Official Surgery Shelf Exam Discussion Thread

[Kaputt]

calm down. I just wanted to know, and theres nothing wrong with that. ive changed resources plenty of times becuase of what people say works and doesnt.

this thread is very, very, very long, and opinions are mixed. ive read hrough it all. unlike other rotations, surgery has a very mixed bag and not many strong opions of what works. im a big beleiver in using the best combo of resources, and its led to multiple perfect scores on shelf exams for me.

I'm amazingly calm right now

Surgery is a mixed bag, yeah, but virtually everyone agrees on Pestana + NMS casebook + UWorld + having done a lot of shelf exams already

Congrats on your perfect scores

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[smmypnts]

My surgery block was 3 months long (1 month gen, 1 month surgical subspecialty for which I did ENT, 2 week anesthesia, 2 week elective for which I did Radiology) so I felt like I had TOO much time to study for the shelf. Plus I had just finished medicine and done 2/3 of the Uworld medicine questions the month before.

I used the Pestana audio files twice: Best resource I found, very easy to remember the material he covers but takes about 20 hrs to finish
Kaplan Surgery Book: Basically the same as the audio files
NMS Casebook (x 2 reads): Contains a lot of relevant material for the test and a lot of extra stuff not on my test but useful for the wards - I highly recommend this as your secondary learning source
Lange Q and A: A few useful questions but many ones with too much detail, many errors, waste of time
PreTest: Same problem as Lange but worse
Kaplan Surgery Qbook: Most questions too easy, mostly reiterates the pestana material
Uworld Surgery (x 2 times): Very good questions.
I also finished all left over Uworld medicine questions and found ENT, GI, Hepatology, Fluid and electrolytes, Heme, Endocrine and a few other sections helpful

However, you should check the grading policy at your school. I unfortunately learned that since the shelf is only worth 1/3 of the grade at my school, it essentially has no impact on most student's letter grades. So if I had to do it again I would skip all but the Pestana stuff since that alone will get you a pass or high pass.

 

[JasonE]

My surgery block was 3 months long (1 month gen, 1 month surgical subspecialty for which I did ENT, 2 week anesthesia, 2 week elective for which I did Radiology) so I felt like I had TOO much time to study for the shelf. Plus I had just finished medicine and done 2/3 of the Uworld medicine questions the month before.

I used the Pestana audio files twice: Best resource I found, very easy to remember the material he covers but takes about 20 hrs to finish
Kaplan Surgery Book: Basically the same as the audio files
NMS Casebook (x 2 reads): Contains a lot of relevant material for the test and a lot of extra stuff not on my test but useful for the wards - I highly recommend this as your secondary learning source
Lange Q and A: A few useful questions but many ones with too much detail, many errors, waste of time
PreTest: Same problem as Lange but worse
Kaplan Surgery Qbook: Most questions too easy, mostly reiterates the pestana material
Uworld Surgery (x 2 times): Very good questions.
I also finished all left over Uworld medicine questions and found ENT, GI, Hepatology, Fluid and electrolytes, Heme, Endocrine and a few other sections helpful

However, you should check the grading policy at your school. I unfortunately learned that since the shelf is only worth 1/3 of the grade at my school, it essentially has no impact on most student's letter grades. So if I had to do it again I would skip all but the Pestana stuff since that alone will get you a pass or high pass.

thx. having medicine right before would def be useful.

 

[zebalong]

Anyone who has done the practice NBME self assessments: was your predictive score is close to what your actual score was?

 

[rocketbooster]

Is the 249 page Pestana surgery notes worth doing on top of the 76 pg one? I like the 76 pg one since it's short and concise and I just look up random things if the answers are not detailed enough. The 249 page Pestana notes are just the Kaplan surgery notes from what I understand. They seem to be a similar style to the short pdf. Worth doing? Also, are the Kaplan audio files also worth doing?

Also for NMS casebook, I heard this basically just repeats Pestana. Is this worth doing or is doing Pestana more than once about the samething?

 

[Depakote]

FYI, the Pestana AUDIO files are considered copyrighted materials. Please do not request them or exchange them on the SDN forums.

 

[Kaputt]

FYI, the Pestana AUDIO files are considered copyrighted materials. Please do not request them or exchange them on the SDN forums.

Does anyone have the pestana audio files? I'd like to spend hours talking about what his accent does for you .. PM if you're interested

lol

 

[dr seuss]

don't usually post in these threads but i got a 99 on this (kind of shocked) so figured i'd share how i studied. had medicine right before surgery - helped a LOT. i would say the test was 1/3 surgery (know kaplan notes inside out), 1/3 medicine (a surgical patient happens to have this medical condition, how do you treat it), and 1/3 totally unexpected stuff, like peds and ob/gyn. definitely a weird grab bag.

-case files
-uworld surgery questions (did all medicine questions during medicine)
-nms surgery casebook x2
-kaplan surgery notes x3
-kaplan qbook: surgery questions x2, as well as all 8 internal medicine tests
-read step up to medicine a second time
-2 sample nbmes

Do you recommend the nbmes?

 

[zebalong]

I posted earlier asking about the practice NBMEs... and i just decided to take one. I thought they were similiar in terms of a lot of medicine/mix grab bag of questions. Predictive value though I had a 90th percentile the day before my real shelf but ended up with a 99 - so i don't think it was too predictive of the real thing but others might have had different experiences.

 

[rocketbooster]

Were the nbmes at least similar content to the real one in terms of a mix of surgery, IM and random topics?

 

[zebalong]

Were the nbmes at least similar content to the real one in terms of a mix of surgery, IM and random topics?

very much so.. it'll give you a good feel for the surgery shelf question bank

 

[happyfeet123]

how do you get these nbme's? both legal and not so legal suggestions appreciated

 

[Kaputt]

how do you get these nbme's? both legal and not so legal suggestions appreciated

You can buy them here:

https://nsas.nbme.org/nsasweb/servlet/mesa_main

$20 each

 

[drdude21]

Do you recommend the nbmes?

definitely - to echo everybody else, they give a good idea of what to expect content-wise and for me they were pretty predictive of real score (i thought they were over-predicting - turned out to be pretty spot on)

 

[rocketbooster]

definitely - to echo everybody else, they give a good idea of what to expect content-wise and for me they were pretty predictive of real score (i thought they were over-predicting - turned out to be pretty spot on)

Is it really worth doing both tests? I'd think one would be enough to give you an idea about the content, but if you think doing both definitely helped a lot then I'd probably consider it worth it. One good enough or both for sure?

 

[Bbon]

If your only goal is to get a feel for the test, one is fine of course. I've been doing both lately because I figure the more questions I see that resemble the real test, the better. I get to see which topics are emphasized, identify areas that I might not have studied sufficiently to that point, and just get as comfortable as possible with the style of questions I'm bound to see. Maybe the extra test won't net you many extra points on the actual shelf, but for me, $20 is an acceptable price to pay.

 

[drdude21]

If your only goal is to get a feel for the test, one is fine of course. I've been doing both lately because I figure the more questions I see that resemble the real test, the better. I get to see which topics are emphasized, identify areas that I might not have studied sufficiently to that point, and just get as comfortable as possible with the style of questions I'm bound to see. Maybe the extra test won't net you many extra points on the actual shelf, but for me, $20 is an acceptable price to pay.

ditto. can't say my score would necessarily have been any different, but i think taking 2 helped my "comfort factor" going into the real thing.

 

[Belleza156]

I didnt take the practice NBMEs for surgery shelf.....would anyone recommend doing them for the internal medicine shelf?

Sent from my SPH-L710 using SDN Mobile

 

[buccsmf1]

Just took it friday so i thought i'd share my experiences. Studied the usual stuff, uworld, large pestana file, NMS casebook. I had taken IM and Psych already.

The thing that surprised me was how little surgery questions were actually on this thing. When i mean surgery questions, I'm talking about the uworld type "surgery" questions. I'd say only 15-20% of this test is actual surgery. The VAST majority of it is IM. There were some questions that called for you to remember extremely specific parameters related to electrolytes and such. There was even some peds thrown on for good measure.

Make sure you know your bleeding disorders cold....

 

[kwel]

Somehow got ahead on my studying...

Finished NMS casebook x1
Halfway through Pestana/Kaplan
Probably about 150 questions left in UW

Since I have some extra time should I:
(1) Do pretest
(2) attempt to do UW questions twice or
(3) keep reading NMS casebook--I'm sure there's lots of stuff in there that could use a second runthrough, especially the GI stuff since that's HY. But I'm afraid NMS might be TOO detailed and end up being low yield for me. Also I like questions and Pretest might be nice, but I've heard some bad things about it for surgery... so if consensus is that NMS >>> Pretest I'd rather do NMS again.

 

[Kaputt]

Somehow got ahead on my studying...

Finished NMS casebook x1
Halfway through Pestana/Kaplan
Probably about 150 questions left in UW

Since I have some extra time should I:
(1) Do pretest
(2) attempt to do UW questions twice or
(3) keep reading NMS casebook--I'm sure there's lots of stuff in there that could use a second runthrough, especially the GI stuff since that's HY. But I'm afraid NMS might be TOO detailed and end up being low yield for me. Also I like questions and Pretest might be nice, but I've heard some bad things about it for surgery... so if consensus is that NMS >>> Pretest I'd rather do NMS again.

Pretest is BAD for surgery. Don't bother. Another pass through Pestana is far more useful. Try one of those NBMEs if you're scrambling for more questions.

 

[kwel]

What areas are tested the most heavily? In other words, if I need to reread/review some topics in depth which ones should I focus on?

I'm guessing GI and trauma, but probably there are more...

 

[happyfeet123]

Hi SDN,

For Pestana Kaplan notes and videos: Pestana says he only discusses the second half the book (the surgical vignettes). To me this discussion looks similar to first half the book which he doesNT read. Is it sufficient to then not read first half of book and only follow him as you will get everything from just listening to Pestana?

Thanks!

 

[rocketbooster]

Shelf tomorrow...do they make you calculate the amounts of fluid to give?

Seems like you always here different ways to calculate fluids. The most consistent one I hear is 4:2:1 for maintenance fluids. Anything specifically to know other than maintenance fluids for this shelf?

 

[ijn]

I really doubt they will make you calculate maintenance fluids. More likely they will ask what kind of fluids to use in what situation.

 

[Jervix]

Took exam 2-8

Lots of bread and butter and esoteric left field questions.

Resources:
Lawrence-newest edition. Thought this was a great resource. Long but just the right amount of details
Recall-pimping only, read before cases
NMS casebook: Buy this. Its direct, its great and gives numerous variations on a theme
NBME practice exams: Its nice to see what questions will look like. Expecting ~90% based off these. Will report score when available.
Uworld: All surgery questions. Very trauma heavy but great
Pastana Shorts: Great resource but pretty superficial. Use as a final source to solidify those "buzzwords"


I had 8-10 questions on bleeding and blood disorders. Hypercoaguable states, blood products-what type and when, surgical bleeding diatheses, DIC vs others etc. I did not expect such a volume of blood questions. I was kicking myself for skimming the blood chapter in Lawrence.

No calculations on my exam

Adjusted Score: 88

 

[JasonE]

Anyone know the answers to these?

1. Pre-mature baby is given indomethacin for a PDA. PDA closes. Which of the following is the most likely explanation for this patient's response to indomethacin?
A. Cortisol inhibition with decreased norepi release
B. Cyclo-oxygenase inhibition with increased norepi release
C. Decreased arterial blockade to promote ductal closure
D. Interleukin 2 receptor blockade to promote ductal closure
E. Secretion of surfactant by pulmonary alveolar cells

ANS is not C. I know it inhibits cyclo-oxygenase, but what does that have to do with norepi?

2. 67-year-old man has 6 week history of nausea and vomitting. Has dec appetite, with 35 lb weight loss over last 6 weeks. Had a distal gastrectomy for PUD 35 yrs ago. He looks cachectic. His BMI is 17. He has gastric adenocarcinoma. What metabolic abnormality is he likely to have?
1. Decreased lipolysis
2. Decreased IL6
3. Hypertriclyceridemia
4. Hypoglycemia
5. Increased TNF

Ans is not hypertriglyceridiemia. I thought it would be, since anorexics usually have high triglycerides. I think it might be increased TNF.

3. 68-year-old has stridor for 2 hours. 2 years ago, he had neck radiation for laryngeal cancer. Examination shows a bulky tumor involving the upper and middle necky bilaterally. ABG on 100% O2 shows pH 7.32, CO2 52, O2 55, HCO3 17. Whats the next step?
A. Place an esophageal airway
B. Bronchoscopy
C. Neck irradiation
D. Trachestomy
E. Laryngectomy

Its not A. I didn't think you could do a trachestomy, since this guy needs an airway ASAP.

 

[VisionaryTics]

Anyone know the answers to these?

1. Pre-mature baby is given indomethacin for a PDA. PDA closes. Which of the following is the most likely explanation for this patient's response to indomethacin?
A. Cortisol inhibition with decreased norepi release
B. Cyclo-oxygenase inhibition with increased norepi release
C. Decreased arterial blockade to promote ductal closure
D. Interleukin 2 receptor blockade to promote ductal closure
E. Secretion of surfactant by pulmonary alveolar cells

ANS is not C. I know it inhibits cyclo-oxygenase, but what does that have to do with norepi?

B. No idea what's going with norepi, but definitely inhibits PGE2 synthesis.

2. 67-year-old man has 6 week history of nausea and vomitting. Has dec appetite, with 35 lb weight loss over last 6 weeks. Had a distal gastrectomy for PUD 35 yrs ago. He looks cachectic. His BMI is 17. He has gastric adenocarcinoma. What metabolic abnormality is he likely to have?
1. Decreased lipolysis
2. Decreased IL6
3. Hypertriclyceridemia
4. Hypoglycemia
5. Increased TNF

Ans is not hypertriglyceridiemia. I thought it would be, since anorexics usually have high triglycerides. I think it might be increased TNF.

TNF. TNF is also known as cachexin, responsible for wasting observed in cancer.

3. 68-year-old has stridor for 2 hours. 2 years ago, he had neck radiation for laryngeal cancer. Examination shows a bulky tumor involving the upper and middle necky bilaterally. ABG on 100% O2 shows pH 7.32, CO2 52, O2 55, HCO3 17. Whats the next step?
A. Place an esophageal airway
B. Bronchoscopy
C. Neck irradiation
D. Trachestomy
E. Laryngectomy

Its not A. I didn't think you could do a trachestomy, since this guy needs an airway ASAP.

Trach him. He's going to need a trach anyway. Why would you place an airway into this guy's esophagus?

4. 21. A 72-year-old woman is brought to the emergency department 48 hours after slipping on a rug and falling. Her son found her lying on the floor. On arrival, she has severe pain of the right hip and thigh. Her pulse is 126/min, respirations are 30/min, and blood pressure is 80/40 mm Hg. There is marked external rotation and shortening of the right lower extremity. Pedal pulses are present. There is a normal sinus rhythm. Which of the following is the most likely cause of her hemodynamic status?

A) Fat embolism
B) Hypovolemia
C) Myocardial infarction
D) Pulmonary embolism
E) Reaction to pain


Its not E or D. Maybe B? But don't you need to lose 30% of your blood volume to become hypotensive

Probably hypovolemia 2/2 decreased access to water (not necessarily hemorrhage). I doubt a patient would be alive for two days with a hemodynamically significant embolism, either PE or fat.

?

as above

 

[kwel]

..

 

[secants]

There's a legit Pestana book coming out for the future test takers

http://www.amazon.com/Dr-Pestanas-S...&qid=1361849681&sr=8-1&keywords=pestana+notes

 

[clifftacopter]

And it looks pretty reasonably priced compared to the price gouging you normally see with these review books.

 

[45408]

Trach him. He's going to need a trach anyway. Why would you place an airway into this guy's esophagus?

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.

 

[ijn]

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.

Keep in mind the question is from 1993. Were fiber-optic intubations being done twenty years ago?

The right answer per the NBME is tracheostomy.

 

[45408]

They did have fiber optics in 1993, yes. It wasn't hooked up to an HD camera of course, but they had them. That's how all endoscopy was done.

 

[evilbooyaa]

We all remember from Pestana (for the last question posted) that the sources of hypovolemic shock are limited to the abdomen, pelvic fx, femur fx (generally multiple), and possibly thoracic(?). I'd say a combination of dehydration and a pelvic/hip fx is likely to blame for her shock.

Thanks for the info about TNF = Cachexin = Cachexia; I don't think I've ever heard that before.

For the guy with a bulging neck mass (going with UPPER and MIDDLE neck, AKA zones I and II), I'd probably do a perc tracheostomy in zone III, below the mass. What will a bronch show of use in this situation? Making the question open-ended, would there be concern of the tumor causing external compression after a fiberoptic intubation?

 

[45408]

We all remember from Pestana (for the last question posted) that the sources of hypovolemic shock are limited to the abdomen, pelvic fx, femur fx (generally multiple), and possibly thoracic(?). I'd say a combination of dehydration and a pelvic/hip fx is likely to blame for her shock.

100-200mL of possible blood loss per rib fracture. Each hemithorax can hold liters of blood.

You also forgot the retroperitoneum, which can hold massive amounts of blood.

For the guy with a bulging neck mass (going with UPPER and MIDDLE neck, AKA zones I and II), I'd probably do a perc tracheostomy in zone III, below the mass. What will a bronch show of use in this situation? Making the question open-ended, would there be concern of the tumor causing external compression after a fiberoptic intubation?

Perc trachs are done when the patient is intubated....while you're doing a bronchoscopy (technique described here). One of the options should have been "intubate the patient," because that's what is truly important.

Did you mean a cricothyroidotomy? And there's really no concern of anything extrinsically compressing your airway once the patient is intubated.

 

[evilbooyaa]

100-200mL of possible blood loss per rib fracture. Each hemithorax can hold liters of blood.

You also forgot the retroperitoneum, which can hold massive amounts of blood.

Ah, well when I say abdomen I meant both. Clarification is appreciated, however.

Perc trachs are done when the patient is intubated....while you're doing a bronchoscopy (technique described here). One of the options should have been "intubate the patient," because that's what is truly important.

Did you mean a cricothyroidotomy? And there's really no concern of anything extrinsically compressing your airway once the patient is intubated.

True, I didn't consider that. I guess it has to be bronchoscopy then? Guess I was thinking of a cricothyroidotomy, although I have read sources that talk about emergent perc trachs. Didn't consider that they probably insinuate the patient is already intubated.

 

[VisionaryTics]

I think the point of the question is that the patient is becoming hypercarbic and needs an airway -- not what the sequence of steps in a bedside percutaneous trach is.

The only answer there that secures an airway would be tracheostomy. I highly doubt they would put endotracheal intubation with or without fiberoptic guidance, cricothyroidotomy, formal OR tracheostomy, and bedside tracheostomy all down as answers in the same question. That's a judgement call.

 

[45408]

Ah, well when I say abdomen I meant both. Clarification is appreciated, however.

I've seen senior medicine residents refer to a retroperitoneal hematoma as "intra-abdominal," but it is a huge difference. You would definitely operate on a patient with free intra-peritoneal hemorrhage, but you frequently do not operate on a patient with retroperitoneal hemorrhage. You might embolize it though.

True, I didn't consider that. I guess it has to be bronchoscopy then? Guess I was thinking of a cricothyroidotomy, although I have read sources that talk about emergent perc trachs. Didn't consider that they probably insinuate the patient is already intubated.

I think the point of the question is that the patient is becoming hypercarbic and needs an airway -- not what the sequence of steps in a bedside percutaneous trach is.

The only answer there that secures an airway would be tracheostomy. I highly doubt they would put endotracheal intubation with or without fiberoptic guidance, cricothyroidotomy, formal OR tracheostomy, and bedside tracheostomy all down as answers in the same question. That's a judgement call.

Again, I would argue that the "judgment call" is the only important part of that question. Why even get an ABG? Some guy with a h/o neck cancer and radiation comes in with new onset stridor? It's not even the ABCs for him, lol, it's Airway Airway Airway. An ABG is part of Breathing (tells you if he's oxygenating and ventilating, and this guy is doing neither when he's 50/50 like that). The last thing I feel like doing is putting him to sleep while laying supine. Open tracheostomies can be challenging in the operating room, let alone in the ED, to say nothing of the guy's irradiated neck. You're hosed if you do anything that impairs your ability to secure his airway, and if you're not the one capable of getting a definitive airway, you shouldn't be doing anything but calling the person who is. This guy needs an ENT or at least an anesthesiologist+surgeon, stat.

My point about the perc trach is that it's not an option to do one until you've already got his airway secured, because the method relies on an ETT.

 

[coreytayloris]

is festana any good to watch before I begin my surgical rotation?
or should I stick to surgical recall?? or ramachandran clinical cases and osces??

 

[kwel]

Is kaplan/pestana sufficient for ortho and subspecialty questions? I don't really know any other good source from which to learn this material. I'm also using NMS casebook and UW

 

[elektroshok]

Just took it, 98 raw, 97 'tile

read recall throughout the rotation and did all of the world questions twice.

Edit, and listened to the pestana audio

 

[rocketbooster]

Just took it, 98 raw, 97 'tile

read recall throughout the rotation and did all of the world questions twice.

Edit, and listened to the pestana audio

You're the man

Edit, seriously the man.

Edit edit, in all seriousness you definitely dd more than that to get that score. Maybe you uses those resources multiple times other than just world, already had internal medicine, etc etc.

 

[elektroshok]

You're the man

Edit, seriously the man.

Edit edit, in all seriousness you definitely dd more than that to get that score. Maybe you uses those resources multiple times other than just world, already had internal medicine, etc etc.

it was my second to last rotation, had medicine already as my first rotation third year.

 

[alicat]

Just took it, 98 raw, 97 'tile

read recall throughout the rotation and did all of the world questions twice.

Edit, and listened to the pestana audio

Where did you get the Pestana Audio???

 

[evilbooyaa]

Just took the shelf this morning.

I went through most of Pestana x 1 (didn't finish the last few lectures on urologic stuff, which I probably should've).
Went through NMS Casebook x 1/4 (was just reaching AAA repair, maybe some of the stuff from other chapters may have helped me)
Went through Step up to Medicine - Only the GI and Fluids/Lytes/Acid-base Chapters
Went through UWorld QBank x 1.5- All of the Surgery questions (timed, 15-20 at a time, marked if I wasn't sure, reviewed all of them focusing more I had marked + any I thought I was sure on but got wrong)
All of the GI + Fluids/Lytes questions from the IM section.

Overall, I didn't think it was terrible. Definitely missed a few questions after discussing them with classmates after the exam, but am not concerned about failing like I was after medicine and pediatrics Heavy focus on 'What do you do next' (make a step-by-step algorithm for diseases, as well as deciding when you can skip imaging based on clinical presentation/urgency). Having medicine previousyl helped massively, as there were some pure medicine topics on the exam (missed a very easy question b/c I forgot what the abx for a certain STD was)

Pestana video/associated Kaplan PDF is very, very good. Some topics (3+) that I completely forgot about from the 1st 2 years that showed up in his audio and showed up on the exam. I think I could probably identify at least 10-20 questions that I went from "uhhh, I'm not sure between these two/three choices" to "oh yeah, it's obviously this" because of Pestana.

Really wish I had done every single lecture in his series, would've likely gotten me a few more questions, especially in urology and ophtho.

Oddly enough, had a patient from Pediatrics show up nearly word for word as a patient case on this exam.

I would say the most important points to take away from this would be:
1) Pestana video/PDF + UWorld QBank is an absolute must. +/- the Step up to medicine sections I mentioned. +/- NMS casebook (a lot of it is in greater detail than what MS3s require for the shelf)
2) Do a Trauma, General Surgery rotations for sure, they make up >50% of the exam.

Know the basic microbio dx and treatments that can present as possible surgical diagnoses, you will likely be asked about them. Review congenital stuff as well; Pestana does a great job covering that material in the depth that you need it.

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.

 

[VisionaryTics]

Took it a few weeks back, just got my score.

99 (not sure raw or scaled). Pestana audio and notes, NMS textbook x1, NMS casebook several times, UWorld GI/surgery. No really great sources. Pretty random exam. It's probably worth it to do as many UWorld medicine questions as possible in addition to the surgery ones.

I had medicine directly before my surgery rotation and completed all the UWorld medicine questions during that.

 

[kaleerkalut]

I would say E.

 

[COdoubleMO2theN]

Abscess - drain it.

 

[JasonE]

the correct ans was E. not sure why.