NBME SURGERY QUESTIONS AND REVIEWED ANSWERS 2023/2024

NBME SURGERY QUESTIONS AND REVIEWED ANSWERS 2023/2024 Question 1 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B -SOB, elevated pulse, low BP, JVD (elevated CVP) , crackles. ---> Cardiogenic shock. Question 2 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--G -sphenopalatine artery (MCC of posterior nosebleeds) -Kiesselbach's plexus (MCC of anterior nosebleeds) Question 3 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B -Carotid duplex. Pt has symptoms of TIA. Question 4 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B -He is about to have a surgery,for resection around the rectum, very vascularized area, you can't have therapeutic dose of heparin or patient will bleed out; simply want to give ppx to prevent the formation of future DVTs Question 5 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E -fever, leukocytosis, obstipation (no passage of gas or stool), peritonitis (guarding and rebound) = strangulated obstruction --> emergency surgery (Pestana's pg. 60) Question 6 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D Question 7 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D Question 8 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D Question 9 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--Answer is B -B because lots of arterial blood will go into venous circulation, leading to increased preload and increased CO, which overtime can lead to high output cardiac failure. See S3 and S4, JVD, crackles Question 10 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B Question 11 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E Question 12 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E -This patient has an abdominal aortic aneurysm and cannot undergo the typical stress tests. Preoperative planar dipyridamole-thallium scanning (DTS) is most useful to stratify selected nonvascular surgery patients at intermediate or high risk by clinical assessment. Question 13 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--F Question 14 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E -Drainage of pancreatic fluid can cause metabolic acidosis from loss of bicarb Question 15 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -Always assume decision making capacity -> Respect decision -> determine the patient's rationale for the refusal (and whether it is informed) and correct misinformation if necessary -> If the patient's refusal remains steadfast, the physician should respect the patient's decision and work with the patient to formulate an alternative diagnostic or therapeutic plan. Question 16 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A Question 17 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--C Question 18 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B Question 19 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D -"Several nonspecific symptoms (atypical chest pain, dyspnea, palpitations, dizziness, anxiety, and panic disorder) and nonspecific ECG changes have been attributed to MVP. S/S in MVP = MVP syndrome. MVP syndrome is benign." Question 20 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -pneumococcus...usually you would only give ceftriaxone...vanco is added these days because of increased incidence of resistance in pneumococcus Question 21 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -The pathogenesis of HS is not fully understood; however, new evidence is emerging [13]. As opposed to early theories that implicated apocrine glands as the primary contributors to HS, most authors now support follicle-centered theories for the pathogenesis of HS. Follicular occlusion, follicular rupture, and an associated immune response appear to be important events in the development of the clinical manifestations of HS. The basic principles that underlie follicle-centered theories are reviewed below. Source: UPTD. Probably not will be asked in the real deal. Question 22 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B Question 23 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -His bacterial overgrowth started after his Billroth II gastrectomy because decreased gastric acid/decreased gastric motility can lead to bacterial overgrowth. The treatment for bacterial overgrowth is antibiotics, so it got better after tetracycline. Question 24 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--B -given the young age of patient and the fact that the vignette tells you that there are absent "skin" finding of chronic hepatic disease (i.e. caput medusa, spider telangiectasia, palmar erythema), the likely hood of this being eso varices secondary to cirrhosis is relatively low. more than likely going to be a mallory-wise tear with hypotension secondary to multiple bouts of emesis more so than the volume of actual blood loss. regardless, you would resuscitate and stbalizes your ABCs before proceding with UGE. Question 25 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--C -ectopic if ruptured leads to hypotension, pain and peritoneal irritation (right shoulder pain). Question 26 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -contrast enema to un-invert the intussusception. The currant jelly stools and drawing up knees are classic, tell-tale signs Question 27 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D -cicatrization of the duodenal ulcer by fibrosis causing gastric outlet obstruction evidenced by borborgymi, succusion splash. Question 28 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D Question 29 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--D Question 30 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A Question 31 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E Question 32 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--E. -It's chronic pancreatitis. He had an acute attack of pancreatitis and then it says he had severe abdominal pain several times after his first attack (most likely the chronic pain associated with chronic pancreatitis). The high glucose (likely from loss of islet cells), steatorrhea (loss of colipase and bicarbonate to assist in catabolic processes in the duodenum/jejunum = crapping out fat), and history of pancreatitis are highly suggestive of pancreatic insufficiency. The reason why amylase and lipase aren't high is because of the pancreatic insufficiency. Hemochromatosis would have elevated liver enzymes along with other physical findings (skin etc). Question 33 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--A -The answer is A. Do pressure on the bleeding site to stop it. Closed reduction can be delayed up to 72 hours in the presence of more imp injuries. No need to do transfusion as the patient at the moment is stabilized ( systolic BP >100) on Crystalloids. Question 34 - CORRECT ANSWERAnswer to the Previous Question - CORRECT ANSWER--C -"This patient has suffered rapid deceleration chest trauma, likely in association with forceful impact with his vehicle's steering wheel. Chest radiography is the most important initial diagnostic study in all stabilized patients (airway, breathing and circulation secure) following blunt chest trauma. This patient's chest x-ray shows a