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Passing the General Surgery Oral Board Exam FM.Qxd 10/28/05 02:30 AM Page I FM.qxd 10/28/05 02:30 AM Page i Passing the General Surgery Oral Board Exam FM.qxd 10/28/05 02:30 AM Page i Passing the General Surgery Oral Board Exam Marc Neff, M.D. Associates in General Surgery, P.A. Cherry Hill, New Jersey FM.qxd 10/28/05 02:30 AM Page iv Marc Neff, M.D. 2201 Chapel Ave. West Cherry Hill, New Jersey 08002 [email protected] Library of Congress Control Number: 2005926770 ISBN-10: 0-387-26077-3 ISBN-13: 978-0387-26077-8 Printed on acid-free paper. ©2006 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written per- mission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dis- similar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed in the United States of America. (SPI/BIN) 987654321 springeronline.com FM.qxd 10/28/05 02:30 AM Page v For Lauren, Jamie, and Andrew who have taught me: “Don’t give up, just go on.” FM.qxd 10/28/05 02:30 AM Page vii Acknowledgements This book would not have been possible without the Thanks to the attendings, students, residents, and remarkable support of countless individuals. I know I will patients that I’ve had the pleasure of knowing during my leave some out, and I hope those I do will accept my medical career. They have provided me on a daily basis apologies. with the constant intellectual stimulation to challenge The first “thanks” goes to my immediate family. They what I know and do. They make my job the best job in the have provided the support that helps me get up again world. They also remind me to never be satisfied in my each and every morning and remind me that there is life level of knowledge and inspire me to read through the outside medicine. Of all, my deceased father and brother piles of journals in my office and at home. deserve the most thanks. It was they who gave me the Finally, thanks to the many healthcare professionals that inspiration to pursue a career in medicine and continue have guided my day-to-day experiences in medicine. to inspire my pursuit of excellence. They both were well Without the secretaries, nurses, nurse managers, operators, respected surgeons in their field and died long before coders, billers, administrators, phlebotomists, respiratory their time. therapists, dictationists, librarians, and other unsung heroes, Thanks to my friends. I have been fortunate to have so the great machinery of the hospital would grind to a halt many friends in my life, each of whom has enriched my and we doctors would not be able to function. I remember experiences in innumerable ways. From elementary school learning volumes from several experienced nurses who through residency, I have truly been blessed with friends I helped to keep me out of trouble during my residency years. could trust and depend on. They have contributed greatly I would not be where I am today if we were not all on to the richness of my life. Sadly, as our paths diverged, the same team. Even if it means sometimes fighting a losing some friends were left behind and I miss them all. battle, together we are all trying to make sick patients well. vii FM.qxd 10/28/05 02:30 AM Page ix Contents Introduction xi Esophagus Organizational Theme xiii Zenker’s Diverticulum 56 Achalasia 58 Malignancy, General 1 Esophageal Cancer 60 Esophageal Perforation 62 Breast Esophageal Varices 64 Nipple Discharge 3 GERD 66 DCIS (Ductal Carcinoma In Situ) 5 Hiatal Hernia 68 Inflammatory Breast Cancer 7 Invasive Ductal Carcinoma 9 Genitourinary Paget’s disease 11 Renal Mass 70 Scrotal Mass 71 Colon and Small Bowel Acute Bowel Ischemia 12 Hepatobiliary Colon Cancer 14 Gallstone Ileus 72 Enterocutaneous Fistula 17 Liver Abscess 74 Hemorrhoids 19 Liver Mass 76 Incarcerated Hernia 21 Post-cholecystectomy Cholangitis 78 Intestinal Angina 23 Post-cholecystectomy Jaundice 80 Large Bowel Obstruction 25 Lower GI Bleeding (LGIB) 27 Pancreas Perirectal Abscess 29 Acute Pancreatitis 82 Rectal Cancer 31 Chronic Pancreatitis 84 RLQ Pain 33 Pancreatic Cancer 86 Ulcerative Colitis 35 Pancreatic Pseudocyst 88 Endocrine Pediatric Surgery Carcinoid 37 Neonatal Bowel Obstruction 90 Cushing’s Syndrome 39 Pyloric Stenosis 92 Hyperthyroidism 41 Tracheoesophageal Fistula 94 Insulinoma 43 Pheochromocytoma 45 Perioperative Care Primary Aldosteronism 47 Hypotension in the Recovery Room 96 Neck Mass 49 Postoperative Fever 98 Hyperparathyroidism 52 Recent MI 100 Thyroid Nodule 54 Renal Failure 101 ix FM.qxd 10/28/05 02:30 AM Page x x Contents Skin and Soft Tissue Extremity Compartment Syndrome 128 Melanoma 103 Duodenal Trauma 130 Sarcoma 105 GU Trauma 132 Skin Cancer (Other than Melanoma) 107 Liver Trauma 134 Pelvic Fracture 136 Stomach and Duodenum Penetrating Neck Trauma 138 Duodenal Ulcer 109 Pulmonary Embolism 140 Gastric Cancer 112 Splenic Trauma 142 Gastric Ulcer 114 Thoracic Trauma 144 Mallory–Weiss Tear 116 Upper GI Bleeding 118 Vascular Abdominal Aortic Aneurysm 146 Acute Lower Extremity Ischemia 148 Thoracic Carotid Stenosis 150 Emphysema 120 Chronic Lowe Extremity Ischemia 152 Lung Cancer 122 Venous Stasis Ulcer 154 Trauma and Critical Care Conclusion and Common Curveballs 156 Abdominal Compartment Syndrome (ACS) 124 Colon and Rectal Trauma 126 Index 159 FM.qxd 10/28/05 02:30 AM Page xi Introduction We regret to inform you that you were not successful in the or that I would mismanage or kill my next hundred Certifying Examination given in Cleveland, OH, in October patients. For me, failing on my first try meant that I was 2002. It was the consensus of your examiners that your per- going to “kick it” to those examiners during the next exam. formance during the examination was not of the level I will share with you a philosophy from my upbringing in required for certification. Philadelphia, home to many underdogs over the years: Who That’s the way the letter reads if you do not pass the knows how to climb a ladder better—the person who climbed General Surgery Oral Exam. Three more paragraphs fol- it once and never missed a step, or the person who climbs it, lowed in that awful letter I read to myself on a cold fall falls, and climbs it again, paying close attention to every rung evening in November 2002, less than four days after I had because he knows what it feels like to fall and is determined to taken the exam. I wondered why I wasn’t more upset. Was succeed? it because a good friend had informed me earlier in the day I can offer a couple of general suggestions to those of that he too had failed? Was it that my gut instinct since I you preparing for this exam: left the Oral Exam had been telling me to prepare myself (1) Read a general surgery textbook cover to cover (it for bad news? Who knows. After reading that letter, how- really doesn’t matter which text you choose), ever, I did know one thing: on my next try, I would know (2) Read lots of previous questions, which you can get everything there was to know about the field of General from any course or your colleagues, Surgery so there would be no possible way for me to fail a (3) Remember that self-induced anxiety is your biggest second time. enemy! Out of that sentiment came the thoughts for this book. I couldn’t sleep well the night after I opened that letter. As I If you passed the written exam, you know the material. thought about what I had done to prepare for the exam— You just have to keep from freezing or getting tongue-tied two review courses, flashcards, a variety of review texts— when you are asked to sum up verbally two or more weeks I realized that my biggest help had been a book entitled Safe of outpatient work-up/inpatient care in about seven min- Answers for the Board. It was an excellent resource that utes per question. The Oral Surgery Certification Exam is helped to clarify and crystallize a lot of what I learnt in res- overly subjective, so regardless of what you are asked idency and I recommend it to all potential examinees. remember that this is a test of your thinking ability and However, after a search on the Internet I discovered there is confidence more than a pure test of your knowledge. no book that tells you what the wrong answers are, or reveals Consider each question as a real-life situation. You are the common curveballs examiners are likely to throw your not an unsafe surgeon, and you should treat the questions way. My goal then became to put together a study guide that the way you would a patient: never make up answers or not only included much of the material necessary to pass operations, and don’t waste time on history and physical the Oral Exam, but that would also prepare an examinee for examination if they tell you “that is all you need.” The what actually happens during the exam.
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