NBME Surgery 2

Question 1

A 45-year-old man presents with sudden severe epigastric pain radiating to the back, nausea, and vomiting.
His serum lipase is 1,200 U/L.
CT scan shows peripancreatic fat stranding but no necrosis.
Which is the most appropriate initial management?

Accepted Answer

IV fluids, bowel rest, and analgesics

Answer

Immediate surgical debridement

Answer

Emergency ERCP

Answer

Oral enzyme replacement therapy

Question 2

A 62-year-old woman undergoes elective sigmoid colectomy. On postoperative day 5 she develops fever, tachycardia, and a wound that appears indurated with thin brownish discharge. Crepitus is palpated along the wound margins. What is the next best step?

Accepted Answer

Immediate surgical debridement and IV antibiotics

Answer

Oral antibiotics and wound culture

Answer

IV antibiotics alone

Answer

Wound vacuum-assisted closure

Question 3

A 28-year-old woman presents with a 3-cm tender mass in the right breast that has been present for 2 weeks. Ultrasound shows a well-circumscribed, anechoic, cystic structure. Fine-needle aspiration yields clear fluid and the mass resolves. What is the appropriate next step?

Accepted Answer

Reassurance and routine follow-up

Answer

Excisional biopsy

Answer

Repeat mammogram in 6 months

Answer

Core needle biopsy

Question 4

A 55-year-old man with a 30-pack-year smoking history presents with a pulsatile, non-tender periumbilical mass. Abdominal ultrasound shows an aortic diameter of 5.8 cm. He is otherwise asymptomatic. What is the most appropriate management?

Accepted Answer

CT angiography and referral for elective repair

Answer

Surveillance ultrasound in 6 months

Answer

Immediate open surgical repair

Answer

Elective endovascular aneurysm repair (EVAR)

Question 5

A 70-year-old woman has a complete small bowel obstruction confirmed on CT. She has no peritoneal signs, no fever, and WBC is 9,000/μL. What is the initial management?

Accepted Answer

NGT decompression, IV fluids, and serial abdominal exams

Answer

Immediate exploratory laparotomy

Answer

Colonoscopic decompression

Answer

High-dose IV corticosteroids

Question 6

A 40-year-old man undergoes total thyroidectomy for papillary thyroid cancer. Six hours postoperatively he complains of tingling around his mouth and in his fingertips. His calcium level is 7.2 mg/dL. What is the immediate treatment?

Accepted Answer

IV calcium gluconate

Answer

Oral calcium carbonate supplementation

Answer

IV magnesium sulfate

Answer

Parathyroid reimplantation

Question 7

A 66-year-old man with known cirrhosis presents with massive upper GI bleeding. Upper endoscopy reveals actively bleeding esophageal varices. After band ligation, bleeding is controlled. What medication should be started to reduce rebleeding risk?

Accepted Answer

Propranolol

Answer

Omeprazole

Answer

Spironolactone

Answer

Lactulose