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Surgery Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Surgery flashcards as text

  1. A 22-year-old man is brought to the ED after a motor vehicle collision with blunt abdominal trauma. He is hypotensive (BP 80/50 mmHg) despite 2L IV crystalloid. FAST exam shows free fluid in the abdomen. What is the next best step?

    Answer: Emergent exploratory laparotomy

    A hemodynamically unstable patient with positive FAST for free abdominal fluid requires immediate exploratory laparotomy without delay for CT.

  2. A 58-year-old woman presents with progressive dysphagia to solids over 4 months and a 10-lb weight loss. Upper endoscopy shows a mid-esophageal mass, and biopsy confirms squamous cell carcinoma. CT shows no distant metastases. What is the preferred treatment approach?

    Answer: Neoadjuvant chemoradiation followed by esophagectomy

    Resectable esophageal squamous cell carcinoma is treated with neoadjuvant chemoradiation followed by esophagectomy to improve survival.

  3. A 35-year-old woman presents with a 1-cm solitary thyroid nodule. TSH is normal. Fine-needle aspiration cytology is read as 'atypia of undetermined significance' (Bethesda III). What is the recommended next step?

    Answer: Repeat FNA in 3–6 months or molecular testing

    Bethesda III (AUS/FLUS) warrants repeat FNA or molecular marker testing to stratify malignancy risk before surgery.

  4. A 50-year-old obese woman presents with right upper quadrant pain, fever (38.8°C), and jaundice. Labs show elevated total bilirubin, alkaline phosphatase, and WBC of 16,000/μL. Ultrasound shows gallstones and a dilated common bile duct. What is the diagnosis?

    Answer: Ascending cholangitis

    Charcot's triad (RUQ pain, fever, jaundice) in the setting of choledocholithiasis and a dilated CBD indicates ascending cholangitis.

  5. A 60-year-old man with a history of smoking presents with left calf claudication after walking 200 meters that resolves with rest. His ABI is 0.65 on the left. He has no rest pain or tissue loss. What is the first-line treatment?

    Answer: Supervised exercise therapy and risk factor modification

    Lifestyle-limiting claudication without critical limb ischemia is managed initially with supervised exercise, smoking cessation, and antiplatelet therapy.

  6. A 48-year-old man undergoes laparoscopic cholecystectomy. On post-op day 2 he develops RUQ pain, fever, and elevated liver enzymes. Repeat ultrasound shows a fluid collection near the liver. MRCP reveals a bile duct injury with bile leak. What is the initial management?

    Answer: ERCP with biliary stenting

    Post-cholecystectomy bile leak from a minor duct injury is initially managed with ERCP and biliary stenting to reduce ductal pressure and allow healing.

  7. A 72-year-old man presents with crampy left lower quadrant pain, fever, and leukocytosis. CT shows pericolic fat stranding around the sigmoid colon with a 3-cm abscess. He is hemodynamically stable. What is the appropriate management?

    Answer: CT-guided percutaneous drainage and IV antibiotics

    Acute diverticulitis with a pericolic abscess ≥3 cm in a stable patient is best managed with CT-guided percutaneous drainage plus IV antibiotics.