Official Surgery Shelf Exam Discussion Thread

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COdoubleMO2theN said:
Abscess - drain it.
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It's not an abscess. That type of severity of pain in that short time span (4 hrs) is probably a ruptured cyst. An abscess would be a milder pain that lasts for several days. This is as emergent as a ruptured appendix, so you have to open them (ex-lap)
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netminder said:
2. C can't be right, because the patient is on antilymphocytic drugs. D can't be right because that's acute rejection. E can't be right because polycystic kidney disease wouldn't be present in a donor kidney. So I guess it's A. A seems somewhat consistent with chronic rejection…?

I agree. It has been three years.
3. Hmm. It can't be A because it's probably cancer. Probably not E because trendy, poorly validated tests are never the answer on a board exam. So between B and D, I guess D?

I would go with D as well. I doubt B is a reasonable choice because it's not usually recommended to do a partial mastectomy like this without some kind of tissue diagnosis. If you can score a diagnosis on a needle biopsy/aspirate, great. But if this is not an option, I think you need a tissue diagnosis before you pursue any kind of mastectomy.
4. Geez CHF in 24 hours seems odd. But what else could it be (already know it's not PE)…?

Yes, it is high-output CHF because the surgeon just created a shunt (the surgically created AV fistula).
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For the kidney transplant question A is not correct as I used that answer. Any other suggestions?
 
kwel said:
It's not an abscess. That type of severity of pain in that short time span (4 hrs) is probably a ruptured cyst. An abscess would be a milder pain that lasts for several days. This is as emergent as a ruptured appendix, so you have to open them (ex-lap)
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Answer is E because it is progressing and there are peritoneal signs now.

I don't think it is an abscess. I was thinking along the lines of a molar pregnancy but not sure.
 
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kaleerkalut said:
Answer is E because it is progressing and there are peritoneal signs now.
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:thumbup:

This patient is sick and has some badness brewing in the abdomen based on physical exam, history, and imaging. Time to take a look.
 
The bolded part informs you that whatever is in her RLQ has ruptured and is now causing peritoneal signs. If it's causing peritoneal signs, you open her up. E.
 
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^^ I would probably say E as well, although I am definitely not sure of it. It seems like the sx of cholestasis are likely due to the cyst. I don't think a HIDA will tell us anything knew, removing the gallbladder doesn't fix the cyst, sphincterotomy doesn't fix the cyst, and I'm not sure about D.

evilbooyaa said:
Just took the shelf this morning.
I don't think I killed it (probably not getting in the 90s scaled) but if I get in the 80s on it I'll be happy. I'll post once I get my score back (likely ~6 weeks). If > 6 weeks have passed and I haven't posted, whoever reads this can feel free to PM me, and I'll post regardless of the score (unless maybe I fail). I've taken a lot from these forums, and this is about the baseline of what I can do re-pay the community.
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Forgot that shelf scores come back ASAP. I got a 78, with minimum passing being a 63. According to my school, that's good enough to qualify me for a high pass, if my clinical and oral exam evaluations hold up. Fingers crossed.
 
Are there generally experimental questions on these shelf exams (like they have on step 1)? anyone know?
 
No one actually knows unless they're ****ing an NBME test question writer. Given that there are only 100 questions and they have to stratify ~16,000 test takers per year, then it's probably unlikely that they will sacrifice any graded questions and lower their discriminator.

My guess is that they test new questions on Step 2 CK first and farm out those questions to the shelf exams in subsequent years. Caveat: I am not ****ing an NBME test question writer.
 
skassf said:
I havent gotten my scores back, but I went into the exam and I was the only kid who was not blind sided by the amount of medicine. In addition to casebook and pestana, I read chapters of step up (Endo, GI, Fluids, parts of Heme. Then, on uworld, I did all the surgery question + GI, Endo, Fluids, Heme/Onc, ENT, Optho, GU, Heptatology. I didnt do any cardio or pulm bc I felt I knew those areas pretty well.

Also taking the clinical science mastery exams helps let you see what the exam is going to be like, which I found really helpful.

I havent taken step 1 yet, so my general knowledge was lacking, hence I did all these uworld questions.

EDIT - got an 81, which assuming the avg is 70 with an sd of 8, is 92nd percentile.
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The avg is no longer 70 for nearly any of these tests. That is an old relic that does not apply anymore.
 
97th percentile.
I'm not sure what advice to give, because I had very little studying prior. I took a NBME the day before and got 82 on the subject score. I did surgery UWorld questions the day before and averaged 70%. Did not read pestana/lawrence/NMS, step up or any other texts. However I had medicine shelf already, so maybe that was the key?
 
No clue how I did on my shelf yet.

But just wanted to pop in and say before I forget: I did both the practice tests and one of the images from the practice test actually showed up on the real thing. Different question stem and answer choices, but same point.
 
my surgery team is riding me like a dog this week when they know I have the shelf. I pretty much only have a day and a half left. I read NMS (except for preop/postop/woundhealing chaps) once, watched Pestana once, and did Uworld once, but this was like over a month ago. This last block been crazy busy. What do you recommend is best to review at this point? Been so long and up to my neck in scut work that i feel like barely remember much
 
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So, I've been studying for the Surgery Shelf - and is it just me, or do the UWorld questions seem exceedingly easy? I'm almost afraid that they are too easy. I'm also reading Pestana and NMS - which seem to be good.
 
98

Uworld (surg + re-did many med ?s), MTB to refresh Medicine; NMS/Pestana here and there during rotation.Test is mainly medicine as most have eluded to with some surgery ?s fairly equivalent to UWorld surg questions.
 
So I am about a week out from the test. I've done NMS casebook x 1, UWorld Surgery/GI/Endo x 1, Long Pestana x1 and Pestana audio x 1.

For the last week I plan to go over all the UWorld questions that I missed. I also have time for one more thing. My question is this: would it be worthwhile to spend the last week thoroughly going over Pestana vignettes one more time or going over NMS casebook one more time? Any suggestions?
 
clifftacopter said:
So I am about a week out from the test. I've done NMS casebook x 1, UWorld Surgery/GI/Endo x 1, Long Pestana x1 and Pestana audio x 1.

For the last week I plan to go over all the UWorld questions that I missed. I also have time for one more thing. My question is this: would it be worthwhile to spend the last week thoroughly going over Pestana vignettes one more time or going over NMS casebook one more time? Any suggestions?
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Pestana for sure
 
Okay so my test is this Friday morning, gives me like 2.5 days. What should I be doing the last couple days? I've got both days off, so I have some breathing room.
I've done Uworld surgery and GI/hepatology questions x2. Read most of case files throughout the rotation (wasn't so good though, don't remember much) and read Pestana notes.

I was thinking of buying Pretest and doing as many questions as possible VS doing Uworld questions endocrine, urinary, ENT, etc.

Any tips? Thanks
 
TheProwler said:
Options are lame. Next option should be to do an awake fiber-optic intubation. Doing a trach on an awake patient with an irradiated neck and a tumor recurrence is not gonna happen, and I wouldn't want to put this guy to sleep. I wonder if the answer is to bronch him, to better characterize the lesion, but I don't think that should be your next step either.
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Not to perseverate on the point, but we had a gentleman with a large obstructing hypopharyngeal SCC on the table for a laryngopharyngectomy yesterday. It was a recurrence, he had an awful post-XRT neck. Fiber optic intubation was attempted and failed.

He got an awake trache.
 
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VisionaryTics said:
Not to perseverate on the point, but we had a gentleman with a large obstructing hypopharyngeal SCC on the table for a laryngopharyngectomy yesterday. It was a recurrence, he had an awful post-XRT neck. Fiber optic intubation was attempted and failed.

He got an awake trach. :smuggrin:
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Sucks for the patient, but at least he can be reassured that his morbid circumstance could be used to win an argument on an internet forum :smuggrin::smuggrin::smuggrin::smuggrin::smuggrin:

Anyway, let's get back to people boasting about their 99s
 
Without knowing all of the answer choices, my first guess would be a retinal artery occlusion.

I had to google the following info:
Optic neuritis is classically painful, unless possibly it's in kids. Most common in MS patients with a younger age of onset (max was ~45).

Retinal artery occlusion is a painless loss of monocular vision.
Typical funduscopic findings of a pale retina with a cherry red macula (ie, the cherry red spot) result from obstruction of blood flow to the retina from the retinal artery, causing pallor, and continued supply of blood to the choroid from the ciliary artery, resulting in a bright red coloration at the thinnest part of the retina (ie, macula). These findings do not develop until an hour or more after embolism, and they resolve within days of the acute event.
 
PiBond said:
Score: 91

Anyone know where to find percentiles or how to calculate them?

Resources used:
- Pestana vignettes
- NMS casebook
- UWorld (X1) surgery, electrolytes, and GI

Haven't taken medicine yet, but I felt like it would have definitely helped.
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If you have your official score report, it has the mean and SD, so you could calculate your own percentile. Your school should have your percentile (unsure where they get it from), because in our Dean's letter it gives the percentile for our shelf exams.
 
PiBond said:
Score: 91

Anyone know where to find percentiles or how to calculate them?

Resources used:
- Pestana vignettes
- NMS casebook
- UWorld (X1) surgery, electrolytes, and GI

Haven't taken medicine yet, but I felt like it would have definitely helped.
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http://bayes.bgsu.edu/nsf_web/jscript/normal_cdf/normal_icdf.htm

Plug in the exam mean (70 I believe) and SD (8) into the appropriate boxes. Then enter probability values of 0.9 and above and compute x. Increase or decrease the probability, i.e. 0.88 or 0.95 or whatever until the computed x equals your shelf score. A score of 92, for example, corresponds to a probability of 0.997. By my count that would thus place you in the 99.7 percentile.
 
That's not quite correct

The test is "scaled" to have a mean of 70 but my school released class/school specific stats and national stats which differed significantly

Ask your school if they hand out stats
 
NewYorkDoctors said:
That's not quite correct

The test is "scaled" to have a mean of 70 but my school released class/school specific stats and national stats which differed significantly

Ask your school if they hand out stats
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This is correct. These exams were normed 10+ years ago and the national averages aren't 70 any more for any of them.

This is not a raw score either, as in a 70 means 70% correct/100. No one knows how many questions you can miss and get a certain scaled score. Think of it as the same as your Step 1 score in that sense.
 
i know this is absurdly basic, but surgery is my first rotation and I literally know nothing about surgery, never been in an OR (IR flouro is closest ive seen), never even watched a surgery TV show or whatever.

I am looking for some basic resource just to familiarize myself with some surgical terminology/tools/etc. Also was curious what are maybe the 5-10 most common general surgery procedures are so I could watch a video or them or something so I have some vague idea what people are talking about.
 
Armadillos said:
i know this is absurdly basic, but surgery is my first rotation and I literally know nothing about surgery, never been in an OR (IR flouro is closest ive seen), never even watched a surgery TV show or whatever.

I am looking for some basic resource just to familiarize myself with some surgical terminology/tools/etc. Also was curious what are maybe the 5-10 most common general surgery procedures are so I could watch a video or them or something so I have some vague idea what people are talking about.
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I would recommend Surgical Recall to review for OR cases: they have alot of questions and answers which are high yield. I believe they have a section on the surgical tools as well, although I would say you probably do not need to know them now at this stage of training (and since in OR you don't use them, you don't need to know the terminology).

With regards to the most common general surgery procedures, definitely know about hernias and vascular surgery including fem-pops (these were common on the gen surg service so I hear). My surgery rotation was not Gen Surg so I will let others answer which other procedures.
 
Another dumb question, when people say they are doing uworld surgery questions, does that mean doing step 2 CK questions related to surgery or do they have a separate uworld for shelf exams?
 
Somewhat of a repeat question (sorry!):

My first rotation, starting next week, is surgery. Since I won't have the benefit of going through IM before surgery, is it worth reading Step Up to Medicine during this rotation? For the shelf, I mean. Or would I be okay reading the big NMS book + Pestana audio and notes + NMS Cases + UWorld? Or is that even too much? The problem is that my surgery rotation is 2 months long, so that gives less time to go through thick books. Any suggestions would be awesome, so I can better plan out what/how to read over the next few weeks. Thanks.
 
Armadillos said:
Another dumb question, when people say they are doing uworld surgery questions, does that mean doing step 2 CK questions related to surgery or do they have a separate uworld for shelf exams?
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Uworld Step 2 QBank (the one iwth 1400 IM questions). People mean the surgery questions (~200?) within those.
 
do you guys think nms casebook is too outdated to be helpful? i noticed some errors while reading.. the textbook is a lot more recent, but so long:confused:
 
In a patient with a small acute subdural hematoma without midline deviation, the management is to minimize swelling.

A treatment option involves having the patient hyperventilate. How does hyperventilation minimize brain swelling?
 
g8orlife said:
In a patient with a small acute subdural hematoma without midline deviation, the management is to minimize swelling.

A treatment option involves having the patient hyperventilate. How does hyperventilation minimize brain swelling?
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I'm not sure specifically regarding subdural hematoma, but I know in head trauma patients, hyperventilation --> respiratory alkalosis --> cerebral vessel constriction --> minimizes cerebral edema. It's because increased PCO2 normally would cause cerebral vasodilation and exacerbate any cerebral edema. So, patients are hyperventilated on purpose to prevent this.
 
Kaushik said:
I'm not sure specifically regarding subdural hematoma, but I know in head trauma patients, hyperventilation --> respiratory alkalosis --> cerebral vessel constriction --> minimizes cerebral edema. It's because increased PCO2 normally would cause cerebral vasodilation and exacerbate any cerebral edema. So, patients are hyperventilated on purpose to prevent this.
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Got It. Thanks!
 
All of the advice is kind of jumbled can someone summarize what resources to use?

I have the following:

UWorld Surgery, GI
Pestana notes
NMS Casebook


Am I missing anything to do well on surgery shelf if its the first one?
 
Can someone clarify what they mean by Pestana? I found a 76 page review online which is what I thought everyone meant, but apparently not?

http://www.amazon.com/exec/obidos/ASIN/1609789164/ref=nosim/studentdoctor-20

Or there is this.

Or there is his material in the Kaplan course (which I think is a 249 page document). Another question, this seems to have a lot of extra information. The entire first part of the book seems to be some introduction. Are people skipping this?

And we can skip procedural and calculation stuff in all of the Pestana stuff, right?
 
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Does the 12 hr pestana audio clip cover the entire 250 page pestana notes? The version of the audio file I've got covers til the end of endocrine surgery.
 
So for someone with surgery as their first shelf, which sources would be sufficient for obtaining a good medicine background?

From previous comments:
Uworld GI/Fluid/Electrolytes questions
Step Up to Medicine (really, you guys are reading all of this for the surgery shelf?)
MKSAP 5 (any specific sections?)

Would you change/add anything to the above sources?
 
birthdaycake said:
So for someone with surgery as their first shelf, which sources would be sufficient for obtaining a good medicine background?

From previous comments:
Uworld GI/Fluid/Electrolytes questions
Step Up to Medicine (really, you guys are reading all of this for the surgery shelf?)
MKSAP 5 (any specific sections?)

Would you change/add anything to the above sources?
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Focus on the Pestana notes and the Uworld questions. Supplement with other stuff as needed.
 
TeamZissou said:
Focus on the Pestana notes and the Uworld questions. Supplement with other stuff as needed.
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I will second this. On my shelf, I found the medicine-related questions to be stuff I would not have ever anticipated or guessed would be on there. If you have NOT had medicine prior to surgery, then maybe try to supplement a little more.
 
I agree that Uworld and Pestana are the most high yield resources. I also used NMS surgery casebook, which was great for more details, but I found the book to contain more info than you need for the exam. I also did Endocrine, GI, hepatology and some heme from Step up to Medicine and those sections in Uworld medicine, which were helpful but less high yield vs. Uworld surgery and Pestana.

I didn't feel that there were very many "medicine" questions. There were a few straight up pulmonology questions and a few name-that-bug type of questions but that was it. What did surprise me was the number of OBS/GYN and peds questions there were. I haven't done those rotations yet so I kind of randomly picked an answer for those questions :(..the rest of the exam was quite fair I think.

Edit: I wrote the exam on July 5.
 
I'm sorry because I know this has been mentioned numerous times. I am starting my surgery rotation soon, and it will be my first rotation, therefore, as from reading multiple pages, I don't have the pleasure of going through medicine beforehand. Anyone recommend a set of texts or plans for someone who hasn't had Medicine yet? The only book I truly have is Surgical Recall, which I know is only good for the pimping side of the rotation.

Thanks!
 
AppleMD said:
I'm sorry because I know this has been mentioned numerous times. I am starting my surgery rotation soon, and it will be my first rotation, therefore, as from reading multiple pages, I don't have the pleasure of going through medicine beforehand. Anyone recommend a set of texts or plans for someone who hasn't had Medicine yet? The only book I truly have is Surgical Recall, which I know is only good for the pimping side of the rotation.

Thanks!
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The best resouces for the surgery shelf are: Pestana review (includes videos), Secrets (aka Crush Step 2), and UWorld. Also, do all of the surgery questions released by the NBME.
 
For those of you who have taken it 1/2 standard deviation above average for honors.

obviously its above average for a reason, but for the typical sdn gunner type, how hard is that really?
 
how are people finding any time to study for this thing? By the time I get home from the hospital I have a max of like 2 and half hours before I have to sleep, and once you factor in eating, showering, etc and then reading about the surgeries for the next day there just isn't any time left? Also Im always so tired that even if I did spend 30 minutes reading pestana or something, I seriously doubt I would remember anything.

Guess the next time I get a full day off I'll have to devote it to trying to crank through a chunk of Uworld Questions.
 
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