Official Surgery Shelf Exam Discussion Thread

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NBME shelf in a few weeks, study plan is memorize all of OME surgery, Pestana 2x, and all UW surgery and IM gi questions. Is this enough to do well (90+ percentile) or should I be doing something else in addition and/or in place of these? Thanks!


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I would try to do Uworld + flagged or incorrects again. Other than that, seems like a solid study plan - I know plenty of people who did your plan and scored >90th percentile. also, maybe take one practice NBME just to get a feel of what it's actually like.

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Hi,
I was wondering . . .this thread, is a mixture of everything about the surgery shelf . . .but I was looking for a thread, that has answer explanations to some of the questions of nbme 3 and 4. . .. I plan to search this thread for them . . .but wouldn't it be easier to have a separate thread for nbme 3 and 4 to discuss q&a? Or is there one already?
 
Could someone please tell me, what the difference is between a Fine Needle Aspiration, A Needle Localized open biopsy and a Core Biopsy?

This is regarding a question on surgery form 1 and it was about a 52 year old woman who is showing stippled micro calcifications. They are asking us for the most appropriate next step?

I chose, Fine Needle Aspiration . . .but it wasn't the best answer
Why would it be Needle localized open biopsy though?
 
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Pulselessness = surgery. In the absence of a "hard sign" of vascular injury, ABI would be indicated.

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Yeah but the problem with this question is that we don't know that pulses are still absent after the reduction and ex fix.. The correct answer should really be, "recheck for pulses", only then can you decide surgery vs ABI
 
how much does pestana audio add if i'm going to make anki out of the pestana book and memorize it anyway? I'm finding it hard to pay attention to the audio lectures... I like the onlinemeded audios better.

and also, what other resources other than UW surg + GI, pestana, all 4 NBMEs, and online meded do I need in order to score 80th percentile on the shelf? thanks in advance!
 
Question about shelf.

So the Surgery Shelf is usually 110-120 questions.
Is the raw score the number correct out of 120? or the percent you got correct.

So lets say raw score is 80. Is that 80/120 or 80% correct on the test
 
Question about shelf.

So the Surgery Shelf is usually 110-120 questions.
Is the raw score the number correct out of 120? or the percent you got correct.

So lets say raw score is 80. Is that 80/120 or 80% correct on the test
It's similar but a bit different than just percent correct. Basically it takes your % correct and says "based on how you did with this 110q sample, we estimate you would have gotten x% correct of the entire bank of questions we have" based on the difficulty of the exam you took vs your classmates who had a different set of 110 questions.
 
Surgery Shelf NBME results
Raw Score:90
Percentile 99%

Resources Used:
UWORLD-Surgery, Pulm,GI,Renal X1.5
NBMEs- Three exams. Averaging between 22-25.
PestanaX3
DeVirgilioX2 (Once throughout rotation, once the week before shelf).
OnlineMedEdX1

Comments:
I am a pretty average Student, PC most of my rotations, got in the 230s for STEP. I also did NOT have internal medicine before this. This score was such a surprise to me, I almost feel like I lucked out with a perfect set of questions or something.

Some tips:
DeVirgilio is so Gold. You will see it online that it is the new standard and it is 100% true. Best book I have ever read in medicine hands down. It takes you through cases in a logical, engaging manner and has high yield Diagnostic and Management flowcharts which made the " next best step" questions a breeze.
UWORLD, online med ed and Pestana are standard resources you need to get the lay of the land for surgery. They are essential for gaining a basic understanding and you should memorize them as best as you can. However it will NOT get you a good grade on the shelf. This shelf is medicine heavy and those three resources do not cover in depth medical management involved in Surgery.
NBMES- Do all 4. I only did 3 because I slacked off and did them all two days before. I would HIGHLY recommend them. So many repeat concepts its ridiculous. Do them the week or two leading to the shelf and try to do one the night before to get yourself in test mode. Try to study missed questions as well.

Overall, NBMEs and Devirgilio is what will push you to the 90th+percentile so study them well. There is very little time in surgery and you will have 0 desire to study. However, if you just push yourself every day to do some studying and go HAM on the weekends, you will be well above the curve.
 
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Surgery Shelf NBME results
Raw Score:90
Percentile 99%

Resources Used:
UWORLD-Surgery, Pulm,GI,Renal X1.5
NBMEs- Three exams. Averaging between 22-25.
PestanaX3
DeVirgilioX2 (Once throughout rotation, once the week before shelf).
OnlineMedEdX1

Comments:
I am a pretty average Student, PC most of my rotations, got in the 230s for STEP. I also did NOT have internal medicine before this. This score was such a surprise to me, I almost feel like I lucked out with a perfect set of questions or something.

Some tips:
DeVirgilio is so Gold. You will see it online that it is the new standard and it is 100% true. Best book I have ever read in medicine hands down. It takes you through cases in a logical, engaging manner and has high yield Diagnostic and Management flowcharts which made the " next best step" questions a breeze.
UWORLD, online med ed and Pestana are standard resources you need to get the lay of the land for surgery. They are essential for gaining a basic understanding and you should memorize them as best as you can. However it will NOT get you a good grade on the shelf. This shelf is medicine heavy and those three resources do not cover in depth medical management involved in Surgery.
NBMES- Do all 4. I only did 3 because I slacked off and did them all two days before. I would HIGHLY recommend them. So many repeat concepts its ridiculous. Do them the week or two leading to the shelf and try to do one the night before to get yourself in test mode. Try to study missed questions as well.

Overall, NBMEs and Devirgilio is what will push you to the 90th+percentile so study them well. There is very little time in surgery and you will have 0 desire to study. However, if you just push yourself every day to do some studying and go HAM on the weekends, you will be well above the curve.
Would you recommend Devirgilio for medicine shelf then?
 
Hey Everybody,

There are a handful of questions from NBME 4 that I can't seem to figure out (paraphrased below, per SDN TOS). Input/answers would be appreciated!

What is the cause of intermittent, unilateral bloody nipple discharge of several months duration in a woman with no breast mass and a normal mammogram?

What might cause hypocalcemia in an adult male with diarrhea and weakness of five days duration who presents with hepatomegaly, mild diffuse abdominal tenderness, and a normal serum amylase?

What is the cause of an air-fluid level posterior to the cardiac silhouette in a patient with GERD and a paraesophageal hernia?

What is the first step in the management of a pediatric trauma patient (20' fall) presenting with mild tachycardia and mild hypotension with normal findings on chest auscultation or CXR?

What is the appropriate management of a bite wound that has penetrated down to the subcutaneous fat (aside from debridement and antibiotics)?

Thanks,
Bill
 
Hey guys, got a question from NBME 3 that I wanted clarification if possible! Thx!!!

57 M presents with 3 mo hx of 5-6 loose stools daily and significant weight loss. He notes that he had 2-3 bowel movements daily for 3 weeks after taking 2 weeks of tetracycline 2 months ago. He's also had a Billroth 2 for perf'd gastric ulcer 1 year ago. No changes in diet, takes ibuprofen for OA, and has a scaphoid abdomen with excess skinfolds. What is causing the diarrhea?

A. Bacterial overgrowth- is this it? I didn't put it bc the timeline didnt make sense, he started 3 mo ago but took the tetracycline after (2 mon ago)
B. Bile reflux
C. COX-2 inhib
D. Dumping syndrome (wrong, my answer; in retrospect this definitely doesnt fit the timeline)
E. Efferent loop obstruction
 
Hey Everybody,

There are a handful of questions from NBME 4 that I can't seem to figure out (paraphrased below, per SDN TOS). Input/answers would be appreciated!

What is the cause of intermittent, unilateral bloody nipple discharge of several months duration in a woman with no breast mass and a normal mammogram?

What might cause hypocalcemia in an adult male with diarrhea and weakness of five days duration who presents with hepatomegaly, mild diffuse abdominal tenderness, and a normal serum amylase?

What is the cause of an air-fluid level posterior to the cardiac silhouette in a patient with GERD and a paraesophageal hernia?

What is the first step in the management of a pediatric trauma patient (20' fall) presenting with mild tachycardia and mild hypotension with normal findings on chest auscultation or CXR?

What is the appropriate management of a bite wound that has penetrated down to the subcutaneous fat (aside from debridement and antibiotics)?

Thanks,
Bill

Someone please confirm

Blood nipple - intraductal papilloma; better seen with a galactogram; hard to see with mammogram
hypocalcemia - cirrhosis? hepatomegaly, low Albumin so low Calcium?
air-fluid level - not sure..? but bowel herniation? (
pediatric - got no clue.. FAST? blunt chest trauma - think blunt aortic/cardiac injury, esophageal/tracheboronchial rupture, diaphragmatic hernia, pulmonary contusion.. CT if hemo stable..
bite - all get tetanus; rabies prophylaxis? CROFAB for snake bites (relative to size of wound, not human weight), extensive irrigation/OR for human bites (dirtiest)

Sorry.. Doubt this was helpful but I tried..

Question: De Virgilio questions.. are they harder than shelf or similar..?
 
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Hey guys, got a question from NBME 3 that I wanted clarification if possible! Thx!!!

57 M presents with 3 mo hx of 5-6 loose stools daily and significant weight loss. He notes that he had 2-3 bowel movements daily for 3 weeks after taking 2 weeks of tetracycline 2 months ago. He's also had a Billroth 2 for perf'd gastric ulcer 1 year ago. No changes in diet, takes ibuprofen for OA, and has a scaphoid abdomen with excess skinfolds. What is causing the diarrhea?

A. Bacterial overgrowth- is this it? I didn't put it bc the timeline didnt make sense, he started 3 mo ago but took the tetracycline after (2 mon ago)
B. Bile reflux
C. COX-2 inhib
D. Dumping syndrome (wrong, my answer; in retrospect this definitely doesnt fit the timeline)
E. Efferent loop obstruction


I'm honestly not sure;; But I would've gone with A .. Having said that, I didn't pay much attention to the timeline like you said
However, it does say "He notes that he had 2-3 bowel movements daily for 3 weeks after taking 2 weeks of tetracycline 2 months ago" - so maybe C. Diff was an exacerbation to an already weakened gut flora?

B - don't know how that's related
C - no cardiac symptoms
D - like you said, timeline doesn't fit
E - no peritonitic/strangulated/SIRS symptoms..

Not sure though
 
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1. What is the cause of intermittent, unilateral bloody nipple discharge of several months duration in a woman with no breast mass and a normal mammogram?

2. What might cause hypocalcemia in an adult male with diarrhea and weakness of five days duration who presents with hepatomegaly, mild diffuse abdominal tenderness, and a normal serum amylase?

3. What is the cause of an air-fluid level posterior to the cardiac silhouette in a patient with GERD and a paraesophageal hernia?

4. What is the first step in the management of a pediatric trauma patient (20' fall) presenting with mild tachycardia and mild hypotension with normal findings on chest auscultation or CXR?

5. What is the appropriate management of a bite wound that has penetrated down to the subcutaneous fat (aside from debridement and antibiotics)?
These are the answers I put, and they were not among my incorrects:
1. G - intraductal papilloma

2. D - hypomagnesemia (I believe it's required for absorption of Ca and hypomagnesemia is very common in alcoholics; I actually saw some form of this question multiple times)

3. D - EGD (question actually asks next step, and the barium swallow demonstrated a hiatal hernia (not paraesophageal). I believe the air-fluid level on CXR is the hernia. Given worsening of sx you want to evaluate for Barrett's esophagus/cancer)

4. A - Xray of the cervical spine (this is actually not the first step - they say in the stem that CXR, lung, and abdominal exam are normal)

5. A - sterile dressing to open wound (some skin is cyanotic, you would wait for it to fully declare before attempting to close)
 
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Thanks VERY much, @shadid and @doyouhaveaflag ! I appreciate the correct answers and the explanations. The only one I find particularly surprising is "xray of the cervical spine," but I suppose it makes more sense than FAST considering the patient was stable and the abdominal exam was normal.

-Bill
 
Question: De Virgilio questions.. are they harder than shelf or similar..?
 
Question: is 85 raw a good score? What percentile would it be?

Looking at all the SDN users posting 90+ raw scorr makes me feel like an underachiever.
 
Question: De Virgilio questions.. are they harder than shelf or similar..?

Wondering the same thing. I did reasonably well on the NBME exams, but I'm getting pretty walloped by the de Virgilio Q's. Wondering what would be the best way to spend the next week until the shelf. Are de V Q's overkill or pretty comparable to what we can expect on the shelf?

-Bill
 
Wondering the same thing. I did reasonably well on the NBME exams, but I'm getting pretty walloped by the de Virgilio Q's. Wondering what would be the best way to spend the next week until the shelf. Are de V Q's overkill or pretty comparable to what we can expect on the shelf?

-Bill

My friend who took surgery last rotation said the Virgilio are harder and if you can do them you can definitely do well on the shelf. He also said apparently the actual shelf has more internal med than the practice shelf exams... Hope that helps, I was looking for someone else to put their input haha

Another question regarding closed vs open reduction and internal vs external fixation..?
Is there such thing as closed reduction and internal fixation (CRIF)?

Can someone please please clarify this?? Also splint vs cast vs others?

Thank you!
 
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My friend who took surgery last rotation said the Virgilio are harder and if you can do them you can definitely do well on the shelf. He also said apparently the actual shelf has more internal med than the practice shelf exams... Hope that helps, I was looking for someone else to put their input haha

Another question regarding closed vs open reduction and internal vs external fixation..?
Is there such thing as closed reduction and internal fixation (CRIF)?

Can someone please please clarify this?? Also splint vs cast vs others?

Thank you!

Thanks! That is encouraging.

Best of luck with surgery shelf studying!

-Bill
 
So when people mention Pestana being gold, do they mean the PDF Pestana - Surgery Review? Or the Kaplan Medical Surgical Notes?
 
They mean Pestana the approximately 150 page book that has about 200 Qs in the back. The gold standard now appears to be the DeVirgilio Surgery text.
 
Are these two books the same?
Amazon product

Amazon product

I'm confused . ..like why is the newer edition a lower edition? Content wise, is the red book the same as the white one? Is there a difference in the content between these books?
 
Real deal: 89 (around 99th percentile maybe 98)
NBME1:94
NBME2:88
NBME3:84
NBME4:82
Used Pestana, OMed, some DEvirg, Uworld, Pretest (very low yield, not sure if this is useful), FC qbank, FC flashcard, Had IM beforehand and scored 92 on it. Felt I missed some gimmes so do not despair if you feel awful afterward
 
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Real deal: 89 (around 99th percentile maybe 98)
NBME1:94
NBME2:88
NBME3:84
NBME4:82
Used Pestana, OMed, some DEvirg, Uworld, Pretest (very low yield, not sure if this is useful), FC qbank, FC flashcard, Had IM beforehand and scored 92 on it. Felt I missed some gimmes so do not despair if you feel awful afterward

89 is 99th percentile? I scored a 85 and that was only 88th percentile.
 
Doubts from NBME Surgery Form 1 for anyone who got these right:

1. Preop evaluation reveals chronic occlusion of lower limb veins and edema - What to do before surgery?

I thought we would give therapeutic dose of Hep for DVT, which was wrong. Would we give low dose hep prophylaxis?

2. Patient is put on a ventillator probably because of ARDS - Tidal vol 1000ml, PEEP 2.5, FiO2 100%. What settings to change/add medications?

I thought the tidal volume was too high and would cause pneumothorax, so I chose to decrease it but that was wrong. Would we increase PEEP because it's <5?

Also does anyone know a good resource for ventilator settings?
 
I meant to post this a while ago.

I used only the devirgilio book and u-world and scored in the 95th percentile. The devirgilio book was probably the best resource I have ever used in medical school. I read the book 2x during my clerkship. I read consistently everyday for about 20 minutes and sometimes more on the weekends.

i did u world questions throughout the rotation and got through them 1x. I did the questions in the back of the devirgilio book about three weeks before my exam and then again one week before and I am sooo happy I did that because I think about 20 questions on my shelf were very similar to the questions I did in the devirgilio book. if you dont use this book, you WILL be handicapped on the rotation.
 
Does anyone have a link for Emma Holiday's Surgery video? You need a login for the website now.
 
Worth doing the de Virgilio Questions?

Honored the shelf with UW and Virgilio (and the questions). Important to constantly read up on the different cases you scrub in, too.

Good luck.
 
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UW, major gen surg chapters in de virgilio (skip subspecialty chapters except vascular), pestana once at beginning and once at end of clerkship. Emma holiday. 94th percentile, I think 87 raw. Honestly this felt more like a medicine exam than a surgery exam
 
Worth doing UWorld renal or pulm questions for the shelf?
 
Anybody have an opinion on doing exam guru for surgery shelf? Just finished Uworld Surgery, GI and Renal but I still want to do some questions before i start doing NBME exams.
 
So UW is telling me that in an alert, hemodynamically stable patient w blunt abdominal trauma, the first test you would do is FAST. Every other resource is telling me to do a CT scan.

I get that stable -> CT, unstable -> FAST

What gives?
 
UW, major gen surg chapters in de virgilio (skip subspecialty chapters except vascular), pestana once at beginning and once at end of clerkship. Emma holiday. 94th percentile, I think 87 raw. Honestly this felt more like a medicine exam than a surgery exam

I meant to post this a while ago.

I used only the devirgilio book and u-world and scored in the 95th percentile. The devirgilio book was probably the best resource I have ever used in medical school. I read the book 2x during my clerkship. I read consistently everyday for about 20 minutes and sometimes more on the weekends.

i did u world questions throughout the rotation and got through them 1x. I did the questions in the back of the devirgilio book about three weeks before my exam and then again one week before and I am sooo happy I did that because I think about 20 questions on my shelf were very similar to the questions I did in the devirgilio book. if you dont use this book, you WILL be handicapped on the rotation.

Which UWorld sections did you do?

Also how helpful is Pestana if you've gone over DeVirgilio already? I tried reading some of Pestana but it really didn't have enough explanations for my liking ...
 
So UW is telling me that in an alert, hemodynamically stable patient w blunt abdominal trauma, the first test you would do is FAST. Every other resource is telling me to do a CT scan.

I get that stable -> CT, unstable -> FAST

What gives?

Did you ever find an answer? I found conflicting sources as well.
 
Did you ever find an answer? I found conflicting sources as well.

Nope. Didn't matter, got rocked anyways lol. Got a lot of random IM and obgyn questions, and surgery was my first shelf
 
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Just got my grade.

105 on the surgery comat.

Not bad for my first shelf with no IM.

Just did Online meded and read the notes like 3 times.

Read pestana's once. Did not do the questions in the back.

Did UW surgery questions and reviewed those twice.

Did Comtest surgery questions and reviewed those twice as well.

There was some RANDOM stuff on mine shelf... so.... good luck.

My exam crashed twice as well... so...

God's plan???

*Cue Drake*

So hopefully everything is downhill from here...
 
Congrats on the score! Do you recommend watching all of the OME videos for surgery, even trauma? I'm using the same resources as you but I have comquest as well that I was going to run through

Just got my grade.

105 on the surgery comat.

Not bad for my first shelf with no IM.

Just did Online meded and read the notes like 3 times.

Read pestana's once. Did not do the questions in the back.

Did UW surgery questions and reviewed those twice.

Did Comtest surgery questions and reviewed those twice as well.

There was some RANDOM stuff on mine shelf... so.... good luck.

My exam crashed twice as well... so...

God's plan???

*Cue Drake*

So hopefully everything is downhill from here...
 
Congrats on the score! Do you recommend watching all of the OME videos for surgery, even trauma? I'm using the same resources as you but I have comquest as well that I was going to run through

Watched them once and just reread the notes.

Questions are where it's at though.

Good luck
 
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Ridiculous amount of IM. It's understated in all resources. The questions were vague. I read DeVirgilios twice, did u world, did kaplan , did pestana, and there was still plenty of crap I hadn't explicitly seen. I wish I had had medicine first.
 
You didn't do combank or comquest? Luckily I have a month of IM before my surgery shelf. I don't know how much that will help because I won't take the IM shelf yet until later on in the year.

Ridiculous amount of IM. It's understated in all resources. The questions were vague. I read DeVirgilios twice, did u world, did kaplan , did pestana, and there was still plenty of crap I hadn't explicitly seen. I wish I had had medicine first.
 
I meant to post this a while ago.

I used only the devirgilio book and u-world and scored in the 95th percentile. The devirgilio book was probably the best resource I have ever used in medical school. I read the book 2x during my clerkship. I read consistently everyday for about 20 minutes and sometimes more on the weekends.

i did u world questions throughout the rotation and got through them 1x. I did the questions in the back of the devirgilio book about three weeks before my exam and then again one week before and I am sooo happy I did that because I think about 20 questions on my shelf were very similar to the questions I did in the devirgilio book. if you dont use this book, you WILL be handicapped on the rotation.
Didn’t touch a book throughout the whole rotation. Just UWorld, practice NBMEs, paying attention to weekly lectures, learning on the floors, etc. Did fine.
 
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