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Official Surgery Shelf Exam Discussion Thread
Started by Pox in a box
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streetdoc said:
I used case files for surgery, and I really liked it, but I didn't use it to study for the shelf. For me, it was a quick read that made some of the things that I hadn't yet seen more memorable than just reading about them in a textbook. I really liked the algorithms in it.
Just took the exam today...I've tried to make this post as helpful as possible as I feel indebted to SDN and there seems to be a lot of confusion about this exam.
A lot of people say this is a medicine exam, and I can definitely see where that is coming from. There are a lot of questions on the exam that resemble those on the IM test (i.e. endocrinology, Infectious Disease, etc). At the same time, there is nothing on the exam that is "purely" internal medicine...i.e. that would require you to study an IM text or that wouldn't be covered in a surgery text. I personally feel that studying MKSAP would be a waste (except the chapter on FEN and abdominal pain). Most of the IM-like topics covered are in the context of surgery and are covered in a book like the Washington Manual for Surgery. There are, however, definitely surgery-only topics that you must study...most of which are in Recall. If you have had IM, then you can do quite well on this exam just studying Recall. If you haven't had IM, it may be worth your while to pick up a text like the Washington Manual of surgery for a focused coverage of the important aspects of the medical management of surgical patients...especially fluids, electrolytes, and nutrition (not big on my exam actually, but "reliable" sources tell me that this has been big on past exams). Definitely do not waste your time studying a separate IM text for this exam; and certainly do not study an IM text at the expense of Surgical Recall. Anybody who tells you to just study MKSAP + trauma is wrong.
Recall is money for this exam. However, less than half of what is in recall is relevant for the exam. You do not have to know any anatomy or histology. Again, no anatomy on this test (at least my version). Also, for the purposes of the shelf exam, do not waste your time with numbers, most commons, specific chemotherapeutic agents, routes of metastasis for cancers, cancer staging (in fact, studying cancer stuff other than screening issues is low yield for all shelf exams), drains, or suturing. If you just went through recall and only looked at questions pertaining to signs/symptoms and workup/treatment, you could do well on this exam. Also, this test does not require you to know the specifics of surgeries. You don't have to know bilroth vs. loop colostomy vs. ileoanal pull through, etc. Just know whether or not a surgery would be indicated for a condition. They like to ask whether or not someone needs an urgent laparotomy vs. laparoscopy vs. surveillance. Infectious disease questions are usually a case, and then you have to ID the offending organism. There are also a fair number of pathophys questions on the exam--here's a chest x-ray what are the blood gases in this patient like? This patient has sudden onset dyspnea, here's his chest x-ray, what are his CO, TPR, etc.?
topics on my exam: trauma (>10 qs...all in Recall), endocarditis (which, incidentally, is also a big topic on the Neuro shelf), pediatric ortho stuff, ethical scenarios (should I give blood to this jehovah's witness), lots of GI, endocrinology, a few chest x-rays, postop stuf (especially sudden onset dyspnea), Neurosurg (surprisingly about 10 questions), Urology, Vascular. (The specialties represented most were neurosurg, urology, and vascular). The test also has LOTS and I mean LOTS of "Next step in management" questions...more than any other shelf exam. A book that I found immensely helpful for these questions was: Common Surgical Diseases: an algorithmic approach to problem solving by keith millikan and theodore saclarides.
Got my score back: 92. Once again, I swear by that surgical algorithms book.
Just as clarification: I'm not saying this isn't a medicine exam. There are definitely tons of questions on the exam that you will cover in medicine. You are definitely at an advantage if you have had medicine. However, I would not recommend studying a medicine text for the exam if you haven't had internal medicine; rather, get a book like Washington manual of surgery which will cover all the med-surg issues you need to know, while leaving out the additional non-surgical med issues you would encounter if you were reading an IM text. For example, on this test, they could ask you about DKA, but they are unlikely to ask you about the outpatient managment of diabetes. A surgery text will only talk about DKA, while an IM text will cover both. Similarly, you could get a question about alcohol withdrawal or delirium tremens (a patient admitted for emergency lap now presents with tachycardia, hallucinations, etc.); however, you are unlikely to get a question about how to treat someone with alcohol dependence. The surgery text will focus solely on withdrawal, while a text like MKSAP covers this plus outpatient med issues that you will not see on the exam. As a further example, I mentioned endocarditis above. On a medicine exam, you would be expected to know how to diagnose this, know which antibiotics to use, etc. On this exam, you are more likely to be asked when surgery would be indicated for endocarditis.
A lot of people say this is a medicine exam, and I can definitely see where that is coming from. There are a lot of questions on the exam that resemble those on the IM test (i.e. endocrinology, Infectious Disease, etc). At the same time, there is nothing on the exam that is "purely" internal medicine...i.e. that would require you to study an IM text or that wouldn't be covered in a surgery text. I personally feel that studying MKSAP would be a waste (except the chapter on FEN and abdominal pain). Most of the IM-like topics covered are in the context of surgery and are covered in a book like the Washington Manual for Surgery. There are, however, definitely surgery-only topics that you must study...most of which are in Recall. If you have had IM, then you can do quite well on this exam just studying Recall. If you haven't had IM, it may be worth your while to pick up a text like the Washington Manual of surgery for a focused coverage of the important aspects of the medical management of surgical patients...especially fluids, electrolytes, and nutrition (not big on my exam actually, but "reliable" sources tell me that this has been big on past exams). Definitely do not waste your time studying a separate IM text for this exam; and certainly do not study an IM text at the expense of Surgical Recall. Anybody who tells you to just study MKSAP + trauma is wrong.
Recall is money for this exam. However, less than half of what is in recall is relevant for the exam. You do not have to know any anatomy or histology. Again, no anatomy on this test (at least my version). Also, for the purposes of the shelf exam, do not waste your time with numbers, most commons, specific chemotherapeutic agents, routes of metastasis for cancers, cancer staging (in fact, studying cancer stuff other than screening issues is low yield for all shelf exams), drains, or suturing. If you just went through recall and only looked at questions pertaining to signs/symptoms and workup/treatment, you could do well on this exam. Also, this test does not require you to know the specifics of surgeries. You don't have to know bilroth vs. loop colostomy vs. ileoanal pull through, etc. Just know whether or not a surgery would be indicated for a condition. They like to ask whether or not someone needs an urgent laparotomy vs. laparoscopy vs. surveillance. Infectious disease questions are usually a case, and then you have to ID the offending organism. There are also a fair number of pathophys questions on the exam--here's a chest x-ray what are the blood gases in this patient like? This patient has sudden onset dyspnea, here's his chest x-ray, what are his CO, TPR, etc.?
topics on my exam: trauma (>10 qs...all in Recall), endocarditis (which, incidentally, is also a big topic on the Neuro shelf), pediatric ortho stuff, ethical scenarios (should I give blood to this jehovah's witness), lots of GI, endocrinology, a few chest x-rays, postop stuf (especially sudden onset dyspnea), Neurosurg (surprisingly about 10 questions), Urology, Vascular. (The specialties represented most were neurosurg, urology, and vascular). The test also has LOTS and I mean LOTS of "Next step in management" questions...more than any other shelf exam. A book that I found immensely helpful for these questions was: Common Surgical Diseases: an algorithmic approach to problem solving by keith millikan and theodore saclarides.
Got my score back: 92. Once again, I swear by that surgical algorithms book.
Just as clarification: I'm not saying this isn't a medicine exam. There are definitely tons of questions on the exam that you will cover in medicine. You are definitely at an advantage if you have had medicine. However, I would not recommend studying a medicine text for the exam if you haven't had internal medicine; rather, get a book like Washington manual of surgery which will cover all the med-surg issues you need to know, while leaving out the additional non-surgical med issues you would encounter if you were reading an IM text. For example, on this test, they could ask you about DKA, but they are unlikely to ask you about the outpatient managment of diabetes. A surgery text will only talk about DKA, while an IM text will cover both. Similarly, you could get a question about alcohol withdrawal or delirium tremens (a patient admitted for emergency lap now presents with tachycardia, hallucinations, etc.); however, you are unlikely to get a question about how to treat someone with alcohol dependence. The surgery text will focus solely on withdrawal, while a text like MKSAP covers this plus outpatient med issues that you will not see on the exam. As a further example, I mentioned endocarditis above. On a medicine exam, you would be expected to know how to diagnose this, know which antibiotics to use, etc. On this exam, you are more likely to be asked when surgery would be indicated for endocarditis.
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streetdoc said:
I really liked Case Files for surgery - we had lectures after grand rounds, and our clerkship director discussed cases grouped based on system/organ/etc. I didn't have much time to study for anything (only opened Lawrence once over the 12 weeks) but got through Case files and Surgical Recall. That's all I did, and felt incredibly prepared when I finished the exam.
Hey guys- I'm into my 3rd week of surgery & just finished up internal medicine. Having done IM, should I just use Surg Recall only for the shelf? One friend recommends Blueprints, another recommends Lawrence, another First Aid. I hate buying a ton of books I don't need. Any suggestions?
I can't speak about Blueprints or 1st Aid b/c I didn't use them, but I wouldn't recommend Lawrence. I found Lawrence to be (somewhat) useful for the rotation itself, but wouldn't recommend buying and reading for the shelf. My advice would be recall + PreTest +/- one of the case books - either NMS (longer, more detailed) or Toy's Casefiles (quick read, better organization). The nice thing about the case books is they give you important info in a clinical scenario making it easier to learn (IMHO) so you cover the basic "surgery" things one will see on the shelf. Having had medicine will be a HUGE help. I didn't understand what people meant when they said the shelf was all medicine + trauma but I learned a few weeks ago. 🙄 There were several questions that had nothing to do with surgery - there didn't even seem to be any relevance to surgery, and there were some straight pathology questions that covered material I would probably have read over on medicine but certainly didn't cover while on surgery. GL!Qwest said:
i want to say that the shelf was easier than i thought it would be... but then again maybe i studied well. and parenthetically, i hope i passed. i had 90 seconds left over; our valedictorian from yrs 1 & 2 ran out of time! this is because around question 56 or so i flipped to the back of the exam around q 90 and answered the long ones first, then over-clocked myself for the easier questions they give you in the beginning of the exam. anyway, pay attention in those classes they teach you. i read 1/2 or lawrence before aborting that project- i am not a 1st aid person but could have done it in just 1st aid, PLATINUM VIGNETTES (man that book rocks) and the appleton & lange q-book. surg recall is nice but i preferred to carry 'round the mont ried book. oh and surgery at a glance was aweful pretty but kind of Euro so their Tx strategies might not be right. all the best-
Seems to have had a lot more trauma than I expected.
I prepared with Recall, NMS case files, and A&L questions. I tried reading bits and pieces of Lawrence relevant to patients I was seeing, but I abandoned this book rather quickly because I just didn't have the time or patience to read after work.
Doing good questions and getting practice cases to go through seemed most helpful for the test.
I prepared with Recall, NMS case files, and A&L questions. I tried reading bits and pieces of Lawrence relevant to patients I was seeing, but I abandoned this book rather quickly because I just didn't have the time or patience to read after work.
Doing good questions and getting practice cases to go through seemed most helpful for the test.
what the <censored> was that question with the image of a retina?
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LovingItAll said:
yeah, thats what I said. I will have to agree with most of the posters here, there is a heavy medicine-y component to this exam, which after 12 weeks of getting to know what surgery is all about, I don't find all THAT surprising. A fair amount of pre-op type stuff (which is more or less cards/pulm), GI, et cetera. Lots of trauma, and lots of "a X year old woman has a Y thingy in her breast, what is it/what do you do next?". There were no "what is the course of this artery" anatomy type questions you might find in Recall.
I think a future lession for any pre clinical kids reading this is, if you school allows you to prioritize how you want your rotations, try to take medicine before surgery. After medicine I really didn't think the Surgery exam was that bad at all.
Edit: Books used
-Surg Recall. Lots of frivolous stuff in it, (i.e. who is the father of American Neurosurgery), but for the most part a decent text, and great to flip through right before a case to handle most pimp questions.
-Appelton and Lange. A complete waste of time, questions are poorly worded, some of the answers were flat out wrong. Its written by people from a particular residency program that rotates at a hospital students at my institution rotate through, and even some of those people think it sucks.
-Pretest. A little nitpicky at times, but so is the shelf. Fairly representative of the real deal.
-Lawrence Essentials of General Surgery. Great for the general/trauma/fluid management type stuff, and can be read fairly quickly. DO NOT solely rely on this though, you need a subspeciality text to back it up (Recall is pretty good for the subspecialty stuff).
I just took the shelf today and overall thought it was not bad and I have not taken medicine yet however I did study a ton of medicine during 2nd year and learned things quite well. Well I too had no idea why the so called surgery shelf was apparently "all medicine" but like DW said-after taking surgery and seeing what its all about and even flipping through different surgery texts like sabistons etc- I quickly realized all surgery is, is medicine with the extra step of fixing something instead of refferring out to get fixed. ie. pt gives signs, symptoms etc. You have to diagnose. Then you have to know which studies, scans, tests to confirm diagnosis. Normally medicine would stop here. Surgery goes further to know which procedure you perform and do it. However for the shelf you do not need to know what procedures to perform so basically its is medicine. However I would say 70 percent is stuff about medicine that gen surgery deals with-GI, liver, gallbladder, pancreas, breast,thyroid, hernias. I would say 20 percent was trauma-pt comes in after a MVA-what do you do next, what test do you order etc. 10 percent. Maybe 20, was stuff that a subspecialist would cover-ie vascular/heart pathology, bone/muscskel path.
In all honesty I am a text book person. I had sabistons and compared it to harrisons or any medicine text and 90 percent was teh same. Any good medicine book will discuss surgical options as well.
How i prepared- I read the GI, Liver/biliary, pancreas, ano-rectal and endocrine sections of harrisons. (this is only because I like the book and am familar with it.) I would say reading those topics alone from any medicine book would give you 60 percent of the shelf. I read the first 10 chapters in the Lawrence book on stuff like fluids, nutrition, trauma, etc. Then to cover the subspecialty stuff on heart/vascular, urology etc. I read the lawrence subspeciality book.
Best advice is to take medicine first. I dont konw how else to explain but a common question is any GI related thing like-lower abd pain, increased bilirubin, scleral icturs- what test do you want to order? or whats the diagnosis? Every question except trauma was like that. My advice if you cant take medicine first. Read the GI, liver, biliary, pancreas, breast and endocrine( which are major gen surgery diseases) in a good medicine book that you like. I find lawrence and some of the surgery review texts to do a poor job of these. Then read any surgery text/review book for trauma knowledge. Then use lawrence subspecialty for the remainder. Its not that it is that great, and honestly theoretically if you could read a medicine text/book about hearts, vascular probslems, urological/kidney problems, that woudl be better, however it takes too long and the lawrence does sum the basics up. IMO recall was not great for the shelf-great for pimping sessions though.
Question books-appelton lange i actually thought was worthwhile doing for the trauma questions and the subspeciality questions. I did not use pretest so cannot comment. FA, NMS, Blueprints all seemed terrible. Everyone else that took it with me used one of those and felt the test murdered them. I felt I aced the test and felt well prepared. good luck
In all honesty I am a text book person. I had sabistons and compared it to harrisons or any medicine text and 90 percent was teh same. Any good medicine book will discuss surgical options as well.
How i prepared- I read the GI, Liver/biliary, pancreas, ano-rectal and endocrine sections of harrisons. (this is only because I like the book and am familar with it.) I would say reading those topics alone from any medicine book would give you 60 percent of the shelf. I read the first 10 chapters in the Lawrence book on stuff like fluids, nutrition, trauma, etc. Then to cover the subspecialty stuff on heart/vascular, urology etc. I read the lawrence subspeciality book.
Best advice is to take medicine first. I dont konw how else to explain but a common question is any GI related thing like-lower abd pain, increased bilirubin, scleral icturs- what test do you want to order? or whats the diagnosis? Every question except trauma was like that. My advice if you cant take medicine first. Read the GI, liver, biliary, pancreas, breast and endocrine( which are major gen surgery diseases) in a good medicine book that you like. I find lawrence and some of the surgery review texts to do a poor job of these. Then read any surgery text/review book for trauma knowledge. Then use lawrence subspecialty for the remainder. Its not that it is that great, and honestly theoretically if you could read a medicine text/book about hearts, vascular probslems, urological/kidney problems, that woudl be better, however it takes too long and the lawrence does sum the basics up. IMO recall was not great for the shelf-great for pimping sessions though.
Question books-appelton lange i actually thought was worthwhile doing for the trauma questions and the subspeciality questions. I did not use pretest so cannot comment. FA, NMS, Blueprints all seemed terrible. Everyone else that took it with me used one of those and felt the test murdered them. I felt I aced the test and felt well prepared. good luck
Thanks Cat for the 411!
Actually, on my medicine shelf exam there were some surgery concepts. Triple AAA rupture into the retroperiotenum, criteria for endotrachael intubation, herniated disk, volvulus, head trauma (without battle sign), and the famous surgery mnemonic "water, wind, walk, wound, and weird drugs" netted me a couple points.
I'm starting to think that each NBME Shelf exam has 10-15% cumulative material of the other rotations. For example, I even had a psych and pediatric question on my medicine shelf. The answer to the Psych question was the antidepressant amtryptiline. The pediatric question boiled down to whether you could distinguish tetraology of fallot, ASD, PDA, VSD from the clinical presentation. Come to think of it, I even had a OB/GYN question of a woman that had pain in the RLQ. The answer choices were appendicitis, pelvic inflammatory disease, kidney stone, or ruptured ovarian cyst.
Actually, on my medicine shelf exam there were some surgery concepts. Triple AAA rupture into the retroperiotenum, criteria for endotrachael intubation, herniated disk, volvulus, head trauma (without battle sign), and the famous surgery mnemonic "water, wind, walk, wound, and weird drugs" netted me a couple points.
I'm starting to think that each NBME Shelf exam has 10-15% cumulative material of the other rotations. For example, I even had a psych and pediatric question on my medicine shelf. The answer to the Psych question was the antidepressant amtryptiline. The pediatric question boiled down to whether you could distinguish tetraology of fallot, ASD, PDA, VSD from the clinical presentation. Come to think of it, I even had a OB/GYN question of a woman that had pain in the RLQ. The answer choices were appendicitis, pelvic inflammatory disease, kidney stone, or ruptured ovarian cyst.
TheCat said:
LovingItAll said:
A distraction. You didn't need the image at all to answer the question.
I had read on this site that a couple of specialties were way overrepresented, but I found that the questions were distributed pretty equally among them. The fluid and electrolyte questions were indeed very basic, as reported here previously.
I felt pretty prepared for the exam, even though I hadn't studied nearly as much as I had wanted to beforehand. But in retrospect, more studying wouldn't have helped much. There were several straight up medicine questions, but the majority of them were medicine with the addition of surgical diagnostic tests and decision-making. Lots of "x days after surgery, the pt becomes febrile with a, b and c additional symptoms, what's the next step in management?"
There were also a couple of questions where I didn't think any of the answers were right. Maybe I missed some crucial piece of info in the question, but I went through each of the answers looking back at the question for the piece of information that would make that answer right, and for all of them, it just wasn't there. Maybe it was something I just didn't know to look for. In any event, I ended up trying to pick the thing that was least wrong. That sucked.
Otherwise, it wasn't the horrendously difficult test I was expecting.
But remember: airway, breathing, circulation, THEN other injuries.
I felt pretty prepared for the exam, even though I hadn't studied nearly as much as I had wanted to beforehand. But in retrospect, more studying wouldn't have helped much. There were several straight up medicine questions, but the majority of them were medicine with the addition of surgical diagnostic tests and decision-making. Lots of "x days after surgery, the pt becomes febrile with a, b and c additional symptoms, what's the next step in management?"
There were also a couple of questions where I didn't think any of the answers were right. Maybe I missed some crucial piece of info in the question, but I went through each of the answers looking back at the question for the piece of information that would make that answer right, and for all of them, it just wasn't there. Maybe it was something I just didn't know to look for. In any event, I ended up trying to pick the thing that was least wrong. That sucked.
Otherwise, it wasn't the horrendously difficult test I was expecting.
But remember: airway, breathing, circulation, THEN other injuries.
Helpful thread. 👍 Posts by DW and Samoa are particularly good. I take this exam in 2 weeks, about halfway done with Lawrence.
92 percentile on my Surgery Shelf.
I used CaseFiles Surgery, Surgical Recall, Boards and Wards (Medicine+Surgery sections), and Appleton and Lange Question book (not bad). For two days before the exam, I read through Boards and Wards (medicine and surgery sections) very slowly.
First of all, is this a medicine exam disguised as a surgery exam?
It depends on how you view it. For those that view questions at a conceptual level, yes it may be viewed as a medicine exam. However, even these questions have question stems that mention a patient that needs a pre-op workup or a patient that is post op. A question might ask you to diagnose MI, DVT, or Sepsis, however these conditions occur post-op. So there is still a surgery theme.
Here are some high yield concepts. This is what most people consider medicine questions. Know all of the postop fever causes "wind, water, walk, wound, wonder where, wonder drugs". For these causes, know how to work up the causes, and treatment. Know all of the preop screening for surgery patients cardiac(CHF, MI post 6 months etc), respiratory (FEV1), renal (creatinine). Be able to diagnose and treat post op complications such as MI, DVT, PE, ARDS. Don't forget your heart sounds i.e. midsystolic click, opening snap, diatolic murmur that radiates to the apex etc. Valular diseases are in this exam because some of them have surgical indications. Oh yeah, I had about ~10 trauma questions. Straight forward bread and butter cases such as tension pneumo, tamponade, epidural hematoma, aortic dissection etc. These trauma questions can be tricky because they ask "the next step in management". Therefore, memorize the trauma algorithms in surgical recall.
Here are some interesting cases!
1. A film of a apple core in the esophagus -> esophageal cancer
2. Tumor in the abdomen, pathology shows psomma bodies -> primary is ovary (cystadenocarcinoma).
3. Surgeon opens up an abdomen and it fills up the operating room with malodorous stench -> Mesenteric Ischemia
4. Patient with pseudomembranous colitis has -> clindamycin resistant C.Diff
5. 14 y/o girl with small bowel obstruction. In the passage it mentioned "patches of alopecia". --> Bezoar (I remembered this from pathology last year).
Good Luck
I used CaseFiles Surgery, Surgical Recall, Boards and Wards (Medicine+Surgery sections), and Appleton and Lange Question book (not bad). For two days before the exam, I read through Boards and Wards (medicine and surgery sections) very slowly.
First of all, is this a medicine exam disguised as a surgery exam?
It depends on how you view it. For those that view questions at a conceptual level, yes it may be viewed as a medicine exam. However, even these questions have question stems that mention a patient that needs a pre-op workup or a patient that is post op. A question might ask you to diagnose MI, DVT, or Sepsis, however these conditions occur post-op. So there is still a surgery theme.
Here are some high yield concepts. This is what most people consider medicine questions. Know all of the postop fever causes "wind, water, walk, wound, wonder where, wonder drugs". For these causes, know how to work up the causes, and treatment. Know all of the preop screening for surgery patients cardiac(CHF, MI post 6 months etc), respiratory (FEV1), renal (creatinine). Be able to diagnose and treat post op complications such as MI, DVT, PE, ARDS. Don't forget your heart sounds i.e. midsystolic click, opening snap, diatolic murmur that radiates to the apex etc. Valular diseases are in this exam because some of them have surgical indications. Oh yeah, I had about ~10 trauma questions. Straight forward bread and butter cases such as tension pneumo, tamponade, epidural hematoma, aortic dissection etc. These trauma questions can be tricky because they ask "the next step in management". Therefore, memorize the trauma algorithms in surgical recall.
Here are some interesting cases!
1. A film of a apple core in the esophagus -> esophageal cancer
2. Tumor in the abdomen, pathology shows psomma bodies -> primary is ovary (cystadenocarcinoma).
3. Surgeon opens up an abdomen and it fills up the operating room with malodorous stench -> Mesenteric Ischemia
4. Patient with pseudomembranous colitis has -> clindamycin resistant C.Diff
5. 14 y/o girl with small bowel obstruction. In the passage it mentioned "patches of alopecia". --> Bezoar (I remembered this from pathology last year).
Good Luck
Please post a link to the Pestana questions! We don't have them at my school. I'm in surgery now and it definetly seems that the review book questions are different then what we need to know for the ward/OR... Any help would be appreciated 🙂
bump... any word on those questions?
thanks!
thanks!
Has anyone used blueprints for surgery? I kinda liked it for OB/Gyn and Peds, but hated it for medicine. Would like feedback on anyone who used it for surgery. thanks..
The accepted formula for surgery is casefiles + a question source (A&L, Qbook, or pretest) + a text (Lawrence, NMS or Kaplan). Personally I used Casefiles twice, Kaplan's text and NMS casebook towards the end and sprinkled in questions from Qbook and Qbank, both of which I thought were good.
NMS casebook is a great idea towards the end because it is structured into cases, but each case will have 10 questions appended to it where one detail from the scenario will change and you will be asked what to do next. So say a guy comes in with a stab wound to the RLQ they will ask what do you do next and what do you worry about. Then they'll ask you how your treatment and diagnosis changes if it was in the LLQ, LUQ, left lower thorax, etc. This way each case gives you a tour of many different possible pathologies.
NMS casebook is a great idea towards the end because it is structured into cases, but each case will have 10 questions appended to it where one detail from the scenario will change and you will be asked what to do next. So say a guy comes in with a stab wound to the RLQ they will ask what do you do next and what do you worry about. Then they'll ask you how your treatment and diagnosis changes if it was in the LLQ, LUQ, left lower thorax, etc. This way each case gives you a tour of many different possible pathologies.
So it's a few days before the surgery shelf and I've managed to get through Case Files once. I've already had medicine and I got a 94 on the med shelf, but can't remember all that much since that was months ago. Now I can either try and get through PreTest or through Recall, but probably not both. Which is more useful for the shelf? Or is there something else I should use?
Appleton and Lange is the biggest piece of crap book ever for Surgery. Not only are there grammatical mistakes, there are missing answer choices as well as errors in the right answers. For instance it will say "D" when the answer is actually "B".
Seriously, this book is lame. It gives the NYMC authors a bad name (obvs they're not responsible for the editing).
Allow me to give 2 examples:
1. "The posterior lobe and hypothalamus release the peptides ADH and vasopressin."
Last time I checked, ADH and vasopressin were the same thing.
2. "What is true of MRSA?" One of the answers listed is "It is resistant to methicillin" yet that one is wrong. Isn't MRSA by definition resistant to methicillin?
Whoever wrote these questions are idiots.
Seriously, this book is lame. It gives the NYMC authors a bad name (obvs they're not responsible for the editing).
Allow me to give 2 examples:
1. "The posterior lobe and hypothalamus release the peptides ADH and vasopressin."
Last time I checked, ADH and vasopressin were the same thing.
2. "What is true of MRSA?" One of the answers listed is "It is resistant to methicillin" yet that one is wrong. Isn't MRSA by definition resistant to methicillin?
Whoever wrote these questions are idiots.
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I second this
Would anybody out there be willing to email me the pestana review or provide a link for download? the previously listed website (www.jimbosdealden.com/LECTURE_STEP2) is dead.
Thanks a MILLION in advance!
[email protected]
Thanks a MILLION in advance!
[email protected]
Just finished the test a few hrs ago. First off, this was actually a fun test to take...I know that sounds ridiculous, but this was a thinker's test. It was full of medicine...I repeat, full of medicine. I have not taken the Medicine shelf yet (will take Thur.) so I can't compare. The questions were well written and consisted of mostly classic disease presentations...the trick was that they'd leave out key info and make you use the available labs and HPI to build bridges to your diagnosis. If you are comfortable with labs they will serve you well on this exam. Having said that, physical diagnosis is hit hard as well. I believe you could do very well on this test if you read "Cope's" classic book supplemented with Step-up (however, I do not recommend this approach). Knowing both physical diagnosis and how to work with the labs enables you to check yourself, and if the "picture doesn't fit" r/o that choice. Don't get me wrong, there were several that were extremely ambiguous, and after discussing with several classmates no consensus could be reached (experimental questions?). One thing that hasn't been stressed recently on this thread is the time factor...I usually finish Qbank and World blocks w/ 10-15 min to spare. I came down to the wire and had to blind answer one near the beginning I skipped. That is my biggest qualm with the boards this year: if they're trying to test us on concepts they should give us the time to think it out rather than knee-jerk/reflexive responses. In my class of ~110, about 7 walked out of the test early. Less than 10% had ample time.
There were a few odd diseases, but even these could be found in any of the standard review books used while studying for other rotations. I had a couple "classic" OB and Peds vignettes on my exam. A few ethics questions to keep it interesting.
It's been said a thousand times, but there is no substitute for studying hard throughout the year.
I will update when my scores come back.
Oh, almost forgot the all important resources list...I had originally planned to go into surgery and therefore bought just about every high rated review book there is. My goal was/is to "gun" like it is going out of style...
Current Surgical Dx and Treatment (Lange) - this is the required text for the rotation and our quizes come straight from this book so I pretty much read all of the general surgery sections. Actually not a bad read. The sections were in depth w/o out being overly so.
First Aid General Surgery: A good concise review of the subject. I liked the format, and used it extensively in the beginning, but found myself reaching for it less and less. If you're a fan of the series it won't let you down.
Surgical Recall: this is a great book packed full of information, however, I didn't use it that often, only to add to information I read in other sources. I don't like to memorize, and I feel that SR doesn't give enough "meat." But then again, that's the point.
Surgery Secrets: this was another great book that I read "most" of. The chapters were lean but presented information/insight not found in other review books. Some chapters were better than others, but very readable. Like after reading about pancreatitis in CSDT, I'd read the 3-4 pages in this book to add another angle.
NMS Casebook: This is a solid book as well, but I didn't enjoy reading it😕 Sounds strange, but it just wasn't for me. I think this is because I approached with the intention of learning more about the path/phys presentation of the disease, whereas this book is more focused on teaching the diagnostic modalities and surgical procedures. I found this same info to be much more concise in Gen. Surgery Review, as mentioned below.
PreTest Surgery: I didn't give it a fair shake, but definitely not on par with other books in the series.
Cope's Dx of the acute abdomen: I only read the Acute abdomen chapter, but it's easily the most well written and widely read source on the subject.
General Surgery Review:THE BEST REVIEW BOOK HANDS DOWN. This was like having a secret weapon. I read it along with the appropriate chapters in CSDT. It presents all the "classic" scenarios and how to work them up...
for those interested:http://www.amazon.com/General-Surge...4499956?ie=UTF8&s=books&qid=1180989583&sr=8-1
Sabiston's Board Review Q book: a real let down. the questions were often a single line and not a single vignette in the whole dang book...
Schwartz's Board Review Q book: not much better. I don't understand why these big textbooks put their name on such crappy question books
whew...looks ridiculous looking back on it. In the end I really just used CSDT and Gen. Surg. Review. I know my words don't carry much weight until I update with my score...soon.
There were a few odd diseases, but even these could be found in any of the standard review books used while studying for other rotations. I had a couple "classic" OB and Peds vignettes on my exam. A few ethics questions to keep it interesting.
It's been said a thousand times, but there is no substitute for studying hard throughout the year.
I will update when my scores come back.
Oh, almost forgot the all important resources list...I had originally planned to go into surgery and therefore bought just about every high rated review book there is. My goal was/is to "gun" like it is going out of style...
Current Surgical Dx and Treatment (Lange) - this is the required text for the rotation and our quizes come straight from this book so I pretty much read all of the general surgery sections. Actually not a bad read. The sections were in depth w/o out being overly so.
First Aid General Surgery: A good concise review of the subject. I liked the format, and used it extensively in the beginning, but found myself reaching for it less and less. If you're a fan of the series it won't let you down.
Surgical Recall: this is a great book packed full of information, however, I didn't use it that often, only to add to information I read in other sources. I don't like to memorize, and I feel that SR doesn't give enough "meat." But then again, that's the point.
Surgery Secrets: this was another great book that I read "most" of. The chapters were lean but presented information/insight not found in other review books. Some chapters were better than others, but very readable. Like after reading about pancreatitis in CSDT, I'd read the 3-4 pages in this book to add another angle.
NMS Casebook: This is a solid book as well, but I didn't enjoy reading it😕 Sounds strange, but it just wasn't for me. I think this is because I approached with the intention of learning more about the path/phys presentation of the disease, whereas this book is more focused on teaching the diagnostic modalities and surgical procedures. I found this same info to be much more concise in Gen. Surgery Review, as mentioned below.
PreTest Surgery: I didn't give it a fair shake, but definitely not on par with other books in the series.
Cope's Dx of the acute abdomen: I only read the Acute abdomen chapter, but it's easily the most well written and widely read source on the subject.
General Surgery Review:THE BEST REVIEW BOOK HANDS DOWN. This was like having a secret weapon. I read it along with the appropriate chapters in CSDT. It presents all the "classic" scenarios and how to work them up...
for those interested:http://www.amazon.com/General-Surge...4499956?ie=UTF8&s=books&qid=1180989583&sr=8-1
Sabiston's Board Review Q book: a real let down. the questions were often a single line and not a single vignette in the whole dang book...
Schwartz's Board Review Q book: not much better. I don't understand why these big textbooks put their name on such crappy question books
whew...looks ridiculous looking back on it. In the end I really just used CSDT and Gen. Surg. Review. I know my words don't carry much weight until I update with my score...soon.
Pretest sucks for surgery.... I started doing the questions and of the bat it just didnt feel like NBME type Qs....Switched to A&L and it is much similar to the real thing in terms of format and lenght of questions. TRAUMA+SHOCK sections are probably the highest yeild. Every page on the shelf seemed to have at least 2 or 3 Qs on Trauma.
I forgot to mention Blueprints Q&A Surgery in my resources thread. These were the best source of questions I found for surgery. The topics were high yield and the explanations were quality.
Just received my grade. Raw = 77, %ile = 78th. This is, by far, my highest shelf exam %ile since starting medical school. I am a completely average medical student and performed OK on my rotation.
Resources:
-Pestana's Kaplan review cases (I think it pretty much available everywhere now - do a search for it on here if you can't locate a copy)
-High Yield Surgery by Nirula (I think)
-Surgical Recall - just bits and pieces. No anatomy questions are on the shelf (except for an X-Ray of a malleolar fracture in which you had to pick which one - lateral versus medial) so don't bother which those in SR. Trauma, Peds, and Burns were all high yield in SR. Fluids and electrolytes wre excellent as well.
That's my story, and that's literally all I used to study. I made it through Pestana twice, High Yield about 1.5, and SR throughout the semester and then the high yield stuff before the exam. We only had 2.5 days to study hardcore for it. In my program, we take 4 shelf exams over the course of two weeks so study time is severely limited.
Good luck, all!
Resources:
-Pestana's Kaplan review cases (I think it pretty much available everywhere now - do a search for it on here if you can't locate a copy)
-High Yield Surgery by Nirula (I think)
-Surgical Recall - just bits and pieces. No anatomy questions are on the shelf (except for an X-Ray of a malleolar fracture in which you had to pick which one - lateral versus medial) so don't bother which those in SR. Trauma, Peds, and Burns were all high yield in SR. Fluids and electrolytes wre excellent as well.
That's my story, and that's literally all I used to study. I made it through Pestana twice, High Yield about 1.5, and SR throughout the semester and then the high yield stuff before the exam. We only had 2.5 days to study hardcore for it. In my program, we take 4 shelf exams over the course of two weeks so study time is severely limited.
Good luck, all!
Used NMS, first aid surgical recall....i hate first aid, memorizing bullet points wont organize your thoughts into a pattern fit for answering shelf questions...nms was decent, surgical recall was not that useful. if i had to do it again id just find a question source and study the crap out of that. got an 83.
That is the one that is recommended at my school.
Just finished the exam a few hours ago, so thought i'd share my thoughts... keep in mind that what i'm saying is probably more applicable if you're taking surgery towards the end of 3rd year, since having experience taking numerous exams as well as having had medicine, peds, ob, etc., is really useful. So, that being said...
I actually thought the exam was pretty straight-forward. That's not to say that all the questions were easy or give aways, but there were only a few that I thought were obscure or tricky. In general, as people have said before, yes, there was a lot of trauma, a lot of GI, and very little subspecialties; i think i remember maybe 2-3 ortho questions, a few vascular (but very straight forward, like AAA rupture), a few neuro (but again, straight forward). From what i remember, there was very little cancer, and the questions that were asked weren't specific, you just had to be able to distinguish findings of a benign vs. malignant breast mass, etc., but didn't need to know the different types. There were also a lot of management questions, a lot of "what's next", and some of that was tricky, but again, if you read enough and pay attention on the wards, a lot of it will just be common sense. And always remember - ABCs, NG tube, IV, and chest/abd/pelvc x-rays in trauma come first, then the C-spine and other studies.
Some things that are helpful to know/remember:
- again, apple core lesion (know what this actualy looks like on X-ray) --> esophageal cancer
- know what sigmoid volvulus and SBO and LBO look like on x-ray
- there were a few random ID-type questions, like what bug is most likely to cause a pneumonia in your patient, so just go over the basics, nothing crazy
- know causes of fevers at different post-op times! and not just the basic wind water, etc.; also, keep in mind pneumonias, abscesses, etc., and how these may present
- random fact that actually came in handy: a ruptured berry aneurysm can present, in later stages, with meningismus! (look it up, know how this presents)
- there were also 2-3 behavioral science questions, believe it or not, like what's ethical in this scenario type things... no way to prepare, just know they're on there
What i used to study:
Surgical Recall - not crucial, maybe just some of the subspecialty stuff, but even then, not at all required. If you throughly read other sources, then don't worry about this one
Surgical Attending Rounds - read this one twice, once at the beginning and once a few days before the exam, and took notes. I thought this book was great, lots of info, but some of the facts are wrong - make sure to look up things that sound incorrect! But, great overall, and *excellent* algorythms!! Know these!!
NMS Casefiles - I also read this one twice, and also thought it was really helpful; read it slowly and think about what you're reading, don't memorize; the test was much more about reasoning than knowing obscure details.
Lange CaseFiles - I think this one is good to read at the very beginning of the rotation, just to get your feet wet and to introduce you to the major surgical topics. Don't use this one alone though, you need at least one other text because it's not comprehensive enough.
Boards & Wards - I read over the surgery section, slowly, right before the exam. It's dense, so it's good to read over once you have a pretty firm grasp on the topics; and, it covers all the important points. By no means necessary, but if you own the book anyway, give it a look-over before the test.
For questions, I used:
Pre-Test Surgery - pretty good, but don't be scared by all the specific questions; the real exam isn't like that. Use it to learn from, not to test yourself!
Blueprints Q&A - this little book has THE BEST surgery questions, by far; and, very representative of the real thing, both in terms of topics covered and length/diffiuclty. Do these!!! Know the topics!!!
A&L - I did the trauma and electrolyte questions; all it did was scare me into studying more. Entirely unnecessary, don't bother unless you need a kick in the pants (but the questions are NOT representative of the real thing!)
Kaplan Step 2 Qbook - Did these the night before the exam; *very* helpful; had a lot more urology and ortho questions than i actually got, but i guess that's variable; good as a last-minute review!
Again, i really didn't think it was that bad - but then again, i've had all the other 3rd year rotations also (except neuro). Also, i obviously studied a lot and used many different sources, which I think is key to making sure you cover all the topics thoroughly.
Good luck!!! And congrats to all the newly-minted 4th years!!! Woohoo!!!! 😀 😀 😀
I actually thought the exam was pretty straight-forward. That's not to say that all the questions were easy or give aways, but there were only a few that I thought were obscure or tricky. In general, as people have said before, yes, there was a lot of trauma, a lot of GI, and very little subspecialties; i think i remember maybe 2-3 ortho questions, a few vascular (but very straight forward, like AAA rupture), a few neuro (but again, straight forward). From what i remember, there was very little cancer, and the questions that were asked weren't specific, you just had to be able to distinguish findings of a benign vs. malignant breast mass, etc., but didn't need to know the different types. There were also a lot of management questions, a lot of "what's next", and some of that was tricky, but again, if you read enough and pay attention on the wards, a lot of it will just be common sense. And always remember - ABCs, NG tube, IV, and chest/abd/pelvc x-rays in trauma come first, then the C-spine and other studies.
Some things that are helpful to know/remember:
- again, apple core lesion (know what this actualy looks like on X-ray) --> esophageal cancer
- know what sigmoid volvulus and SBO and LBO look like on x-ray
- there were a few random ID-type questions, like what bug is most likely to cause a pneumonia in your patient, so just go over the basics, nothing crazy
- know causes of fevers at different post-op times! and not just the basic wind water, etc.; also, keep in mind pneumonias, abscesses, etc., and how these may present
- random fact that actually came in handy: a ruptured berry aneurysm can present, in later stages, with meningismus! (look it up, know how this presents)
- there were also 2-3 behavioral science questions, believe it or not, like what's ethical in this scenario type things... no way to prepare, just know they're on there
What i used to study:
Surgical Recall - not crucial, maybe just some of the subspecialty stuff, but even then, not at all required. If you throughly read other sources, then don't worry about this one
Surgical Attending Rounds - read this one twice, once at the beginning and once a few days before the exam, and took notes. I thought this book was great, lots of info, but some of the facts are wrong - make sure to look up things that sound incorrect! But, great overall, and *excellent* algorythms!! Know these!!
NMS Casefiles - I also read this one twice, and also thought it was really helpful; read it slowly and think about what you're reading, don't memorize; the test was much more about reasoning than knowing obscure details.
Lange CaseFiles - I think this one is good to read at the very beginning of the rotation, just to get your feet wet and to introduce you to the major surgical topics. Don't use this one alone though, you need at least one other text because it's not comprehensive enough.
Boards & Wards - I read over the surgery section, slowly, right before the exam. It's dense, so it's good to read over once you have a pretty firm grasp on the topics; and, it covers all the important points. By no means necessary, but if you own the book anyway, give it a look-over before the test.
For questions, I used:
Pre-Test Surgery - pretty good, but don't be scared by all the specific questions; the real exam isn't like that. Use it to learn from, not to test yourself!
Blueprints Q&A - this little book has THE BEST surgery questions, by far; and, very representative of the real thing, both in terms of topics covered and length/diffiuclty. Do these!!! Know the topics!!!
A&L - I did the trauma and electrolyte questions; all it did was scare me into studying more. Entirely unnecessary, don't bother unless you need a kick in the pants (but the questions are NOT representative of the real thing!)
Kaplan Step 2 Qbook - Did these the night before the exam; *very* helpful; had a lot more urology and ortho questions than i actually got, but i guess that's variable; good as a last-minute review!
Again, i really didn't think it was that bad - but then again, i've had all the other 3rd year rotations also (except neuro). Also, i obviously studied a lot and used many different sources, which I think is key to making sure you cover all the topics thoroughly.
Good luck!!! And congrats to all the newly-minted 4th years!!! Woohoo!!!! 😀 😀 😀
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I had zero questions of this type.
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Just curious, how pathetic a score is the 7th percentile? I ask b/c that's our minimum score to pass the exam for my school (though obv. you wouldn't exactly be Honoring at that point), and it's always nice to have less worry knowing you're going to pass b/c the minimum is such a low threshold 😀
does anyone know how to convert your raw score to a national percentile for people that recently took the exam?
i saw someone wrote that a score of 77 = 78th percentile but is that always true? i.e. i heard that people that took the shelf recently should have lower scores because most people are just beginning third year, haven't done medicine yet, this is probably their first shelf, etc.
i saw someone wrote that a score of 77 = 78th percentile but is that always true? i.e. i heard that people that took the shelf recently should have lower scores because most people are just beginning third year, haven't done medicine yet, this is probably their first shelf, etc.
B
Blade28
WAY too much detail. You won't need to know this until residency.
took the shelf exam about two weeks ago, and just got back score of 92🙂. this was my first rotation. Having just studied for Step 1 was definitely useful, as there were some straight up medicine diagnoses that didn't have anything to do with surgery.
-Anyways books and resources I used:
-NMS Casebook-wonderful
-Pestana Review-also very high-yield
-1/2 of Pretest questions-not that great
-USMLE world Step 2 Questions- Good
Good luck to everyone!!!👍
-Anyways books and resources I used:
-NMS Casebook-wonderful
-Pestana Review-also very high-yield
-1/2 of Pretest questions-not that great
-USMLE world Step 2 Questions- Good
Good luck to everyone!!!👍
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