NBME Review #1

Re-read weak chapters

• Plan a day where you focus on one chapter

Key words of fibrocystic change in breast: clear yellow fluid, disappearance on aspiration, tense and smooth

• Key words of fibroadenoma: firm, movable, well-defined edges, often painless, rubbery consistency.

Key words of breast cancer: irregular shape, hard mass, may or may not be painful, fixation to underlying tissue, potential lymphadenopathy.

Neostigmine will worsen bradycardia and should be used cautiously in patients with underlying cardiac conditions.

If 3 liters of LR is given, especially in elderly patients, that will run the risk of fluid overload, leading to complications such as pulmonary edema or heart failure.

If there is gastric distension, it will also have abdominal pain, bradycardia and hypotension due to vagal stimulation from the distended stomach, which can further exacerbate cardiovascular issues.

• In this case, nasogastric tube should be inserted because it can help decompress the stomach, relieving distension and subsequently alleviating vagal stimulation effects, which may improve the patient's cardiovascular stability.

The time to do a Whipple procedure is when there is a diagnosis of pancreatic adenocarcinoma or other resectable tumors of the head of the pancreas, along with the absence of significant local vascular invasion or distant metastasis.

• Can also be done with duodenal carcinoma and cholangiocarcinoma

The triangle of Calot is where the gallbladder is right under the liver

• This anatomic landmark is vital for surgeries involving the gallbladder, as it helps to identify the cystic artery and duct for safe dissection.

Key words of PSC: “beads on a string”, history of UC, and association with cholangiocarcinoma, which is important to consider during diagnosis and management.

Key words of cholangiohepatitis: history of hepatitis virus, and potential for progression to cirrhosis, along with typical symptoms including jaundice and abdominal pain.

Trying to dig out a bullet from a gunshot wound is only recommended when it can be done safely and without further injury to the patient, often necessitating advanced imaging techniques and careful surgical planning. Generally it is not recommended

• Cases where a bullet needs to be removed are when it poses a risk of penetrating vital structures, or when the bullet is lodged within the abdomen and causes significant discomfort or obstruction.

In cases of any kinds of cancer/tumors

• Identify the kind of cancer

• Get the correct biopsy for that cancer

  • Core needle biopsy is often preferred due to its ability to obtain a larger tissue sample compared to fine needle aspiration, allowing for more accurate diagnosis and characterization of the tumor.

  • Stereotactic biopsy is another valuable technique, particularly for tumors located in challenging areas, as it uses imaging guidance to precisely target the lesion.

• Find the stage of the cancer through imaging studies such as CT scans, MRIs, or PET scans to determine the extent of disease spread and inform treatment options.

• An open-book pelvic fracture occurs when the pelvic ring is disrupted, usually involving a break in the pubis and/or ischium, often resulting from high-energy trauma and may require surgical intervention depending on severity.

  • Pelvic binder will close the fracture and help stabilize the pelvic ring, reducing the risk of further injury and hemorrhage during initial management.

  • When the patient is hemodynamically stable, the procedure will be external fixation of the fracture