NBME Surgery Shelf Exam Questions and Answers Latest
Question 1
Do we use FNA or core needle biopsy to biopsy breast masses in general?
Correct Answer
In general, use core needle needle biopsy as FNA cannot adequately differentiate in situ from
carcinoma
Question 2
37 yo F with neck swelling. No weakness, heat or cold intolerance, change in weight. Serum
tests show circulating Ab's against thyroid peroxidase and thyroglobulin.
Most likely dx?
Correct Answer
Hashimoto thyroiditis
Question 3
Obese 11 yo presents to pediatrician due to limping for past day. Dull pain in right knee. Pain
increased by physical activity. Tenderness to palpation at anterior hip + limitation in internal
rotation of the hip.
Plain films show subluxation of the right femoral head. Next step?
Correct Answer
Operative stabilization with surgical pinning.
This is SCFE!
Question 4
Labs to differentiate cause once hypercortisolism established?
Correct Answer
,1. Plasma ACTH: if low -> ACTH-independent adrenal tumor
if high -> ACTH-dependent Cushing's due to either pituitary adenoma or ectopic ACTH
2. Subsequent high-dose dex suppression
Suppresses ACTH from pituitary source
Does not suppress ACTH from ectopic
Question 5
Cornerstone of tx for venous stasis ulcers due to chronic venous insufficiency?
Correct Answer
Compression therapy with an Unna boot - compressive gauze that contains zinc oxide and
calamine to promote wound healing.
Question 6
2nd step in management of septic shock?
Correct Answer
Vasopressors (in order): norepinephrine (+/- vasopressin), epinephrine
*Note: dopamine and phenylephrine are used in neurogenic shock but not septic
Question 7
Insidious onset of pain over tibia in young pt with sudden increase in physical activity (army
recruit, young surgeon traveling abroad, ballerina). Pain on palpation and some surrounding
edema of the skin.
Most likely dx and next step?
Correct Answer
Tibial stress fracture. Order a plain film
Question 8
,52 YO nulligravid woman comes to physician due to 2 m of progressive abdominal swelling and
decr appetitie. She has astma treated with steroidsand T2DM. Exam shows a fluid wave. An Ct
shows mulple levic masses and omental thickening. Most likely dx?
Correct Answer
Ovarian adenocarcinoma
Question 9
88yo woman has a fall. Complains of right hip pain. Leg is externally rotated and shortened.
Most likely dx and complication?
Correct Answer
Femoral neck fracture (would be confirmed with X-ray) and can lead to avascular necrosis
Question 10
88 yo M with PD and COPD has BRBPR. Afebrile with normal BP. NG tube returns yellow bile.
Colonoscopy shows bright red blood in colon, multiple diverticula, but due ot large amount of
stool and blood clots, no active bleeding sources are able to be seen . He continues to have
blood per rectum over next hour. Hemodynamically stable.
Next step in mgmt?
Correct Answer
99mTc red blood cell scintigraphy! (arteriography is also acceptable but scintigraphy is less
invasive)
Ex lap if hemodynamically unstable
Question 11
35 yo F with nonhealing ulcer on medial ankle (above the malleolus). She developed
pigmentation of the skin around medial ankle several years ago, which then became an ulcer.
Superficial and painless.
, Best diagnostic test? ***High yield question!
Correct Answer
Venous duplex US!
The pigmentation represents lipodermatosclerosis and the venous ulcer is likely due to reflux in
the superficial perforator, and deep venous systems
Question 12
Indication for parathyroidectomy in asympomatic patients with primary HPT?
Correct Answer
Serum calcium level 1.0 mg/dL greater than the upper limit of normal
- Creatinine clearance reduced to <60 mL/min
- Bone mineral density with T-score less than −2.5 at any site
- Age <50
- Patients that do not desire or cannot undergo routine surveillance
Go straight to surgery if symptomatic
Question 13
A 45 YOm has daily temps to 100.9 and 15 lb wt loss over 3 m. he has pallor, normal vitals and
normal CV and P exams except a low pitched disatolic rumble at the apex that dissappears when
he lies on his R side. Hb is 10. Most liekly dx?
Correct Answer
Atrial myxoma!
Question 14
College football player sustained a knee injury following a tackle. Lower leg sags on passive
flexion of the knee at 90degrees while patient is supine
Most likely dx?
Question 1
Do we use FNA or core needle biopsy to biopsy breast masses in general?
Correct Answer
In general, use core needle needle biopsy as FNA cannot adequately differentiate in situ from
carcinoma
Question 2
37 yo F with neck swelling. No weakness, heat or cold intolerance, change in weight. Serum
tests show circulating Ab's against thyroid peroxidase and thyroglobulin.
Most likely dx?
Correct Answer
Hashimoto thyroiditis
Question 3
Obese 11 yo presents to pediatrician due to limping for past day. Dull pain in right knee. Pain
increased by physical activity. Tenderness to palpation at anterior hip + limitation in internal
rotation of the hip.
Plain films show subluxation of the right femoral head. Next step?
Correct Answer
Operative stabilization with surgical pinning.
This is SCFE!
Question 4
Labs to differentiate cause once hypercortisolism established?
Correct Answer
,1. Plasma ACTH: if low -> ACTH-independent adrenal tumor
if high -> ACTH-dependent Cushing's due to either pituitary adenoma or ectopic ACTH
2. Subsequent high-dose dex suppression
Suppresses ACTH from pituitary source
Does not suppress ACTH from ectopic
Question 5
Cornerstone of tx for venous stasis ulcers due to chronic venous insufficiency?
Correct Answer
Compression therapy with an Unna boot - compressive gauze that contains zinc oxide and
calamine to promote wound healing.
Question 6
2nd step in management of septic shock?
Correct Answer
Vasopressors (in order): norepinephrine (+/- vasopressin), epinephrine
*Note: dopamine and phenylephrine are used in neurogenic shock but not septic
Question 7
Insidious onset of pain over tibia in young pt with sudden increase in physical activity (army
recruit, young surgeon traveling abroad, ballerina). Pain on palpation and some surrounding
edema of the skin.
Most likely dx and next step?
Correct Answer
Tibial stress fracture. Order a plain film
Question 8
,52 YO nulligravid woman comes to physician due to 2 m of progressive abdominal swelling and
decr appetitie. She has astma treated with steroidsand T2DM. Exam shows a fluid wave. An Ct
shows mulple levic masses and omental thickening. Most likely dx?
Correct Answer
Ovarian adenocarcinoma
Question 9
88yo woman has a fall. Complains of right hip pain. Leg is externally rotated and shortened.
Most likely dx and complication?
Correct Answer
Femoral neck fracture (would be confirmed with X-ray) and can lead to avascular necrosis
Question 10
88 yo M with PD and COPD has BRBPR. Afebrile with normal BP. NG tube returns yellow bile.
Colonoscopy shows bright red blood in colon, multiple diverticula, but due ot large amount of
stool and blood clots, no active bleeding sources are able to be seen . He continues to have
blood per rectum over next hour. Hemodynamically stable.
Next step in mgmt?
Correct Answer
99mTc red blood cell scintigraphy! (arteriography is also acceptable but scintigraphy is less
invasive)
Ex lap if hemodynamically unstable
Question 11
35 yo F with nonhealing ulcer on medial ankle (above the malleolus). She developed
pigmentation of the skin around medial ankle several years ago, which then became an ulcer.
Superficial and painless.
, Best diagnostic test? ***High yield question!
Correct Answer
Venous duplex US!
The pigmentation represents lipodermatosclerosis and the venous ulcer is likely due to reflux in
the superficial perforator, and deep venous systems
Question 12
Indication for parathyroidectomy in asympomatic patients with primary HPT?
Correct Answer
Serum calcium level 1.0 mg/dL greater than the upper limit of normal
- Creatinine clearance reduced to <60 mL/min
- Bone mineral density with T-score less than −2.5 at any site
- Age <50
- Patients that do not desire or cannot undergo routine surveillance
Go straight to surgery if symptomatic
Question 13
A 45 YOm has daily temps to 100.9 and 15 lb wt loss over 3 m. he has pallor, normal vitals and
normal CV and P exams except a low pitched disatolic rumble at the apex that dissappears when
he lies on his R side. Hb is 10. Most liekly dx?
Correct Answer
Atrial myxoma!
Question 14
College football player sustained a knee injury following a tackle. Lower leg sags on passive
flexion of the knee at 90degrees while patient is supine
Most likely dx?
