Official Surgery Shelf Exam Discussion Thread

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nextbestanswer said:
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1. A
2. C
3. idk I also missed this one; not D though
4. I

If you're not sure why these are the correct answers let me know and I can post a brief explanation
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I did:
Pestanas (The "new" book) twice
NMS Casebook
Uworld all the surgery questions and all the IM questions (Except Infectious disease, cardio, preventative, biostats, neuro or respiratory)
Firecracker 100% surgery and about 65% of IM banked.
I completed Neurology, Family Med and Peds rotations before surgery.

97 scaled.

Pestanas book and NMS were golden but there was a ton of IM questions on the shelf.
 
Took this a couple of weeks ago. Raw score 90% not sure about scaled percentile

Materials used:
skimmed through NMS Casebook in the hospital during downtime, took notes, skipped details about surgeries.
Pestana 70 page cases document once during hospital downtime, once a day before test.
UWorld Surgery questions X2
during last 2 weeks reviewed my uworld and nms notes and did Pretest 400/500 questions.
Took NBME exams and got 78% on 1st and 72% on 2nd a day before exam.

Had OB and IM before this rotation.

I found pestana very helpful, Pretest was also good at covering wide range of topics that uworld didn't go into.
overall the test wasn't too bad. I had only 2 or 3 strictly IM questions, most were similar to pestana cases, pretest and uworld.
 
I used the Kaplan Pestana book and Pestana short notes, NMS Casebook, and UWorld. I don't think I would have used other resources, looking back. Pestana is an absolute MUST, as it hits all the big stuff and made at least half of the test very very simple. There were still quite a few difficult questions that I still don't know the answer to. In terms of material, expect to be tested on any medicine topic that has a potential surgical treatment. Sometimes the answer will be the medical treatment and not the surgical treatment, which I think explains why so many people say the test is medicine heavy. However, surgical concepts are still the majority. There will also be a small number of ethical questions. After the test I felt like I was hit by a truck and worse than I did after taking Step 1.

NBME #1 74 (panicked and read all of Pestana notes in one day)
NBME #2 82 (the next day after reading Pestana)

Result: 88 scaled 93rd percentile

Absolutely relieved as honors at my school is 85, and I felt that the exam was pretty challenging. I had taken only medicine beforehand.
 
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I'm starting Surgery tomorrow and I'm really confused. I have the Kaplan Surgery Lectures and the Kaplan Surgery Notes that go accordingly. What is the difference between these and the Pestana Audio and Lecture notes????? I know Pestana does the Kaplan lectures so I'm totally lost.

I'm hoping they are the same so I don't have to go try to track down the Pestana stuff. I've been searching online for like an hour and can't find anything.

Can someone maybe send me the Pestana audio and notes? That would be really awesome :)
 
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TheOcean said:
I'm starting Surgery tomorrow and I'm really confused. I have the Kaplan Surgery Lectures and the Kaplan Surgery Notes that go accordingly. What is the difference between these and the Pestana Audio and Lecture notes????? I know Pestana does the Kaplan lectures so I'm totally lost.

I'm hoping they are the same so I don't have to go try to track down the Pestana stuff. I've been searching online for like an hour and can't find anything.

Can someone maybe send me the Pestana audio and notes? That would be really awesome :)
Click to expand...

Use this: http://www.amazon.com/Dr-Pestanas-Surgery-Notes-Vignettes/dp/1609789164
It's the "new" Pestana book that has what you need.
 
There's a lot of buzz about Medicine being heavy on the shelf. Is simply UWORLD enough to cover those bases? and if so which questions are worth reviewing?
 
Seriously... screw that exam. NMS and Uworld only covers 40-50% of it. You're better off studying Step Up-Medicine front to back. I don't understand where anything in NMS/Uworld surgery was necessary/covered in better detail than Step Up. I wish I'd just stop wasting my time with Pestana/Uworld/NMS. Don't waste your time with NMS. Do Pestana if you really think you don't understand trauma and then just do Uworld for Medicine.
 
darkelfprincess said:
There's a lot of buzz about Medicine being heavy on the shelf. Is simply UWORLD enough to cover those bases? and if so which questions are worth reviewing?
Click to expand...

Yes, UW is enough. MKSAP gives you a different perspective. Lot's of the test is medicine and/or pre-surgical workup.

There was more peds and even ob/gyn on my exam (not to mention overwhelmingly more medicine) than true surgical questions.
 
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Pain in right hip and flank following MVC. Abrasions, echymoses over right flank Urinalysis shows gross blood. What do you do?
CT abdomen w/ contrast, renal angio, or cystoscopy?
----------------
Recurrent vomiting bright red blood and near syncope for 3 hours. Low BP, high pulse. Epigastric tenderness. What do you do?
Rapid infusion of normal saline or endoscopy?

I thought it would be endoscopy because you're pretty certain of the source of the bleed (pestana), but I guess the answer would be resus first?
--------------
Dyspnea, myalgia, flank pain during transfusion. Urine is dark, blood in the surgical drain. Which test would you do to diagnose this? ABG, blood culture, measure Hb concentration, repeat type and cross, screen for DIC?
---------------
LLQ pain, fever, tender w/ rebound, leukocytosis, fever. Xray w/ nonspecific gas pattern. Sounds like diverticulitis. I thought with the peritoneal signs you would do an ex lap. But that was wrong. The question asks for next step in diagnosis. So would you just do a CT anyway?
 
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JP2740 said:
Pain in right hip and flank following MVC. Abrasions, echymoses over right flank Urinalysis shows gross blood. What do you do?
CT abdomen w/ contrast, renal angio, or cystoscopy?
----------------
Recurrent vomiting bright red blood and near syncope for 3 hours. Low BP, high pulse. Epigastric tenderness. What do you do?
Rapid infusion of normal saline or endoscopy?

I thought it would be endoscopy because you're pretty certain of the source of the bleed (pestana), but I guess the answer would be resus first?
--------------
Dyspnea, myalgia, flank pain during transfusion. Urine is dark, blood in the surgical drain. Which test would you do to diagnose this? ABG, blood culture, measure Hb concentration, repeat type and cross, screen for DIC?
---------------
LLQ pain, fever, tender w/ rebound, leukocytosis, fever. Xray w/ nonspecific gas pattern. Sounds like diverticulitis. I thought with the peritoneal signs you would do an ex lap. But that was wrong. The question asks for next step in diagnosis. So would you just do a CT anyway?
Click to expand...

Recurrent vomiting bright red blood and near syncope for 3 hours. Low BP, high pulse. Epigastric tenderness. What do you do?
Rapid infusion of normal saline.
Always follow your ABCs. Stabilization always takes place before definitive management.
--------------
Dyspnea, myalgia, flank pain during transfusion. Urine is dark, blood in the surgical drain. Which test would you do to diagnose this? ABG, blood culture, measure Hb concentration, repeat type and cross, screen for DIC?
This is an acute hemolytic transfusion reaction. Usually due to ABO mismatch. Repeat type and cross will confirm (probably a clerical error). Checking for DIC is also something you would do as it effects management, but the presence of DIC doesn't confirm the diagnosis.
---------------
LLQ pain, fever, tender w/ rebound, leukocytosis, fever. Xray w/ nonspecific gas pattern. Sounds like diverticulitis. I thought with the peritoneal signs you would do an ex lap. But that was wrong. The question asks for next step in diagnosis. So would you just do a CT anyway?
People don't get ex-laps before confirmatory tests unless they are medically unstable. The CT scan is the next step. Keep in mind the questions are often phrases "next step in diagnosis." You don't need an ex-lap to diagnose diverticulitis. You might need one to treat it. You would also give antibiotics prior to surgery.
 
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Lavan said:
Recurrent vomiting bright red blood and near syncope for 3 hours. Low BP, high pulse. Epigastric tenderness. What do you do?
Rapid infusion of normal saline.
Always follow your ABCs. Stabilization always takes place before definitive management.
--------------
Dyspnea, myalgia, flank pain during transfusion. Urine is dark, blood in the surgical drain. Which test would you do to diagnose this? ABG, blood culture, measure Hb concentration, repeat type and cross, screen for DIC?
This is an acute hemolytic transfusion reaction. Usually due to ABO mismatch. Repeat type and cross will confirm (probably a clerical error). Checking for DIC is also something you would do as it effects management, but the presence of DIC doesn't confirm the diagnosis.
---------------
LLQ pain, fever, tender w/ rebound, leukocytosis, fever. Xray w/ nonspecific gas pattern. Sounds like diverticulitis. I thought with the peritoneal signs you would do an ex lap. But that was wrong. The question asks for next step in diagnosis. So would you just do a CT anyway?
People don't get ex-laps before confirmatory tests unless they are medically unstable. The CT scan is the next step. Keep in mind the questions are often phrases "next step in diagnosis." You don't need an ex-lap to diagnose diverticulitis. You might need one to treat it. You would also give antibiotics prior to surgery.
Click to expand...


Thank you. What about the trauma case I posted? The first one?
 
Do the NBMEs have any predictive power? I got 82 on both a week out from exam
 
JP2740 said:
Pain in right hip and flank following MVC. Abrasions, echymoses over right flank Urinalysis shows gross blood. What do you do?
CT abdomen w/ contrast, renal angio, or cystoscopy?
Click to expand...

CT abdomen will demonstrate the renal laceration and hematoma contributing to both the ecchymosis and hematuria. Renal angios are no longer performed for diagnostic purposes but can be used to noninvasively treat some renal lacerations, pseudoaneuryms etc (not ever going to be a correct answer on a shelf exam). Cystoscopy can be used when there is suspicion for a bladder injury (but only once a urethral injury is ruled out). Invasive diagnostic (+/- therapeutic) procedures are almost never the correct answer if a non-invasive and more rapid exam can also be used.
 
Could a few people please post their Surgery Self Assessment answers? Just the answers 1.a 2.c 3.d etc.. (to avoid the mod from deleting the post) for the ones you know are correct. I'll compile them together so we can have an answer key of sorts.

Unless the questions are randomized on the self assessment then ignore this.
 
I got an 88 on the shelf, good enough to honor. I actually came out really disappointed in myself because I identified 6 questions right off the bat that I made dumb mistakes on. I knew my stuff cold for this rotation.

The best resource, hands down, is that pestana book from amazon. There were plenty questions that came DIRECTLY from this book. It was more of a gimmie than any shelf exam I ever took-those questions that came it seemed right from the pestana book. Also, listen to his audio, because there were 2 questions that actually mimicked exactly his vignettes. There was a good amount of trauama and ortho-moreso than the people on here lead me to believe.

Pestana book
Pestana audio
NMS
Uworld surgery + Uworld select medicine
 
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I got a 94 on the shelf.

Resources:
Pestana book and questions 2x's with notes
NMS Casebook 2x's with notes
Pretest 2x's with notes
UWorld surgery 2x's
A smattering of NMS textbook
Both of the NBME practice exams (predicted 93% on both tests)

Honestly I thought this exam was hands down pretty easy - on par with Peds shelf. It was SO MUCH EASIER than the medicine shelf omg. I went through the surgery shelf two times AND had extra time at the end to go through marked questions a third time.

SO MUCH OB/GYN on this exam what the heck.....
 
Recently got my scores back. A few thoughts
A) 92 raw, 95% scaled. This exam gets a lot of hype, but its bark is worse than its bite. Similar to any other shelf exam.
B) Pestana Book aka Kaplan Surgery notes was by far the best resource for this exam. Must know everything in this book
C) For my administration, there was a lot of orthopedics I felt wasn't covered well in review books. On your own here as far as what to read.
D) This is by far the worst thread I have read so far on this website. A lot of people here are asking for the audio and video, instead of contributing. I have used these threads in a positive manner all year to help me and my colleagues prepare for shelf exams, and none have been this poor. I was passed down the video from someone at my school, and it is honestly a waste of your time. You would be much better off memorizing the Pestana book instead.
 
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Pompeymagnus said:
Recently got my scores back. A few thoughts
A) 92 raw, 95% scaled. This exam gets a lot of hype, but its bark is worse than its bite. Similar to any other shelf exam.
B) Pestana Book aka Kaplan Surgery notes was by far the best resource for this exam. Must know everything in this book
C) For my administration, there was a lot of orthopedics I felt wasn't covered well in review books. On your own here as far as what to read.
D) This is by far the worst thread I have read so far on this website. A lot of people here are asking for the audio and video, instead of contributing. I have used these threads in a positive manner all year to help me and my colleagues prepare for shelf exams, and none have been this poor. I was passed down the video from someone at my school, and it is honestly a waste of your time. You would be much better off memorizing the Pestana book instead.
Click to expand...

Do we go to the same school? haha....

88 raw, 91% scaled.

NBME Surg practice one = 74 (four weeks prior)
NBME Surg practice two = 69 (two weeks prior)

As you can see the practice tests were not that predictive for me.

-Read NMS once through (except for like two chapters)
-Did about 300/500 Pretest
-All of UWorld Surg
-Read Pestana Surgery Notes (the short book) 2X's
-Completed all 180 questions at the end of Pestana book

Best resource was the Pestana book. I've slowly learned over third year to choose few but meaningful resources. NMS was a decent foundation, but I think I would have done just as well had I just done the questions and the short Pestana book. Regardless I agree with the assessment above that this shelf wasn't as bad as I had heard. If I can do will, then I know most everyone else on here can too.
 
got some questions about nbme 2

1. lady with 1 wk of nausea, scleral icterus, and right sided abdominal cramps; already had lap chole 2 mo ago but no intra-op cholangiography; T bili 8, Direct 5, alk phos 650, ALT/AST normal
Cause of jaundice? i put primary biliary sclerosis (wrong) and other choices were choledocholithiasis, cirrhosis, pancreatic cancer, or postop bile leak
Maybe postop bile leak was the ans b/c the others don't make sense with the LFTs, but would appreciate if someone could explain

2. woman undergoing ex lap for chronic pelvic pain. already consented with husband as witness, but after receiving narcotics, she gets panics and doesn't want operation anymore. What do you do?
I put reconfirm with husband, give benzo, and proceed to operation b/c I thought she wouldn't have decision making capacity after getting the narcs, but that was wrong
other choices: cancel op, consult psych, proceed with op as planned, or proceed with op after giving opioid antagonist

3. 15 yo boy with small right pneumothorax. next step in eval?
I put CT chest since you could look for apical blebs (incorrect)
other choices: observation, PFTs, VQ scan, bronch
 
1tbspofpatience said:
got some questions about nbme 2

1. lady with 1 wk of nausea, scleral icterus, and right sided abdominal cramps; already had lap chole 2 mo ago but no intra-op cholangiography; T bili 8, Direct 5, alk phos 650, ALT/AST normal
Cause of jaundice? i put primary biliary sclerosis (wrong) and other choices were choledocholithiasis, cirrhosis, pancreatic cancer, or postop bile leak
Maybe postop bile leak was the ans b/c the others don't make sense with the LFTs, but would appreciate if someone could explain

2. woman undergoing ex lap for chronic pelvic pain. already consented with husband as witness, but after receiving narcotics, she gets panics and doesn't want operation anymore. What do you do?
I put reconfirm with husband, give benzo, and proceed to operation b/c I thought she wouldn't have decision making capacity after getting the narcs, but that was wrong
other choices: cancel op, consult psych, proceed with op as planned, or proceed with op after giving opioid antagonist

3. 15 yo boy with small right pneumothorax. next step in eval?
I put CT chest since you could look for apical blebs (incorrect)
other choices: observation, PFTs, VQ scan, bronch
Click to expand...

1. Choledocholithiasis - you can still have stones after a lap chole that can impact in the biliary tree.
2. You absolutely do have the right to cancel your surgery at any time. Consent given previously or not.
3. Observe. Small pneumothorax = no biggie, it will resorb. Chest tube if they can't breathe. Imaging plays no role in pneumothorax workup AFAIK.
 
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thanks wordead. one more question though, why don't you get elevated AST/ALT if you have a stone in the common bile duct?
 
Which of the following findings best indicates adequate fluid resuscitation?
- Pulse <90
- SBP >100
- Urine output 30-40 mL/h

The literature says the most adequate marker is serum lactate, but of the choices which?
 
UOP 30-40cc/hr for fluid resuscitation
nerve conduction studies for carpal tunnel dx
 
A lot of people are just writing that they used "Pestana"...does this mean the 75 page Pestana case notes, or the 200+ page Kaplan book you can order off Amazon?

Also, I only finished ~700 UW questions for medicine. Would it be a good use of my time to finish the remaining UW IM questions for the surgery shelf?
 
Took this beast. Honestly didn't think it was too bad but maybe I'm being overconfident.

I used Pestana/Kaplan book & Casefiles. I also did all of UWorld surgery. I did maybe 25 questions in pretest and wanted to kill myself due to the sheer amount of detail/random questions they had.

Practice NBME 1: 76 Practice NBME 2: 88

Will update when I get my score (2-3w)
 
just got score back 86. unsure if it's scaled or whatever. had medicine immediately prior to surgery. This is my second to last rotation. Limited resources because I tend to be a minimalist. I like to stick to one good book and a question bank. My surgery rotation was 4 weeks specialty service (inpatient neurosurgery) and 4 weeks general surgery.

Resources: NMS surgery casebook x 1 and Surgery UWorld x 2. That's it. But I did read Step Up 2 Medicine and do 60% of the medicine UWorld questions during medicine in the 8 weeks before. I think this definitely helped.

I walked out of this shelf thinking I failed it. Needed a 60 minimum score to pass the course and it's 50% of my surgery grade. I really didn't think I made the 60, that's how difficult I found the exam. As everyone says, a good portion of the test was medicine. I found NMS to be extremely helpful. I'm overall pleased with my score.
 
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Can someone help me with these Clinical Mastery Questions?

1. 45 yo man with low grade fever and 15 lb weight loss .... has a low pitched, rumbling diastolic murmur heart at the apex; the murmur disappears when the pt lies on his R side. Hb concentration is 10g/dl. Most likely dx?
AI (wrong)
AS (no)
Atrial Myxoma?
Pericarditis?
VSD (no)

2.
 
MS3inOhio said:
Can someone help me with these Clinical Mastery Questions?

1. 45 yo man with low grade fever and 15 lb weight loss .... has a low pitched, rumbling diastolic murmur heart at the apex; the murmur disappears when the pt lies on his R side. Hb concentration is 10g/dl. Most likely dx?
AI (wrong)
AS (no)
Atrial Myxoma?
Pericarditis?
VSD (no)

2.
Click to expand...

I think this question is fair in that you should know how to eliminate the wrong answers.

As for ausculation of atrial myxoma, I'm assuming that because it's a septal lesion and it's affecting the mitral valve, laying on the right would put the lesion on the septum, while laying on the left would pull the lesion away from the septum more in line with the valve.

I can't imagine any physician using this as either a specific or sensitive test... echo would be much better.
 
62 yo F with 3 wk hx of progressive SOB, mild pain in R chest wall, non-productive cough. 12 lb wt loss over last 3 months. Diagnosed w/ R breast cancer 6 yrs ago treated w/ lumpectomy and radiotherapy and chemo. In mild resp distress, appears cyanotic and cachectic. BMI 20. Pulse 88, RR 24, BP 114/80. Oxy sat 90% room air. Tenderness to palpation over R chest. Breast sounds decreased on R w/ dullness to percussion. friction rub heard at the R. HS normal. Most likely Dx?
a) Chest wall recurrence- no.
b) Empyema
c) Pericardial effusion
d) PE
e) Malignant pleural effusion


67 yo F end stage renal disease, CAD, DM undergoes operative formation of AV conduit in the L forearm for vascular access. Performed under axillary block anesthesia. 24 hrs later, SOB. Temp 99, HR 129, RR 38, BP 100/55. Exam shows jugular venous distention. Crackles heard at both bases. S1 and S2 normal. S3 and S3 present. No edema of sacrum or extremities. Administration of 300mL fluids begun. Most likely dx?
a) atelectasis
b) high output CHF
c) hypovolemia
d) pneumonia
e) PE- Wrong
 
Sugar87 said:
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Click to expand...

D. IV calcium gluconate is # 1 tx. for hypocalcemia

B. low-dose heparin prophylaxis will reduce the risk of bleeding during surgery

MS3inOhio said:
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I. "sensation to pinprick is decreased below nipples" suggest lesion @ lvl. of thoracic spinal cord

MS3inOhio said:
content removed by moderator staff
Click to expand...

E. breast cancer is associated w/ malignant pleural effusion

B. AV fistulas are associated w/ high-output CHF
 
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Finally got a chance to make up for my piss-poor performance on my psych shelf. Got a 97 on this shelf (unsure if raw/scaled).

I was worried b/c I marked ~20 questions on my form. I used Surgery 101 free podcasts x 2, Kaplan vids, 80% of cases from Clerkship Companion (via RSNA website), casfiles, casebook, pestana, uw surgery, ~40% uw incorrects, qbook, qbank.

Edit: Also used Surgical Recall daily before morning rounds and before going to the OR.
 
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Got my grade back for this shelf: 96 raw, 96% scaled to 100

I used the Pestana book x 3 , Kaplan surgery step 2 ck videos (taught by pestana, probably overkill with the book but I did them anyway, probably don't need these), Uworld and Kaplan Qbank surgery questions, I read a topics as needed in NMS surgery (the textbook) to prepare for the oral boards my school gives.

I had IMED before this and there were def some random IMED questions
 
Sugar87 said:
Got my grade back for this shelf: 96 raw, 96% scaled to 100

I used the Pestana book x 3 , Kaplan surgery step 2 ck videos (taught by pestana, probably overkill with the book but I did them anyway, probably don't need these), Uworld and Kaplan Qbank surgery questions, I read a topics as needed in NMS surgery (the textbook) to prepare for the oral boards my school gives.

I had IMED before this and there were def some random IMED questions
Click to expand...

Did IM help you? Because just reading pestana, uw, and kaplan doesn't seem like it would give you the breathe of knowledge you need for the shelf.
 
abc12341 said:
Did IM help you? Because just reading pestana, uw, and kaplan doesn't seem like it would give you the breathe of knowledge you need for the shelf.
Click to expand...

IM did help but there were some random questions that I couldn't have really prepared for, there was even a question on childhood tumors, I did think that pestana helped quite a bit though, i went through it three times over a 12 week period, the last run was a few days before the actual shelf
 
Sugar87 said:
IM did help but there were some random questions that I couldn't have really prepared for, there was even a question on childhood tumors, I did think that pestana helped quite a bit though, i went through it three times over a 12 week period, the last run was a few days before the actual shelf
Click to expand...

did you use the book from amazon or the pdf
 
Hey guys, surgery is my first rotation - would it be a good idea to read step up to medicine since I haven't had internal med or any other rotation yet? Or should I stick to Uworld/Pestana/just surgery books? Thanks! And sorry for the inappropriate post location, but I think this thread is more frequented than the other ones I've seen...
 
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