NBME Surgery 3

Question 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?

Accepted Answer

Emergent exploratory laparotomy

Answer

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

Question 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?

Accepted Answer

Neoadjuvant chemoradiation followed by esophagectomy

Answer

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

Question 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?

Accepted Answer

Repeat FNA in 3–6 months or molecular testing

Answer

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

Question 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?

Accepted Answer

Ascending cholangitis

Answer

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

Question 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?

Accepted Answer

Supervised exercise therapy and risk factor modification

Answer

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

NBME Practice Test

NBME Practice Test

NBME Surgery 3