Anyone take the Surgery Shelf recently

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Taking the surgery shelf in two weeks, what I have been studying is case files, kaplan step 2 notes and recall. Was planning on flipping through case files and kaplan step 2 notes again with some pre-test questions. This is my first shelf.

Any advice, opinions?

Hi.
Study the perioperative management of patients. They love questions about this. Also, I know this is nerdy, but if you can take the time to memorize as many normal lab values as possible it will help.

Quit studying surgical specifics. Practically the entire test is medical management.

Finally, if you can get a brain transplant and acquire the knowledge of a PGY-2,that would be best. About 1/3 of the questions are "what would be your next step" in patient management.

May the force be with you.

Thanks,

Are the normal lab values given to you on the exam, also roughly how many questions are on the surgery shelf?

Yes the values are all there, but it is a pain looking them up. There are 100 questions you get 2 hrs 10 min. Have fun.

I just took the surgery shelf a few weeks back, it was nothing like I expected. Like a lot of people have said, its a lot of medicine. Its being able to make a confident diagnosis based on a clinical scenario. That is literally 80-90% of the test. A bunch of the questions require you to do this, then to offer up the next therapeutic/diagnostic step.

For instance, they will give you a history suggesting a pheo, and ask you what lab test could confirm the diagnosis. Keep in mind that they never actually TELL you what the diagnosis is, so its a 2-tiered question.

I actually didn't find it so bad, save for the fact that the time limit was tough on me. I normally finish exams very quickly and I barely finished this one. More than a few people were furiously answering "C" to fill in the last 10 or so when time was called. So, budget your time properly and don't let yourself freak out.

Also, I really didn't get a lot of perioperative/fluid/nutrition management on my exam. As I said, a good majority of it was diagnosis and work-up. Some trauma, where the answer was invariably to either a) give IVF or b) properly perform your ABC's. A couple of weird wound healing and tissue infection questions, go over that chapter in Robbins or whatever text you are using; some of those questions were taken directly out of the Robbins chapter (e.g. which pathogen causes cellulitis most often).

OK, good luck.

Well, what do you recommend to preapre for the exam? I have the Lawrence, Pretest and Recall but I am stunned at how hard the Pretest is for me. I can hardly answer these freakin' questions and then I get most of them wrong. I am going to flunk this stupid test, I know it ...

This is my first rotation and so I don't have the IM or FP stuff down. I really have no idea what I am doing and I sort of want to drop out of school right now.

For most people at my school one's hardest shelf of 3rd year is either medicine or surgery, whichever one of the two that you have first. I had medicine first so it was by far my worst score and the one I came least closest to actually finishing (I only finished 1 shelf all year). Do not freak out if you don't finish, it does not mean you will fail, I still did above the mean on all of mine. Do not expect to ace your first shelf, this is a totally new testing format for most of us and it takes getting used to. Most people improve considerably as the year goes on. As for surgery specifically, Lawrence is a great book if you have the time (I didn't, I think I read like 3 chapters), FA is okay (but I don't like FA in general), I thought case files was pretty good and Kaplan notes are ok (although not quite the magic bullet I had been led to believe). Personally I think Pretest is a waste of time for surgery, those questions are way too esoteric in many cases and too specific to actual surgeries, which there will none of on the actual exam. They will not ask you about what type of incision, how to drain an abscess, what suture material to use, details of how to do a lap chole, etc. They will ask you what might be the cause of a pt's temp of 102 on POD #1 s/p a lap chole. Focus on diagnosis and post-op management. Hope this helps.

I just took the surgery shelf ~1 week ago and did well on it, my best advice to anyone taking it would be the following,

1. read the answers FIRST. then read the last sentence of the question. if needed, go back and read the question top to bottom. I can't tell you how many of my questions gave a long, detailed question stem and the last sentence would say something like "what is the arterial supply for X?" Many people find the time crunch to be a problem on this test, and you really can skip through the meat of alot of the questions.

2. I agree with what others have been saying concerning the amount of medicine that is on the test. If you haven't had it, well, just do your best with it. Don't waste time reading medicine books, just use your common sense and the brains that got you into med school to pick the answer that looks the best.

3. Focus on perioperative care for sure. And focus on decision making. You'll get far in this test if you know WHEN to operate on someone who is losing blood. Would you choose to do an ex. lap. after 3 units of PRBC's have failed to resuscitate? 6 units failed? Basically, you need to know the INDICATIONS for every surgery. And the contraindications. Alot of questions on this type of subject matter. Study the why's and when's behind the decision to do a surgery. The whats, the hows and the where's (eg the details of the surgeries) will be less represented on the test (though don't ignore them!)

This is all I can think of for now, off to the Peds ER to diagnose bug bites and do some more rapid strep tests!

Took it recently. <5 questions did not relate to medical management/diagnosis. Lots of GI stuff. Fluids Q's are easy. Management is usually straightforward if you know the disease. I did A&L, PreTest and Lawrence questions. PreTest was a waste of time compared to my version of the shelf. A&L is OK, kind of low yield because of its esoteric questions. There were a dozen or so questions that were verbatim out of Lawrence and Case Files, I mean VERBATIM. My unsolicited advice is to read Lawrence and then Case Files for a review. It is the breadth that makes this test challenging. Don't run out of time. Good luck.

I'm taking the surgery shelf a week from tomorrow. I've used the NMS Casebook for the bulk of my studying, and I'm considering using Casefiles too....

For those of you who have taken it, would you recommend that I stick with the NMS Casebook alone and know it really well, or try to finish Casefiles too (and maybe not know NMS as well)...??

I would recommend Appleton and Lange question book. I used PreTest too, but it ended up being pretty off-base. The majority of the shelf is medicine rather than surgery, so hopefully you've had medicine already or have been studying pathophys of diseases you've encountered in your surgery rotation. Trauma was very well represented on the shelf also, if I remember correctly.

A lot of it was pt management and medicine stuff. Surgery was my first rotation so I didn't have a really good medicine base for it. The only advice i'd give is to pace yourself during the shelf b/c some people I knew who took it didn't have time to finish b/c they'd spend too long on questions. Either you know it or you don't.

Took it about 3 weeks ago. My test had a lot of Trauma, GI stuff, acute abdomens, and Oncology. Surprisingly, there were about 5-6 Urology questions, but most of them were in the acute abdomen diagnosis -- kidney stones, pyelo, UTIs. None of the other subspecialties were very represented--maybe 2 Peds questions and a couple of Ortho and Neuro ones. Just study the main general surgery areas and you should be fine. Almost all of the questions were about management, as others have said. I had a lot of questions related to which imaging study you would do next, whether to operate or not. As for studying, I did not hav e a ton of time, so I mainly used NMS, both the case book and the review book in outline format. I read the whole Blueprints surgery the night before. It was short and basic and a good way to put together the high yield topics at the last minute. DO NOT do Pretest. I started and found it a big waste if time. The questions were way too detailed and related to surgical procedures. A&L seemed okay, but i did not have much time to do it. I also used a Blueprints Surgery question book which had longer question stems. The questions were straightforward and good to learn from but probably easier than the shelf. This was my first shelf and was hard but doable. Definitely watch your time. I barely finished and many of my classmates ran out of time. Good luck.

My test had some matching pedi questions at the very end. One was TE fistula (presentation of). I also had a ton of trauma or hemorrhaging patients, so know when to give fluids, when to give blood, and when to go straight to the OR.

Time is definitely a factor. I was one of 3 people in my group (of 40+) to actually finish the exam before time was called.

For the test, I used Pretest, Casefiles, and Lawrence (mostly to look stuff up). When I reviewed Casefiles 2 days prior to the test, I read the scenario and answered the questions before turning the pages. If you can a) quickly diagnose the patient using "key words" and b) think "what is the next step"? then you should do well.