Surgery shelf NBME Exam Updated Questions and
Answers 2024
"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?",
gastric bypass
"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?",
forumulation of antiplatelet antibodies (idiopathic thrombocytopenic purpura)
"87 YOM has sudden onset of SOB after emergent colon resection for obstructing
Ca. T 100, HR 104, RR 32, BP 88/50. PE: JVD, crackles over midlungfields.
NMRG.Liver span is 13. ECG shoews ST elevation. Mostlikely Dx?",
Cardiogenic schock (MI)
"A 13 YOB has increasingly severe left thigh pain and knee pain and limp for 2
days. No Hx of trauma, BMI =20, Passive motion of hip elicits pain, Most likely
Dx?",
slipped capital femoral epiphysis
"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?",
fat embolism
"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?",
,Lymphoma
"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?",
Thoracic spinal cord: T10 is nipples
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?,
avascular necrosis of the femoral head
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
decr renal fxx?,
failure to surpress class II antigen recognition in the host ( rejection)
"For 4 hours, a 55 YOM has acute intermittent pain that begins in right flank and
radiates to right testicle. Most likely finding on UA?",
microscopic hematuria (30 /hpf in sediment)
"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?",
laparotomy (toxic megacolon)
"The driver of an automobile is brought into ED after head on MVC at 50 mph. He
has mid chest tenderness. All diagnostic tests are norma, except an XR of the
chest which shows a widened mediatinum. NExt step?",
aortic arch arteriogram ( I guess they are assuming CT is neg)
"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?",
rapid infusion of 0.9% saline. Fluids, then you can figure out the bleeding source
"A 62 YOW comes to the physisics with 3 w of progressive SOB, mild pain in right
chest, and nonproductive cough. 12 lb wt loss in last 3 m. She had br ca 6 years
, ago s/p mastectomy. She appears cyanotic and cachectic. friction rub is heard on
the right.Dx?",
malignant pleural effusion (lung mets)
"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?",
ABI is first before duplex. arteriogram is a preop test
"Following diganosis of ectopic pregnancy in a 25 YOW, an abdominal operation
is performed. Exam of the abdomen shows a normal uterine pregnancy but an
inflamed appendix. An appy is performed despite the fact the consented only
ectopic removal. Is that ok?",
inappropriate because the patient had not been previously informed of the risks of an
appendectomy
"A 67 YOW with ESRD, aterosclerodic CAD, T2DM undergoes formation of an AVF
in left forearm under ax block. 24 hours later. SHe has SOB, , tacycardia, RR 38
with JVD. S3 and S4 are present. Most likely Dx?",
high output congestive heart failure ( atelectasis just doesnt cover enoguh)
"4 days after CABG, a hospitalized 47 YOM has the sudden onset of severe pain
in his left great toe. He was admitted to the hospital 10 days ago for chest pain
with exertion, and has been getting aspirin and heparin. CBC: 12.2/27%/8. PT and
PTT normal. Dx?",
heparin induced thrombocytopenia
"a 27 YOw, HIV +, 6 m of nonbloody diarrhea now with bloody diarrhea. She has a
high fever, and a rigid abdomen. She ends up with an ileostomy for a perforated
cecum and the path report shows nuclear inclusion bodeis in colon. Most likely
organism?",
CMV
"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
Answers 2024
"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?",
gastric bypass
"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?",
forumulation of antiplatelet antibodies (idiopathic thrombocytopenic purpura)
"87 YOM has sudden onset of SOB after emergent colon resection for obstructing
Ca. T 100, HR 104, RR 32, BP 88/50. PE: JVD, crackles over midlungfields.
NMRG.Liver span is 13. ECG shoews ST elevation. Mostlikely Dx?",
Cardiogenic schock (MI)
"A 13 YOB has increasingly severe left thigh pain and knee pain and limp for 2
days. No Hx of trauma, BMI =20, Passive motion of hip elicits pain, Most likely
Dx?",
slipped capital femoral epiphysis
"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?",
fat embolism
"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?",
,Lymphoma
"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?",
Thoracic spinal cord: T10 is nipples
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?,
avascular necrosis of the femoral head
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
decr renal fxx?,
failure to surpress class II antigen recognition in the host ( rejection)
"For 4 hours, a 55 YOM has acute intermittent pain that begins in right flank and
radiates to right testicle. Most likely finding on UA?",
microscopic hematuria (30 /hpf in sediment)
"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?",
laparotomy (toxic megacolon)
"The driver of an automobile is brought into ED after head on MVC at 50 mph. He
has mid chest tenderness. All diagnostic tests are norma, except an XR of the
chest which shows a widened mediatinum. NExt step?",
aortic arch arteriogram ( I guess they are assuming CT is neg)
"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?",
rapid infusion of 0.9% saline. Fluids, then you can figure out the bleeding source
"A 62 YOW comes to the physisics with 3 w of progressive SOB, mild pain in right
chest, and nonproductive cough. 12 lb wt loss in last 3 m. She had br ca 6 years
, ago s/p mastectomy. She appears cyanotic and cachectic. friction rub is heard on
the right.Dx?",
malignant pleural effusion (lung mets)
"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?",
ABI is first before duplex. arteriogram is a preop test
"Following diganosis of ectopic pregnancy in a 25 YOW, an abdominal operation
is performed. Exam of the abdomen shows a normal uterine pregnancy but an
inflamed appendix. An appy is performed despite the fact the consented only
ectopic removal. Is that ok?",
inappropriate because the patient had not been previously informed of the risks of an
appendectomy
"A 67 YOW with ESRD, aterosclerodic CAD, T2DM undergoes formation of an AVF
in left forearm under ax block. 24 hours later. SHe has SOB, , tacycardia, RR 38
with JVD. S3 and S4 are present. Most likely Dx?",
high output congestive heart failure ( atelectasis just doesnt cover enoguh)
"4 days after CABG, a hospitalized 47 YOM has the sudden onset of severe pain
in his left great toe. He was admitted to the hospital 10 days ago for chest pain
with exertion, and has been getting aspirin and heparin. CBC: 12.2/27%/8. PT and
PTT normal. Dx?",
heparin induced thrombocytopenia
"a 27 YOw, HIV +, 6 m of nonbloody diarrhea now with bloody diarrhea. She has a
high fever, and a rigid abdomen. She ends up with an ileostomy for a perforated
cecum and the path report shows nuclear inclusion bodeis in colon. Most likely
organism?",
CMV
"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
