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Surgery Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Surgery flashcards as text

  1. A 45-year-old woman presents with a 2-cm irregular, spiculated breast mass on mammography. Core needle biopsy reveals invasive ductal carcinoma, ER+/PR+/HER2−. Sentinel lymph node biopsy is negative. What is the appropriate adjuvant therapy after breast-conserving surgery plus radiation?

    Answer: Endocrine therapy (aromatase inhibitor or tamoxifen)

    Hormone receptor-positive, HER2-negative early breast cancer with node-negative disease is treated with adjuvant endocrine therapy after surgery and radiation.

  2. A 30-year-old man is stabbed in the left chest at the 5th intercostal space, midaxillary line. In the ED, BP is 80/50 mmHg, HR 130 bpm, breath sounds are equal bilaterally, and JVP is elevated. Heart sounds are muffled. What is the immediate intervention?

    Answer: Emergency pericardiocentesis or ED thoracotomy

    Beck's triad (hypotension, elevated JVP, muffled heart sounds) after penetrating chest trauma indicates cardiac tamponade requiring immediate pericardiocentesis or ED thoracotomy.

  3. A 55-year-old man is found to have a 2.5-cm carcinoid tumor of the appendix incidentally during laparoscopic appendectomy for acute appendicitis. The tumor is confined to the appendix with no lymphovascular invasion. What additional surgery is required?

    Answer: No further surgery required

    Appendiceal carcinoids ≤2 cm are cured by appendectomy alone; tumors 2–2.5 cm without adverse features typically require no further resection.

  4. A 68-year-old man undergoes elective CABG. On postoperative day 3, his urine output drops to 15 mL/hr, creatinine rises from 1.0 to 2.8 mg/dL, and he remains hemodynamically stable. What is the most likely diagnosis?

    Answer: Acute tubular necrosis

    Acute kidney injury peaking 48–72 hours after major cardiac surgery most commonly represents ischemic acute tubular necrosis from intraoperative hypoperfusion.

  5. A 38-year-old woman presents with a 6-month history of intermittent rectal bleeding and a change in bowel habits. Colonoscopy reveals a 4-cm pedunculated polyp in the descending colon. Histology shows a tubulovillous adenoma with high-grade dysplasia but clear margins. What is the next step?

    Answer: Surveillance colonoscopy in 1 year

    Complete endoscopic removal of a polyp with high-grade dysplasia and clear margins warrants repeat colonoscopy at 1 year due to elevated adenoma recurrence risk.

  6. A 52-year-old man with end-stage renal disease receives a deceased-donor kidney transplant. On postoperative day 7, serum creatinine rises from 2.1 to 4.5 mg/dL and urine output decreases. Ultrasound shows normal vascularity. Biopsy reveals lymphocytic infiltration of the tubules and interstitium. What is the treatment?

    Answer: High-dose IV corticosteroids (pulse methylprednisolone)

    Acute cellular rejection (T-cell mediated) after renal transplant is treated with pulse IV corticosteroids as first-line therapy.

  7. A 77-year-old man with a history of atrial fibrillation (on warfarin) presents with sudden onset of severe left leg pain, pallor, and absent pulses below the femoral level. INR is 2.3. What is the most likely diagnosis and initial treatment?

    Answer: Acute limb ischemia from embolism; emergent embolectomy or catheter-directed thrombolysis

    Sudden onset of the 6 P's (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia) in an anticoagulated AF patient indicates acute embolic limb ischemia requiring emergent revascularization.