Surgery Practice NBME 4 |exam review
1. Step of diagnosis for an esophageal hiatal hernia?: Esophagogastroduo- denoscopy (EGD)
2. Esophagogastroduodenoscopy (EGD)?: endoscopic evaluation of the esoph- agus, stomach,
and duodenum. It is indicated for the evaluation of various gastroin- testinal pathology,
including mucosal neoplasms, peptic ulcers, and esophagitis ( esophagitis, Barrett esophagus,
or esophageal adenocarcinoma.
Can be combined with techniques such as endoscopic ultrasound and endoscopic retrograde
cholangiopancreatography for definitive evaluation of visceral organs and the biliary tree.
3. Thoracoscopy?: visualization and examination of the lung surface and pleural space through
a thoracoscope.
4. Paraesophageal Hernia?: o herniation of the proximal stomach through the esophageal hiatus,
without superior translation of the gastroesophageal junction. This can result in obstructive
symptoms and has a less pronounced impact on reflux
5. A sliding hiatal hernia?: a refers to displacement of the gastroesophageal junction superiorly
('sliding'). This increases the risk for worsening heartburn given the non-anatomic location of
the gastroesophageal junction, which results in altered mechanics to block gastric acid from
entering the esophagus.
6. 24-hour pH monitoring?: patients who demonstrate negative endoscopy find- ings and are
being considered for an antireflux endoscopic or surgical procedure, or who demonstrate typical
reflux symptoms without relief from empiric proton pump inhibitor therapy.
7. Endoscopic ultrasonography?: evaluation of suspicious pancreatic masses or submucosal
gastrointestinal masses, allowing for identification and tissue sampling.
8. Esophageal manometry?: measures the pressure generated along the length of the
esophagus and lower esophageal sphincter.
evaluation of suspected esophageal dysmotility disorders such as achalasia and diffuse
esophageal spasm
9. Adhesions?: most common cause of small bowel obstruction (SBO) in patients with a prior
history of intra-abdominal surgery
10.Small bowel obstruction?: occurs from partial or complete blockage of the small bowel
lumen and typically presents with nausea, vomiting, and abdominal pain. Partial SBO allows a
degree of continued flatus with diminished stooling, and complete SBO will result in obstipation
(no passage of stool or flatus).
abdominal tenderness, distention, tympany to percussion, and borborygmi (high-
pitched, hyperactive bowel sounds).
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, Surgery Practice NBME 4 |exam review
11.Potential complications of SBO?: bowel rupture and/or necrosis, which can result in
suddenonset peritonitic abdominal signs such as rebound tenderness and guarding.
12.Abdominal x-rays of SBO?: multiple air-fluid levels in the setting of dilated small bowel
loops.
13.Management of SBO?: bowel rest and intravenous hydration followed by sur- gical
intervention if the obstruction does not autoreduce.
Partial SBO may resolve with monitoring, supportive care, and bowel rest, whereas complete
obstruction or any complicated partial obstruction generally requires man- agement through
exploratory laparotomy.
14.Diabetic gastroparesis?: presents with slowly progressive early satiety, nau- sea, vomiting of
undigested food, and abdominal bloating with a succussion splash heard during physical
examination.
15.Inguinal hernias?: protrusions of abdominal contents into the inguinal region through a
defect in the lower abdominal wall
Incarceration and strangulation are potential complications of inguinal hernias and may require
surgical correction.
Hernias are the second most common cause of SBO in patients with a prior history of intra-
abdominal surgery.
16.Acute mesenteric ischemia?: typically occurs from a critical decrease in in- testinal blood
flow, most commonly from thromboembolic occlusion of a mesenteric vessel (e.g., superior
mesenteric artery) or a severe hypoperfusion state (e.g., hemorrhagic shock)
results in ischemia and potential necrosis of the bowel, which presents with abdom- inal pain
out of proportion to the physical examination findings.
17.Sigmoid volvulus?: twisting of the sigmoid mesentery, which can lead to large bowel
obstruction and potential rupture or necrosis if not treated. It typically demon- strates a coffee-
bean appearance on abdominal x-rays
18.Breast cancer?: presents as a palpable, immobile breast mass that may demonstrate
features such as spiculated margins and microcalcifications on mam- mography. They can be
associated with pathologic nipple discharge, although intra- ductal papillomas more commonly
present with unilateral bloody nipple discharge.
19.Galactocele?: painless breast lump typically following cessation of lactation. They do not
present with pathologic nipple discharge, and they often resolve spon- taneously
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
, Surgery Practice NBME 4 |exam review
20.Inflammatory carcinoma of the breast?: breast carcinoma invading the der- mal lymphatics,
resulting in diffuse cutaneous thickening and peau d'orange appear- ance. It is less likely to
present with unilateral bloody nipple discharge.
21.Sebaceous cyst?: epidermal inclusion cyst, describes a cutaneous lesion that contains
proliferating squamous epithelium and sebum, typically presenting as a firm, rubbery,
nontender skin lump
22.What to do when a breast biopsy comes back ER positive?: Reexcision of the biopsy site is
the next most appropriate step in the setting of biopsy-proven invasive estrogen receptor-
positive carcinoma.
In addition to further excision of the site of cancer, the patient will likely require radiation
therapy and adjuvant chemotherapy depending on the stage of disease.
23.Topical podophyllin therapy?: antimitotic, cytotoxic medication that can be used for the
treatment of genital warts once a clear diagnosis is made.
24.When to excise HPV growth in HIV pt?: considered for the definitive removal of this perinea!
mass but should be considered once the diagnosis is confirmed.
25.What to do first in HPV lesion in pt with HIV?: Biopsy is indicated when a suspicious mass
exists without clear clinical explanation. Masses arising from the rectum and perineum in the
setting of a known history of HIV and perianal warts may represent giant condyloma
acuminatum (genital warts) or verrucous carcinoma (variant of well-differentiated squamous
carcinoma).
26.Syphilis?: demonstrates multiple stages with varying symptoms, including pri- mary with a
painless chancre; secondary with fever, lymphadenopathy, and condy- lomata lata; and tertiary
with tabes dorsalis, aortitis, and gummas. The painless chancre of primary syphilis can present
as a painless ulcerative genital lesion, although VDRL is generally positive in primary syphilis.
27.penile cancer?: s squamous cell carcinoma. rare, a lack of circumcision and infection with
HPV are risk factors
28.Precursor lesions to squamous cell carcinoma of the penis?: Bowen dis- ease, which presents
as leukoplakia of the penile shaft, or erythroplasia of Queyrat, which presents as erythroplakia
of the glans. The most common location of penile cancer is the glans penis.
29.Squamous cell cancer of the penis?: range in presentation from a small area of induration to
a large ulcerating, infiltrative lesion
30.Hydrocortisone enemas?: treatment of ulcerative colitis and proctitis to assist in reduction of
inflammation and relief of symptoms of inflammatory bowel disease.
31.Anal manometry?: evaluation of patients with chronic constipation or fecal incontinence
through measuring anal sphincter pressure
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
1. Step of diagnosis for an esophageal hiatal hernia?: Esophagogastroduo- denoscopy (EGD)
2. Esophagogastroduodenoscopy (EGD)?: endoscopic evaluation of the esoph- agus, stomach,
and duodenum. It is indicated for the evaluation of various gastroin- testinal pathology,
including mucosal neoplasms, peptic ulcers, and esophagitis ( esophagitis, Barrett esophagus,
or esophageal adenocarcinoma.
Can be combined with techniques such as endoscopic ultrasound and endoscopic retrograde
cholangiopancreatography for definitive evaluation of visceral organs and the biliary tree.
3. Thoracoscopy?: visualization and examination of the lung surface and pleural space through
a thoracoscope.
4. Paraesophageal Hernia?: o herniation of the proximal stomach through the esophageal hiatus,
without superior translation of the gastroesophageal junction. This can result in obstructive
symptoms and has a less pronounced impact on reflux
5. A sliding hiatal hernia?: a refers to displacement of the gastroesophageal junction superiorly
('sliding'). This increases the risk for worsening heartburn given the non-anatomic location of
the gastroesophageal junction, which results in altered mechanics to block gastric acid from
entering the esophagus.
6. 24-hour pH monitoring?: patients who demonstrate negative endoscopy find- ings and are
being considered for an antireflux endoscopic or surgical procedure, or who demonstrate typical
reflux symptoms without relief from empiric proton pump inhibitor therapy.
7. Endoscopic ultrasonography?: evaluation of suspicious pancreatic masses or submucosal
gastrointestinal masses, allowing for identification and tissue sampling.
8. Esophageal manometry?: measures the pressure generated along the length of the
esophagus and lower esophageal sphincter.
evaluation of suspected esophageal dysmotility disorders such as achalasia and diffuse
esophageal spasm
9. Adhesions?: most common cause of small bowel obstruction (SBO) in patients with a prior
history of intra-abdominal surgery
10.Small bowel obstruction?: occurs from partial or complete blockage of the small bowel
lumen and typically presents with nausea, vomiting, and abdominal pain. Partial SBO allows a
degree of continued flatus with diminished stooling, and complete SBO will result in obstipation
(no passage of stool or flatus).
abdominal tenderness, distention, tympany to percussion, and borborygmi (high-
pitched, hyperactive bowel sounds).
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
, Surgery Practice NBME 4 |exam review
11.Potential complications of SBO?: bowel rupture and/or necrosis, which can result in
suddenonset peritonitic abdominal signs such as rebound tenderness and guarding.
12.Abdominal x-rays of SBO?: multiple air-fluid levels in the setting of dilated small bowel
loops.
13.Management of SBO?: bowel rest and intravenous hydration followed by sur- gical
intervention if the obstruction does not autoreduce.
Partial SBO may resolve with monitoring, supportive care, and bowel rest, whereas complete
obstruction or any complicated partial obstruction generally requires man- agement through
exploratory laparotomy.
14.Diabetic gastroparesis?: presents with slowly progressive early satiety, nau- sea, vomiting of
undigested food, and abdominal bloating with a succussion splash heard during physical
examination.
15.Inguinal hernias?: protrusions of abdominal contents into the inguinal region through a
defect in the lower abdominal wall
Incarceration and strangulation are potential complications of inguinal hernias and may require
surgical correction.
Hernias are the second most common cause of SBO in patients with a prior history of intra-
abdominal surgery.
16.Acute mesenteric ischemia?: typically occurs from a critical decrease in in- testinal blood
flow, most commonly from thromboembolic occlusion of a mesenteric vessel (e.g., superior
mesenteric artery) or a severe hypoperfusion state (e.g., hemorrhagic shock)
results in ischemia and potential necrosis of the bowel, which presents with abdom- inal pain
out of proportion to the physical examination findings.
17.Sigmoid volvulus?: twisting of the sigmoid mesentery, which can lead to large bowel
obstruction and potential rupture or necrosis if not treated. It typically demon- strates a coffee-
bean appearance on abdominal x-rays
18.Breast cancer?: presents as a palpable, immobile breast mass that may demonstrate
features such as spiculated margins and microcalcifications on mam- mography. They can be
associated with pathologic nipple discharge, although intra- ductal papillomas more commonly
present with unilateral bloody nipple discharge.
19.Galactocele?: painless breast lump typically following cessation of lactation. They do not
present with pathologic nipple discharge, and they often resolve spon- taneously
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
, Surgery Practice NBME 4 |exam review
20.Inflammatory carcinoma of the breast?: breast carcinoma invading the der- mal lymphatics,
resulting in diffuse cutaneous thickening and peau d'orange appear- ance. It is less likely to
present with unilateral bloody nipple discharge.
21.Sebaceous cyst?: epidermal inclusion cyst, describes a cutaneous lesion that contains
proliferating squamous epithelium and sebum, typically presenting as a firm, rubbery,
nontender skin lump
22.What to do when a breast biopsy comes back ER positive?: Reexcision of the biopsy site is
the next most appropriate step in the setting of biopsy-proven invasive estrogen receptor-
positive carcinoma.
In addition to further excision of the site of cancer, the patient will likely require radiation
therapy and adjuvant chemotherapy depending on the stage of disease.
23.Topical podophyllin therapy?: antimitotic, cytotoxic medication that can be used for the
treatment of genital warts once a clear diagnosis is made.
24.When to excise HPV growth in HIV pt?: considered for the definitive removal of this perinea!
mass but should be considered once the diagnosis is confirmed.
25.What to do first in HPV lesion in pt with HIV?: Biopsy is indicated when a suspicious mass
exists without clear clinical explanation. Masses arising from the rectum and perineum in the
setting of a known history of HIV and perianal warts may represent giant condyloma
acuminatum (genital warts) or verrucous carcinoma (variant of well-differentiated squamous
carcinoma).
26.Syphilis?: demonstrates multiple stages with varying symptoms, including pri- mary with a
painless chancre; secondary with fever, lymphadenopathy, and condy- lomata lata; and tertiary
with tabes dorsalis, aortitis, and gummas. The painless chancre of primary syphilis can present
as a painless ulcerative genital lesion, although VDRL is generally positive in primary syphilis.
27.penile cancer?: s squamous cell carcinoma. rare, a lack of circumcision and infection with
HPV are risk factors
28.Precursor lesions to squamous cell carcinoma of the penis?: Bowen dis- ease, which presents
as leukoplakia of the penile shaft, or erythroplasia of Queyrat, which presents as erythroplakia
of the glans. The most common location of penile cancer is the glans penis.
29.Squamous cell cancer of the penis?: range in presentation from a small area of induration to
a large ulcerating, infiltrative lesion
30.Hydrocortisone enemas?: treatment of ulcerative colitis and proctitis to assist in reduction of
inflammation and relief of symptoms of inflammatory bowel disease.
31.Anal manometry?: evaluation of patients with chronic constipation or fecal incontinence
through measuring anal sphincter pressure
For assistance with assignments (Discussions, research paper , literature review , essays ..) or any revision material contact
