Surgery nbme 2 answers

Surgery nbme 2 answers DEFAULT

the HY Medicine

1) Toxic thyroid adenoma • Focal patch of autonomously functioning thyroid tissue = “hot nodule”

2) Nerve conduction studies

• Confirmatory study for carpal tunnel syndrome (shows slowing in median nerve at wrist)

• EMG rules out other things such as polyneuropathy, plexopathy, radiculopathy, etc.

3) Loss of bicarbonate from the gastrointestinal tract • Drainage of pancreatic fluid can cause metabolic acidosis form loss of bicarbonate

4) CT scan of the abdomen and pelvis

• Acute abdominal pain in LLQ, fever, leukocytosis = acute diverticulitis

• CT is diagnostic

• Tx: NPO, IVF, Abx

5) Duodenal hematoma

• Contrast CT to confirm the diagnosis

• Hematoma may obstruct duodenal lumen → double bubble sign

• Diagnosis may be delayed as the retroperitoneal location prevents peritonitis

6) Urine output of mL/h

• Adequate end-organ perfusion is best indicated by urine output of mL/kg/h; average adult male weighs ~70kg (70 x = 35 mL/h)

• HR, mental status, and cap refill may be affected by underlying disease processes (less reliable markers)

7) Pharyngoesophageal (Zenker) diverticulum

• Presents with dysphagia, obstruction, halitosis, and aspiration (leading to multiple episodes of pneumonia)

• Common in elder males

8) Esophagogastroduodenoscopy

• Dysphagia to solids, age >50, chronic smoker/drinker = concern for esophageal cancer

• Definitive diagnosis of esophageal cancer = esophageal endoscopy with biopsy

• Subsequent CT scan can be used for staging or if endoscopy is unrevealing

9) Laparotomy • perforated bowel → free air under diaphragm → laparotomy

10) Cholecystoduodenal fistula with an impacted gallstone

• Multiple dilated loops of small bowel = obstruction

• Gas within small bowel lumen and liver suggests communication (fistula) between enteric and biliary tracts

• Stone leaves through fistula to cause sxs

11) Distal pancreatectomy • Large (>4 cm) cystadenomas should be resected

12) Venous valvular insufficiency

• Ulcer on medial malleolus

• Post-thrombotic syndrome = development of chronic venous insufficiency following DVT

13) Repeat typing and crossmatching of the transfused blood • Crossmatching error - the patient is having an acute hemolytic reaction, most likely due to ABO incompatibility

14) Hypertension • Post-op HTN associated with cerebral hyperperfusion syndrome - manipulation of the carotid artery/sinuses lead to baroreceptor dysfunction

15) Massive hemothorax • Hypotension + flat neck veins + absent breath sounds after knife wound = hemothorax

16) Crohn disease • “string sign” on barium x-ray = thin luminal contrast, usually in terminal ileum from spasm and eventual fibrosis

17) Colonoscopy

• Age >50 with lower GI bleed → colonoscopy

• In all anorectal problems, cancer has to be ruled out first; once diagnosis has been confirmed, internal hemorrhoids are tx with rubber-band ligation, whereas external hemorrhoids require surgery

18) Surgical excision of the cyst • Choledochal cyst (cystic dilation of biliary tree) • U/S is best non-invasive test; ERCP for definitive diagnosis • Tx: surgical excision to relieve obstruction and biliary-enteric anastomosis

• Excision helps prevent malignant transformation (cholangiocarcinoma)

19) Hypovolemia

• Patient was down, laying on the floor for 48 hours (likely volume depleted)

• She hasn’t moved → muscle breakdown and rhabdo → lactic acidosis → compensatory hyperventilation

20) Intubation and hyperventilation • GCS <8 → Intubate • Hyperventilation → ↓ CO2 → vasoconstriction and ↓ ICP (CO2 is a potent vasodilator in the brain)

21) Herpes simplex conjunctivitis • Acute onset pain, conjunctival injection, vesicular lesions, visual blurring, discharge = HSV keratitis

22) Central retinal artery occlusion • Acute painless monocular vision loss with pallor of optic disc = CRAO

• Retinal vein occlusion → retinal hemorrhage and venous engorgement

23) Thyroidectomy • Follicular neoplasm with prior history of head/neck radiation - definitive treatment is total thyroidectomy

24) Bupivacaine • Amides (“i” before “caine" such as bup”i”vacaine) are intermediate/long acting • Esters (no ‘i’ before “caine” such as procaine and chloroprocaine) are short acting (tetracaine is a long-acting exception)

25) Surgical debridement

• Fournier’s gangrene = extensive tissue necrosis/infection of perineum in diabetics

• Tx: urgent surgical debridement

26) Tracheostomy • Recurrence of tumor → obstruction → difficult to maintain an endotracheal airway

• Tracheostomy would be below the lesion → maintain airway

27) Radionuclide scan with thallium and dipyridamole • Pharmacologic stress test (dipyridamole thallium scanning - DTS); dilates coronary arteries without increasing HR or BP

28) Cyclo-oxygenase inhibition with increased norepinephrine release

• Indomethacin is an NSAID that inhibits PGE2 synthesis via COX inhibition

• Increased arterial tension is the natural way that the PDA closes

29) Ruptured diaphragm • Traumatic disruption of hemidiaphragm → gas occupying the lower third of the left hemithorax

30) Ceftriaxone and vancomycin therapy • No spleen → susceptible to encapsulated organisms

31) Collapse of the right middle lobe of the lung from decreased inspiratory effort

• Hasn’t been out of bed yet, POD#1, egophany (consolidated or collapsed) → atelectasis

32) Intraductal papilloma • Most common cause of nipple discharge (serous or bloody)

• Mammillary duct ectasia = mass + green/brown discharge

33) Reintubation and mechanical ventilation • Elevated PCO2 = hypoventilation • Oxygenation is adequate (do not need to increase FiO2)

34) Choledocholithiasis

• Cholangiography/imaging was not performed, suggesting a retained stone in bile duct

• Normal AST/ALT rule out cirrhosis

• No weight loss/painless jaundice rule out pancreatic cancer

35) Rupture of the thoracic aorta

• “hidden injury” - asymptomatic until hematoma contained by the adventitia expands

• 1st rib break, presence of wide mediastinum, severe deceleration injury should all raise suspicion

36) Secondary hyperparathyroidism • Hypocalcemia → ↑ PTH secretion → ↑ ALP

• CKD → ↑ creatinine and ↑ phosphate

37) Cholecystitis • Risk factors: female, fat (BMI >30), fertile, forty

38) Mitral valve prolapse

• Mid-systolic click = MVP

• MVP syndrome is associated with nonspecific sxs (palpitations, dyspnea, dizziness, panic/anxiety attacks, numbness/tingling, etc.)

39) Torn meniscus

• Medial joint line tenderness with effusion = Meniscal; pain when getting up from a

low position is a classic presentation

• Medial joint line tenderness without effusion = MCL

40) Increased serum tumor necrosis factor concentration • Cachectic (weight loss, muscle atrophy, fatigue) is mediated by cytokines TNF, IFN-Ɣ,

IL-1, and IL Appetite is usually suppressed (via hypothalamus) and BMR is increased → ↑ lipolysis, hypotriglyceridemia.

41) Basal cell carcinoma • Upper lip, pearly surface, telangiectasia = basal cell carcinoma

• Lower lip = squamous cell carcinoma

42) Prednisone therapy and temporal artery biopsy immediately • Requires immediate prednisone therapy to prevent blindness and bx to confirm dx

43) Apocrine glands • Hidradenitis Suppurativa = inflammation of apocrine sweat glands

44) Observation • Primary spontaneous pneumothorax

45) Exploratory celiotomy • Atherosclerosis, lactic acidosis and leukocytosis = acute mesenteric ischemia

• Celiotomy (laparotomy) is needed to resect dead bowel

46) Retrograde urethrography

High-riding prostate + blood at urethral meatus = urethral injury

• Suspected urethral injury should be evaluated with retrograde urethrogram

• IV pyelogram is useful for suspected ureter injuries; Cystoscopy is useful for

suspected bladder injuries (should rule out urethral injury first, as cystoscope must go through urethra and could exacerbate existing injuries)

47) Cancel the operation • Respect the patients decision and determine rationale for refusal

48) Varicocele • “ropy mass” = “bag of worms” • Stasis of venous blood → ↑ temp → damage to sperm

49) Exploratory operation • Torsion of ovarian cyst • Tx: surgical uncoiling and possible oophoropexy to fixate ovary (prevent recurrence)

• Drainage is contraindicated as it increases risk of spread/seeding

50) Insulinoma

• Whipple triad: low blood glucose, sxs of hypoglycemia, resolution of sxs with normalization of blood glucose

• Tx: surgical resection

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    Assuming that you are talking about MISC.  Note that there are other s.check this post - Form MISC Rules & RegulationsQuick answer - A Form MISC must be filed for each person to whom payment is made of:$ or more for services performed for a trade or business by people not treated as employees;Rent or prizes and awards that are not for service ($ or more) and royalties ($10 or more);any fishing boat proceeds,gross proceeds of $, or more paid to an attorney during the year, orWithheld any federal income tax under the backup withholding rules regardless of the amount of the payment, etc.
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  • Do military members have to pay any fee for leave or fiancee forms?

    NOOOOOOO. You are talking to a military romance scammer. I received an email from the US Army that directly answers your question that is pasted below please keep reading.I believe you are the victim of a military Romance Scam whereas the person you are talking to is a foreign national posing as an American Soldier claiming to be stationed overseas on a peacekeeping mission. That's the key to the scam they always claim to be on a peacekeeping mission.Part of their scam is saying that they have no access to their money that their mission is highly dangerous.If your boyfriend girlfriend/future husband/wife is asking you to do the following or has exhibited this behavior, it is a most likely a scam:Moves to private messaging site immediately after meeting you on Facebook or SnapChat or Instagram or some dating or social media site. Often times they delete the site you met them on right after they asked you to move to a more private messaging siteProfesses love to you very quickly & seems to quote poems and song lyrics along with using their own sort of broken language, as they profess their love and devotion quickly. They also showed concern for your health and love for your family.Promises marriage as soon as he/she gets to state for leave that they asked you to pay for.They Requests money (wire transfers) and Amazon, iTune ,Verizon, etc gift cards, for medicine, religious practices, and leaves to come home, internet access, complete job assignments, help sick friend, get him out of trouble, or anything that sounds fishy.The military does provide all the soldier needs including food medical Care and transportation for leave. Trust me, I lived it, you are probably being scammed. I am just trying to show you examples that you are most likely being connned.Below is an email response I received after I sent an inquiry to the US government when I discovered I was scammed. I received this wonderful response back with lots of useful links on how to find and report your scammer. And how to learn more about Romance Scams.Right now you can also copy the picture he gave you and do a google image search and you will hopefully see the pictures of the real person he is impersonating. this doesn't always work and take some digging. if you find the real person you can direct message them and alert them that their image is being used for scamming.Good Luck to you and I'm sorry this may be happening to you. please continue reading the government response I received below it's very informative.   You have contacted an email that is monitored by the U.S. Army Criminal Investigation Command. Unfortunately, this is a common concern. We assure you there is never any reason to send money to anyone claiming to be a Soldier online. If you have only spoken with this person online, it is likely they are not a U.S. Soldier at all. If this is a suspected imposter social media profile, we urge you to report it to that platform as soon as possible. Please continue reading for more resources and answers to other frequently asked questions:  How to report an imposter Facebook profile: Caution- < Caution- >   Answers to frequently asked questions:  - Soldiers and their loved ones are not charged money so that the Soldier can go on leave.  - Soldiers are not charged money for secure communications or leave.  - Soldiers do not need permission to get married.  - Soldiers emails are in this format: [email protected] < Caution-mailto: [email protected] > anything ending in .us or .com is not an official email account.  - Soldiers have medical insurance, which pays for their medical costs when treated at civilian health care facilities worldwide – family and friends do not need to pay their medical expenses.  - Military aircraft are not used to transport Privately Owned Vehicles.  - Army financial offices are not used to help Soldiers buy or sell items of any kind.  - Soldiers deployed to Combat Zones do not need to solicit money from the public to feed or house themselves or their troops.  - Deployed Soldiers do not find large unclaimed sums of money and need your help to get that money out of the country.  Anyone who tells you one of the above-listed conditions/circumstances is true is likely posing as a Soldier and trying to steal money from you.  We would urge you to immediately cease all contact with this individual.  For more information on avoiding online scams and to report this crime, please see the following sites and articles:   This article may help clarify some of the tricks social media scammers try to use to take advantage of people: Caution-< Caution->   CID advises vigilance against 'romance scams,' scammers impersonating Soldiers  Caution- < Caution- >   FBI Internet Crime Complaint Center: Caution-< Caution->   U.S. Army investigators warn public against romance scams: Caution-< Caution->   DOD warns troops, families to be cybercrime smart -Caution-< Caution->   Use caution with social networking  Caution-< Caution->    Please see our frequently asked questions section under scams and legal issues. Caution- < Caution- > or visit Caution- < Caution- >.  The challenge with most scams is determining if an individual is a legitimate member of the US Army. Based on the Privacy Act of , we cannot provide this information. If concerned about a scam you may contact the Better Business Bureau (if it involves a solicitation for money), or local law enforcement. If you're involved in a Facebook or dating site scam, you are free to contact us direct; ()   If you have a social security number, you can find information about Soldiers online at Caution- < Caution- > . While this is a free search, it does not help you locate a retiree, but it can tell you if the Soldier is active duty or not.  If more information is needed such as current duty station or location, you can contact the Commander Soldier's Records Data Center (SRDC) by phone or mail and they will help you locate individuals on active duty only, not retirees. There is a fee of $ for businesses to use this service. The check or money order must be made out to the U.S. Treasury. It is not refundable. The address is:  Commander Soldier's Records Data Center (SRDC)  East 56th Street Indianapolis, IN  Phone:   In addition, it is not possible to remove social networking site profiles without legitimate proof of identity theft or a scam. If you suspect fraud on this site, take a screenshot of any advances for money or impersonations and report the account on the social networking platform immediately.  Please submit all information you have on this incident to < Caution- > (FBI website, Internet Criminal Complaint Center), immediately stop contact with the scammer (you are potentially providing them more information which can be used to scam you), and learn how to protect yourself against these scams at Caution- < Caution- > (Federal Trade Commission's website)
  • How do we know the eligibility to fill out Form 12 BB?

    Every year as a salaried employee many of you must have fill Form 12BB, but did you ever bothered to know its purpose. Don’t know ??It is indispensable for both, you and your employer. With the help of Form 12BB, you will be able to figure out how much income tax is to be deducted from your monthly pay. Further, with the help of Form 12BB, you will be in relief at the time of filing returns as at that time you will not have to pay anything due to correct TDS deduction.So, before filing such important form keep the below listed things in your mind so that you may live a tax hassle free life.For More Information:- 7 key points which must be known before filling Form 12BB

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Weekly Exam Instructions

Weekly exams are given using the software "Blackboard" via the Internet. The exams are password protected and the passwords will be active for the entire surgical clerkship rotation. These exams are provided to you as a study/learning tool for the NBME Surgery Shelf Exam and it's your responsibility to take one exam each week. These exams will count for 10% of your final grade.

Note: Your browser should be upgraded to the most current version before you attempt to take these exams. Free upgrades are available on the Internet.

Important: If your connection is interrupted at any time during your exam before you submit your answers, all answers will be lost—as a precaution, you may want to write your answers on a piece of paper as you take the exam in case your connection is interrupted, then you'll at least have your answers to reenter.

1. Log on to Blackboard.

2. Enter your user name (first initial and last name).

3. Enter your password (this was given to you as a second-year student when you were given access to Blackboard). If you do not remember your password, contact the Department of Surgery office on your campus to receive a new one.

4. This will take you to the first page of the program—under "My Courses" click on the appropriate course (Third-Year Surgical Clerkship or ROME/MILE Third Year Surgery)—this will take you to the Announcement Page.

5. Once you are logged on to the exam you must complete the exam as you are only allowed to enter each exam one time.

6. Click on the exam you are going to take.

7. Enter the Password you were provided for the selected exam, then click Submit—you will be allowed to save your progress and resume the exam at a later date.

When you are finished taking the exam, at the end you will submit your answers. All multiple-choice questions will be graded immediately, and your grade will reflect only the multiple-choice questions. The essay will be graded manually by an instructor; then your grade is revised according to the points you received for your essay.

When the computer shows you your grade, it will also show you the question as well as the answer you selected and tell you if the answer you selected was right or wrong. It will not tell you what the correct answer is. You may print your exam results at this time to use as a study tool for the NBME Shelf Exam in Surgery. If you do not choose to print your exam at this time, it can be done at a later date under Student Tools.

At any time, you can go under Tools and view your grades and exams. If your recorded grade is an exclamation mark instead of a letter grade, this means that your essay question has not yet been graded. As soon as the instructor has graded your essay question, your grade will be revised and the final grade will be listed. If you wish to print your exam for review purposes, click on your grade for the exam you want to review, and it will appear on your screen. Click Print on the top control bar.

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  • NBME Self-Assessments for USMLEs have ~ questions each. The Shelf-specific assessments have only 50 questions. Even the Shelf exams themselves are shorter than the USMLEs. Each Shelf exam is questions, whereas Step 1, which has the fewest questions, has items.

  • Currently, the available NBME CBSSA forms are Form 13, 15, 16, 17, 18 and 19 and are considered the best and most accurate way to assess one&#;s predicted performance on the USMLE Step 1.

  • In general, students should not take more than one practice assessment per week. While all students should take at least 3 or more NBME practice exams, ideally these will be appropriately spaced throughout the dedicated study period so as not to use up the 6 NBMEs too quickly.

  • Each Self Assessment exam is a question timed test, with questions designed for skill levels. After completing an exam, you may review comprehensive rationales for each question and see a detailed analysis of your performance.

  • Your First NBME Should Be Before Your First Pass Through First Aid/UWorld.

  • Suggested clip How to take an NBME Self-Assessment - YouTubeYouTubeStart of suggested clipEnd of suggested clip How to take an NBME Self-Assessment - YouTube

  • Below are the names for each NBME and what USMLEs they correlate with: Comprehensive Basic Science Self-Assessment (Step 1): questions/self-assessment. Each block is 1 hour 15 mins.

  • GEMS by NBME 4+ GEMS provides access to on-line item authoring, item banking, test publishing, and a test delivery platform to individual institutions. The iPad app allows examinees to access exams via iPad devices. Available on iPad ios and above.

  • Suggested clip How to take an NBME Self-Assessment - YouTubeYouTubeStart of suggested clipEnd of suggested clip How to take an NBME Self-Assessment - YouTube

  • Suggested clip How to take an NBME Self-Assessment - YouTubeYouTubeStart of suggested clipEnd of suggested clip How to take an NBME Self-Assessment - YouTube

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Answers 2 surgery nbme

Suddenly the thought burned through her that he would now also see her naked. She could have asked him to stay, but then who will protect her if they try to throw her this stupid kit or something else. The inevitability of new humiliation filled her eyes with tears again.

General Surgery Review Questions (Part 2) - CRASH! Medical Review Series

Sasha, - said Irina Vitalievna, holding in hands holding slippers. - What happened here. Have you decided to surprise me.

Now discussing:

Lisa saw her former lover with her family at one of the theater premieres: next to him in the box was already a second-grader Tanya, still plump, and a slender. Blonde over 30 with a confident face. They went backstage, talked with Eugene, Liza saw them from afar. Tanya waved her hand, but did not come up, Liza also waved to her.

One afternoon, next to Liza, who was walking with a stroller, an unknown car stopped: the front door swung open, and Alexander smiled at her from.

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