NBME Surgery Shelf Exam 2026 Exam Latest!!
LATEST VERSIONS 100 QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH
RATIONALES (100% CORRECT) A+ GRADED
ASSURED
1 day hx of RUQ pain worsened with greasy foods, nausea, altered mental status, jaundice and
fever.
Most likely dx? - CORRECT ANSWER: Acute cholangitis secondary to gallstone impaction
11 month old girl brought to ED 1 hr after onset of fever and passing of purple current jelly
stools. Elongated mass palpable in RUQ.
Next step in management? - CORRECT ANSWER: Contrast enema!
Both diagnostic and therapeutic for intussusception
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
,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
1st step in management of septic shock? - CORRECT ANSWER: IV fluids
2 days after a Whipple procedure, patient has 30cm of white opaque drainage from drain.
Next step? - CORRECT ANSWER: Send fluid for amylase level!
25 yo in ED after MVC. After primary and secondary survey, found to have a fracture of the
right clavicle. Bruit heard over the right upper chest. Most appropriate next step? - CORRECT
ANSWER: CT angiogram of the chest and arm (remember the neurovascular exam)
CT angiogram indicated in presence of thrill or bruit around clavicle, diminished or absent
radial/brachial pulse, fx of first rib, large hematoma in supraclavicular region or mediastinum
widening on CXR
29 yo M with SAH. He is managed appropriately. Recovery complicated by progressive lethargy,
agitation and eventual coma.
Likely explanation? - CORRECT ANSWER: SAH predisposes to cerebral salt-wasting
syndrome or SIADH! -> hyponatremia
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
, 30 yo M presents with 4 months of painful right great toe. + claudication after 2 blocks. 20 pack
year smoking hx. Total XOL 160. PEx no palpable dorsalis pedis or posterior tibial pulses in
either foot. Big toe slightly bluish and tender to palpation.
Most likely dx and tx? - CORRECT ANSWER: Buerger's disease!
Smoking cessation is cornerstone!
32 yo housekeeper comes to physician for hip pain localized to the lateral aspect of the hip. Hip
pain is interrupting her sleep. She denies any muscle weakness or numbness and tingling.
TTP on the lateral aspect of her hip while in the lat decubitus position.
Most likely dx? - CORRECT ANSWER: Trochanteric bursitis!
(Meralgia paresthetica would have numbness/tingling)
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
35 yo w/ serum Ca 12.8 and elevated PTH. Thin with no significant PMH. 2weeks of loose
stools, polydipsia, and polyuria. PEx shows large erythematous erosions with blisters over lower
abdomen.
LATEST VERSIONS 100 QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH
RATIONALES (100% CORRECT) A+ GRADED
ASSURED
1 day hx of RUQ pain worsened with greasy foods, nausea, altered mental status, jaundice and
fever.
Most likely dx? - CORRECT ANSWER: Acute cholangitis secondary to gallstone impaction
11 month old girl brought to ED 1 hr after onset of fever and passing of purple current jelly
stools. Elongated mass palpable in RUQ.
Next step in management? - CORRECT ANSWER: Contrast enema!
Both diagnostic and therapeutic for intussusception
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
,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
1st step in management of septic shock? - CORRECT ANSWER: IV fluids
2 days after a Whipple procedure, patient has 30cm of white opaque drainage from drain.
Next step? - CORRECT ANSWER: Send fluid for amylase level!
25 yo in ED after MVC. After primary and secondary survey, found to have a fracture of the
right clavicle. Bruit heard over the right upper chest. Most appropriate next step? - CORRECT
ANSWER: CT angiogram of the chest and arm (remember the neurovascular exam)
CT angiogram indicated in presence of thrill or bruit around clavicle, diminished or absent
radial/brachial pulse, fx of first rib, large hematoma in supraclavicular region or mediastinum
widening on CXR
29 yo M with SAH. He is managed appropriately. Recovery complicated by progressive lethargy,
agitation and eventual coma.
Likely explanation? - CORRECT ANSWER: SAH predisposes to cerebral salt-wasting
syndrome or SIADH! -> hyponatremia
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
, 30 yo M presents with 4 months of painful right great toe. + claudication after 2 blocks. 20 pack
year smoking hx. Total XOL 160. PEx no palpable dorsalis pedis or posterior tibial pulses in
either foot. Big toe slightly bluish and tender to palpation.
Most likely dx and tx? - CORRECT ANSWER: Buerger's disease!
Smoking cessation is cornerstone!
32 yo housekeeper comes to physician for hip pain localized to the lateral aspect of the hip. Hip
pain is interrupting her sleep. She denies any muscle weakness or numbness and tingling.
TTP on the lateral aspect of her hip while in the lat decubitus position.
Most likely dx? - CORRECT ANSWER: Trochanteric bursitis!
(Meralgia paresthetica would have numbness/tingling)
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
35 yo w/ serum Ca 12.8 and elevated PTH. Thin with no significant PMH. 2weeks of loose
stools, polydipsia, and polyuria. PEx shows large erythematous erosions with blisters over lower
abdomen.
