ABS Oral exam - HELP!!!

[tussy]

Hello all,

I'm doing the oral portion of the ABS exam in just 9 days in Cleveland (the ABS Certifying exam). I was hoping someone out there might have some sample questions that were asked on previous exams, just so I can get an idea of the format of the exam.

For anyone that's done the exam (or about to do it) I have a few questions:

Do they ask for details on how to do procedures including describing what insturments you use, anatomy, etc. or is it more simple than that.

If you don't know how to do something they ask is it better to wing it on your limited knowledge or just declare your ignorance and tell them that you have limited experience and that you'd refer the patient to a specialist in that area (i'm thinking about things like carotids - not part of our gen surg training here in canada, and although I could describe the steps that i memorized from the text I would be hard pressed to do a good carotid in real life).

Are the examiner friendly or are they out to try and mess with your head and make you second guess everything you know (our Canadian exams were of the latter type).

Are the questions all "case based" or is it "general surgery jeopardy" with short general knowledge snappers.

Is there a "critical error" rule - ie. even if you're a superstar thru most of the exam if you make certain "critical errors" you automatically fail. Or is it based on an overall score (ie if you screw up one question and do well on the rest you still have a chance at passing)?

Thanks alot for all your help

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[boston]

If you don't know how to do something they ask is it better to wing it on your limited knowledge or just declare your ignorance and tell them that you have limited experience and that you'd refer the patient to a specialist in that area (i'm thinking about things like carotids - not part of our gen surg training here in canada, and although I could describe the steps that i memorized from the text I would be hard pressed to do a good carotid in real life).

based on the mock orals administered by one of our attendings, he always says the best approach for such a situation during the oral boards is to say, "I have never personally performed or been involved with a carotid endarterectomy, but based on my reading, I would make the following approach: make a longitudinal incision anterior to the SCM, incise the platysma, ligate the facial vein, gain proximal and distal control on the CCA, ECA, ICA, etc..."

 

[njbmd]

Hello all,

I'm doing the oral portion of the ABS exam in just 9 days in Cleveland (the ABS Certifying exam). I was hoping someone out there might have some sample questions that were asked on previous exams, just so I can get an idea of the format of the exam.

For anyone that's done the exam (or about to do it) I have a few questions:

Do they ask for details on how to do procedures including describing what insturments you use, anatomy, etc. or is it more simple than that.

If you don't know how to do something they ask is it better to wing it on your limited knowledge or just declare your ignorance and tell them that you have limited experience and that you'd refer the patient to a specialist in that area (i'm thinking about things like carotids - not part of our gen surg training here in canada, and although I could describe the steps that i memorized from the text I would be hard pressed to do a good carotid in real life).

Are the examiner friendly or are they out to try and mess with your head and make you second guess everything you know (our Canadian exams were of the latter type).

Are the questions all "case based" or is it "general surgery jeopardy" with short general knowledge snappers.

Is there a "critical error" rule - ie. even if you're a superstar thru most of the exam if you make certain "critical errors" you automatically fail. Or is it based on an overall score (ie if you screw up one question and do well on the rest you still have a chance at passing)?

Thanks alot for all your help

There is a book out there called Safe answers for the Oral Surgery Boards. A number of my colleages have used this book and attended the Osler Review for Oral Boards and found both were helpful.

I believe that the guy who wrote the Safe Answers Book does address your questions and does address the scoring. An advertisement for this book is usually in the back of Surgical Achives or General Surgery News.

A friend of mine said that the questions are case-based and deal mostly with complications. He said that they are along the lines of operating on a patient and the anesthesiologist keeps giving fluids but the patients blood pressure keeps dropping what would you do? The follow-up with what would you do if the patient starts to wheeze during the case? That was the example that he gave me.

I have been so busy studying for the Written Part of the Boards that I have pitifully neglected the Orals. I do plan to take the Osler Course though. We have Mock Orals coming up in the Spring so I haven't been through that experience yet either.

I hope this has been helpful and knock them dead. I suspect that you are going to be fine. My friend also said that they like people who pick plan of action, stay with it and can back up what they say with evidence.

I don't envy you at all. You have just remined me that I need to get my "b-tt" into gear on the orals.

Good luck!

 

[Winged Scapula]

The answer you don't want to give is, "well, I'm doing a colorectal fellowship, so don't really do carotids," etc. You are taking the general surgery boards so even if you've never done a case, you are expected to know something about it. In general, yes they do want you to know where you make your incision, etc. so you need to memorize those key procedural steps.

They don't specifically ask about instruments, but rather just ask you to tell them how you would do the procedure. If you can do it with a spoon successfully, that would be alright (although I don't recommend mentioning that)!

The US exams are purportedly more straight forward than in the old days when "messing with your head' and intimidating the candidates was encouraged. There was an old rumor going around about one of the examiners (Hiram Polk) actually urinating in the room while you were being asked questions! I think its much less intimidating now.

You don't have to pass all of the rooms to pass; I don't know about any critical errors but you could fail a room for that kind of answer. As noted above, get Passing the Oral Boards if you have enough time. I have it and am told its good stuff.

 

[Dr. Z]

I took the oral exam in 2004 and I found the exam to be fair. If you do not know much about the format of the exam here is a brief layout of how the day went for me.

There were two sessions, a morning session and an afternoon session. A briefing precedes each session. You will be assigned to either the morning or afternoon session and you must attend the briefing for your session. I was assigned to the afternoon session. At the briefing, they tell you how the exam will be administered and the do's and don'ts. You will also get a list that has your examiners on it. They want to be sure that you do not know any of your examiners and if you do they have a procedure for this so that you can be reassigned. You will find out at the meeting if you are in the early or the late group. I was in the late group. This was a surprise to me. I thought the exam would start for me at 1:00pm, however, this was not the case. I had to wait about 1.5 hours before my time slot came up. Just be ready for this. I was ready to go (from a mental standpoint) at 1:00pm and when I found out that I had to wait, it was a big let down. Then I had to repeat the psych up process again an hour later!

When your appointed time comes, you go to your assigned room number. Do not knock on the door. You just stand in the hallway in front of the door. The people administering the exam will come to the door and invite you in when they are ready for you. It is a little strange standing in a hotel hallway looking at your peers disappear one by one into hotel rooms. Particularly when you are the last one to go.

Once you are in the room the exam begins after a brief introduction. They just jumped right in. I averaged about 3-4 questions per room. There are three rooms with 2 examiners each in room (1 senior ABS member and a local person invited to administer the exam). They alternated asking me questions in each of the rooms. I had 30 minutes in each room.

The questions were in the following format. "A such and such year old female/male presents to your office/ed with a chief complaint of _____." This was followed by a brief history. At this point I asked questions regarding the history and physical exam. They did not seem to want to spend a lot of time on this once they figured out that I would be complete. Next I would move onto my differential and then I would order any tests. They would give me answers based on what tests I ordered. Eventually I would end up operating on the patient. I had to describe the operation. I never had to describe the exact instruments I would use, but, I was asked what type of suture I wanted to use a couple of times. I also ran into the issue of not having performed an operation myself. I simply stated that I had not performed the particular operation myself. If I were to perform this operation in my own practice today, I would ask a senior partner to help me with the operation. Here is how I would plan to perform the case....then I described the operation. Nearly all of my patients suffered a complication. Do not let this throw you off. It does not necessarily mean that you screwed up. There were no “surgical jeopardy” type questions. All of my questions were case based.

All in all, I thought the questions were fair. I felt that the purpose of the test was to make sure that I had enough core knowledge and enough good surgical judgment to be safe. I do not think they were intentionally trying to play head games with me. However, the entire experience is intimidating. I found safe answers for the boards helpful. I would also recommend that you have a partner or two give you a mock exam. This really helped me to think on my feet and to get my thoughts organized prior to the exam.

Nearly all my friends who have taken the exam (and me included) thought they had failed the exam when they left. So, if you feel like that you will be normal! Thankfully, none of us had any problems.

Good Luck!

 

[tussy]

Thanks for all your help,

Unfortunately it's too late to buy any books. I think i'll just brush up on my vascular and critical care and hope i can slide thru on my knowledge for the rest of it.

Sounds like the format is similar to the Royal College of Surgeons exam that i did in June.

Dr. Z. Thanks for your input - it really helps knowing what to expect on the day to get yourself mentally prepared.

thanks all, and if anyone has a file with old questions i'd love to have it. I don't have any acutal questions yet

 

[FliteSurgn]

As a rule, I would always mention that you would refer any patient that needs an operation that you don't personally perform. They'll say that there are no specialists available and still expect you to know what to do, but at least it lets them know that you refer appropriately when necessary.

Most of my examiners were cordial and didn't particularly try to trick me, but a few were more confrontational. Don't let a previous room's experience cloud your vision for the next room. Just try to keep your cool and go with the flow. There certainly were some "technique" questions regarding some operations that I had recommended based on the scenarios, but those should be second nature. You can "fail" one of the three rooms and still pass the exam.

Let's see if I can remember some of my questions...

13 y/o child with isolated splenic injury. How do you decide operative vs non-op therapy? How do you monitor them? For how long? What is your threshold for failing non-op? What to do in the OR?

75 y/o female scheduled for sigmoid resection the following day now has rapid a.fib and hypotension. What do you do? Cardiovert? Chemical or electrical? Drugs and doses? Electrolyte abnormalities? Still go ahead with surgery next day?

60 y/o female immediately s/p APR. Has anuria in the recovery room. Causes? How do you figure out what's going on? Now hypotensive too.

35 y/o male with testicular mass. How do you approach it? Work up? Surgical therapy for presumed testicular cancer? Retroperitoneal node dissection?

65 y/o male with fevers and distant h/o AAA repair. Hands me a single CT scan slice showing an aortic graft with gas surrounding it. How do you approach this? How do you reconstruct? Timing? Likely organisms? Antibiotic choices?

50 y/o male s/p open chole 10 years ago now has RUQ pain, jaundice, and fever. Differential? Work-up? ERCP unsuccessful. Impacted stone in distal CBD/ampulla. How do you approach? Maneuvers to clear the duct? What if you can't clear the duct?

40 y/o female with GERD. Work-up for Nissen? Do you do your own endoscopy? Who's a good candidate for a Nissen? How do you perform?

30 y/o black male with 1.5cm pigmented lesion on the plantar surface of the foot. How do you biopsy? Margins? Sentinel node? Staging? How do you reconstruct the skin/soft tissue defect on the bottom of the foot?

That's about everything that I can remember off the top of my head. At the very least, it may whet your appetite and give you a general idea of how the sessions run. Good luck.

 

[tussy]

I just got my result this morning and I passed the ABS certifying exam. I'm still suffering a little post traumatic stress disorder after the exam, but i'm mostly recovered.

Here are my questions if anyone is interested.

50 y.o. fever and hypotension 2 days post L.A.R. On assessment wound is very tender with some fluid draining. Basically necrotizing soft tissue infection. I took to the OR and debrided. they wanted to know how I would close the defect.

32 y.o. with chronic pancreatitis from gallstones, previous cholecystectomy and ERCP with ES years ago. I repeated imaging and found multiple CBD stones and very dilated distal pancreatic duct. She also had malabsorption symptoms from pancreatic insufficiency and they asked a bunch of questions about nutrition

62 y.o. previous ovarian ca with SBO - in or you find peritoneal mets and an obstructed loop stuck down in the pelvis

60y.o. smoker with LLL lung cancer. They gave me a bunch of different scenarios (small cell, nonsmall cell path, positive paratracheal nodes and negative nodes...)

Aspiration -- wanted to know how to resuscitate and ICU management. Very straighforward questions

Patient postop from lower leg embolectomy returns to ICU from the OR with wide complex tachycardia. K+=6.9, pH=7.1 (metabolic acidosis). Wanted ICU management of patient

Blunt abdominal trauma, unstable bleeding in the belly, Lapartomy has a major liver injury

GSW to abdomen, unstable, to OR - arrests in OR but i get him back with thoracotomy and cross clamp aorta. you find a major injury to the lower aorta at the bifurcation.

32 y.o. with calcifications on mammogram. They gave a bunch of different scenarios - DCIS, LCIS, strong family history,...

64 y.o with abdominal pain after coronary angioplaasty. Mesenteric angio shows occlusion of SMA.

70 y.o. post op 6 days from sigmoid resection for diverticular disease. Fever - CT and gastrograffin enema show small leak from anastomosis. Mgt

25 y.o. nurse has episodes of hypoglycemia. I work her up and she has insulinoma in head of pancreas. I enucleate it and get a pancreatic fistula - mgt of pancreatic fistula.

 

[Winged Scapula]

Congratulations!!!😀

 

[Dr. Z]

Congrats!