NBME Surgery Shelf Exam 2026
Questions and Answers
A previosuly healthy 47 YOM comes in with 2 weeks of progressive abd swelling.
PE shows distention and shifting dullness, bowel sounds are normal. There is no
tenderness, masses or organomegaly. Paracentesis: 50ml milky chylous fluid. Most
likely cause? - Correct answer-Lymphoma
47 YOW comes in with a BMI of 67 , chafed skin on inner thighs, under breasts,
twice requiring admission for abtx for panniculitis. Also has thick curdy vaginal
discharge.Best long term management for this pt? - Correct answer-Gastric bypass
(NOT panniculectomy!)
37 YOw bruising on arms and abdomen x3w. ibuprofen for HA. afebrile.
PE:eccymoses over upper extremities and trunk. Lungs CTAB, Labs: norm Hb,
6.8k WBC, 45k plt, Bleeding time is high,PT normal. Bone marrow shows
megakayocytes. Explanation for findings? - Correct answer-ITP
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,A 13 YOB has increasingly severe left thigh pain and knee pain and limp for 2
days. He is 6 ft tall and 145lbs. No Hx of trauma, BMI =20, Passive motion of hip
elicits pain, Most likely Dx? - Correct answer-SCFE!
12 hours after rod stabilization of a femoral fracture, 27 YO homeless ,an has
sudden onset of combativeness and disorientation. HR 120, RR 24, BP 140/85.
Exam shows petichiae over axila. Most likely cause? - Correct answer-Fat
embolism
52 YOW has back pain with hx of treatment for breast cancer 5 years ago.
Decreases sensitivity below nipples. Hyperreflexive and decr strength with +
babinski in legs, arms are normal. Where is the lesion? - Correct answer-Thoracic
spinal cord
Previously healthy *YOB has intermittent pain in the right anterior thigh for the
past 3 w.activity level is high.mother notes he limps. 25th percentile ht and wt.
Vitals normal. Atalgic gait. Abduction and internal rotation of the feur is limited.
Dx? - Correct answer-Avascular necrosis of the femoral head (Legg-Calve-Perthes
Dz)
ASX 72 YOW comes in with decreased renal fx. Elevation in Cr over last 3 days.
got 2nd renal transplant from 65 YO donor 1 m ago. Most likely explanation for
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,decr renal fx? - Correct answer-Acute rejection - failure to suppress class II antigen
recognition in the host
36 hours after admission for evaluation of diffuse abd pain, a 42 YOw is still
obstipated. She has a 9yr history of scleroderma. Current temp is 100, P 110,
RR22, BP 110/60. Abd is distended with colon dilation and WBC 14k. Next step? -
Correct answer-She has signs of peritonitis - answer is almost always gonna be
laparotomy!
A 68 YOM is broguht to the ED because of recurrent vomiting of bright red blood,
and near syncope x 3 hours. He is afebrile, pulse 110, respirations are 16, BP 90/60
mm Hg and he has mild epigastric tenderness. Next step? - Correct answer-Rapid
infusion of 0.9% NS
So fluids first then figure out bleeding
A 67 YOW, 8m bilateral calf pain with walking. initially only after long walk, now
only after 300 ft. pain is relieved with rest. She has hypertension and
hypercholesterol. She is on atherscler drugs and smokes. pulses decr bil.elevated
BUN. Next step? - Correct answer-ABI is done first before imaging.
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, Move on to imaging like Duplex if ABI < 0.9
12 hours after pancreatic abscess drainage, a 52 YOM with alcoholism becomes
bradycardic and hypoxic and requires intubation. His FiO2 is 100, with a tidal
volume of 1000 and PEEP of 2.5. He still has acidosis with O2 = 48 and CO2 of
40. Next step? - Correct answer-Increase PEEP
Tidal volume is super high here and should probably be lowered but won't address
his hypoxemia
Only increasing FiO2 or increasing PEEP will increase PACO2
a 60 YOW has a sigmoid resection and colostomy for diverticulitis with rupture.
That night she becomes confused, oliguric and febrile. the area around the
colostomy is indurated and crepitant. Most likely causal organism? - Correct
answer-Clostridium perfringens!!
Don't get confused by the source!
The crepitus gives it away
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Questions and Answers
A previosuly healthy 47 YOM comes in with 2 weeks of progressive abd swelling.
PE shows distention and shifting dullness, bowel sounds are normal. There is no
tenderness, masses or organomegaly. Paracentesis: 50ml milky chylous fluid. Most
likely cause? - Correct answer-Lymphoma
47 YOW comes in with a BMI of 67 , chafed skin on inner thighs, under breasts,
twice requiring admission for abtx for panniculitis. Also has thick curdy vaginal
discharge.Best long term management for this pt? - Correct answer-Gastric bypass
(NOT panniculectomy!)
37 YOw bruising on arms and abdomen x3w. ibuprofen for HA. afebrile.
PE:eccymoses over upper extremities and trunk. Lungs CTAB, Labs: norm Hb,
6.8k WBC, 45k plt, Bleeding time is high,PT normal. Bone marrow shows
megakayocytes. Explanation for findings? - Correct answer-ITP
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,A 13 YOB has increasingly severe left thigh pain and knee pain and limp for 2
days. He is 6 ft tall and 145lbs. No Hx of trauma, BMI =20, Passive motion of hip
elicits pain, Most likely Dx? - Correct answer-SCFE!
12 hours after rod stabilization of a femoral fracture, 27 YO homeless ,an has
sudden onset of combativeness and disorientation. HR 120, RR 24, BP 140/85.
Exam shows petichiae over axila. Most likely cause? - Correct answer-Fat
embolism
52 YOW has back pain with hx of treatment for breast cancer 5 years ago.
Decreases sensitivity below nipples. Hyperreflexive and decr strength with +
babinski in legs, arms are normal. Where is the lesion? - Correct answer-Thoracic
spinal cord
Previously healthy *YOB has intermittent pain in the right anterior thigh for the
past 3 w.activity level is high.mother notes he limps. 25th percentile ht and wt.
Vitals normal. Atalgic gait. Abduction and internal rotation of the feur is limited.
Dx? - Correct answer-Avascular necrosis of the femoral head (Legg-Calve-Perthes
Dz)
ASX 72 YOW comes in with decreased renal fx. Elevation in Cr over last 3 days.
got 2nd renal transplant from 65 YO donor 1 m ago. Most likely explanation for
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
,decr renal fx? - Correct answer-Acute rejection - failure to suppress class II antigen
recognition in the host
36 hours after admission for evaluation of diffuse abd pain, a 42 YOw is still
obstipated. She has a 9yr history of scleroderma. Current temp is 100, P 110,
RR22, BP 110/60. Abd is distended with colon dilation and WBC 14k. Next step? -
Correct answer-She has signs of peritonitis - answer is almost always gonna be
laparotomy!
A 68 YOM is broguht to the ED because of recurrent vomiting of bright red blood,
and near syncope x 3 hours. He is afebrile, pulse 110, respirations are 16, BP 90/60
mm Hg and he has mild epigastric tenderness. Next step? - Correct answer-Rapid
infusion of 0.9% NS
So fluids first then figure out bleeding
A 67 YOW, 8m bilateral calf pain with walking. initially only after long walk, now
only after 300 ft. pain is relieved with rest. She has hypertension and
hypercholesterol. She is on atherscler drugs and smokes. pulses decr bil.elevated
BUN. Next step? - Correct answer-ABI is done first before imaging.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
, Move on to imaging like Duplex if ABI < 0.9
12 hours after pancreatic abscess drainage, a 52 YOM with alcoholism becomes
bradycardic and hypoxic and requires intubation. His FiO2 is 100, with a tidal
volume of 1000 and PEEP of 2.5. He still has acidosis with O2 = 48 and CO2 of
40. Next step? - Correct answer-Increase PEEP
Tidal volume is super high here and should probably be lowered but won't address
his hypoxemia
Only increasing FiO2 or increasing PEEP will increase PACO2
a 60 YOW has a sigmoid resection and colostomy for diverticulitis with rupture.
That night she becomes confused, oliguric and febrile. the area around the
colostomy is indurated and crepitant. Most likely causal organism? - Correct
answer-Clostridium perfringens!!
Don't get confused by the source!
The crepitus gives it away
©COPYRIGHT 2025, ALL RIGHTS RESERVED 4
