiand iiCCB; iibotox;
iiforceful iidilatation ii(pneumatic iiballoon) ii- iithis iiis iicurrently iipreferred; ii"Heller
iimyotomy" ii
diffuse iiesophageal iispasm: iiinc iiLES, iiinc iiLEP
systemic iisclerosis: iidec iiLES, iidec iiLEP
67 iiyo ii- iif/u iiexam
PMHx: iiHTN; iiangina iipectoris; iimild iiCOPD
meds: iiNTG; iialbuterol iiinhaler
SHx: iismokes ii2 iipacks iiof iiits iiqd iifor ii48 iiyrs ii
BMI: ii21 ii
BP: ii165/105 iimmHg
labs: iiBUN ii36; iiCr ii1.9 ii
renal iiUS: ii14 iicm iiL.kidney, ii7 iicm iiR.kidney
most iilikely iicause iiof iiHTN iiand iirenal iiatrophy? ii- iiAnswers ii-renal iiartery iistenosis
activates iiRAAS ii> iiHTN ii
MC iicause iiof iisecondary iiHTN
*atherosclerosis ii- iiseen iiin iielderly iimen*; iismoking iiand iihigh iichol ii- iipredisposing
iifactors ii
fibromuscular iidysplasia ii- iiyoung iifemales ii
features: iisudden iionset iiof iiHTN iiw/o iiFHx; iidec iirenal iifxn; iiabd iibruit ii(RUQ, iiLUQ,
iiepigastrium; iimore iicommon iiin iithose iiw/ iidysplasia) ii
dx: iirenal iiarteriogram; iiMRA ii(for iithose iiw/ iirenal iifailure)
tx: iirevascularization iiw/ iiPRTA ii+/- iiconservative iimeds ii(ACEi, iiCCB)
28 iiyo ii- iifatigue, iiinc iibreast iisize/tenderness, iiand iiinc iiur iifreq ii- ii8 iiwks
> iislight iiint iicramping iiin iimidline ii
LMP: iiuncertain ii
BMI: ii37 ii
US: iipreg iihigh iiin iiuterus ii- ii8 iiwks iigest ii
2 iiwks iilater: iisevere iiR. iiabd iipain ii+ iiR. iishoulder iipain ii
US iiof iipelvis: iiviable iipreg iiin iiR.cornual iiarea iiof iiuterus
> iiimmediately iiafter: iivitals iiunstable ii
most iilikely iidx? ii- iiAnswers ii-ectopic iipregnancy ii
pt iipresents iiw/ iitypical iisigns iiof iipreg
> iiimaging iiconfirms
cornual iipreg ii= iiectopic iipregnancy iithat iidevelops iiin iithe iiinterstitial iiportion iiof iithe
iifallopian iitube iiinvading iithrough iithe iiuterine iiwall
> iiruptures iilater ii- iibc iimyometrium iimore iidistensible iithan iifallopian iitube ii
> iioften iimisdiagnosed iias iiintrauterine iipreg
HoTN, iipain, iiand iiperitoneal iiirritation ii> iipreg iihas iiruptured
52 iiyo ii- ii30 iilb iiweight iiloss ii- ii6 iimonths
