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Date Updated: February 09, 2012

Surgery Advanced Clinical Examination (ACE)

The Surgery ACE is a web-based examination designed to assist residency program directors in assessing the baseline competency of new residents, and to measure the effectiveness of the fourth year subinternship experience at medical schools. This assessment aids in identifying knowledge gaps so that instruction may be tailored accordingly. The exam consists mainly of test items that describe clinical situations and require examinees to provide one or more of the following:

  • a diagnosis
  • a prognosis
  • an indication of underlying mechanisms of disease
  • the next step in medical care, including preventive measures

In addition to the traditional multiple-choice, one-best-answer items, the exam includes several sequential item sets that unfold and challenge residents to use their clinical knowledge in problem solving and in managing patients over time. The ACE is delivered using test administration and proctoring software developed by the NBME, and a variety of test delivery environments can be supported.

Program directors can access preliminary percent-correct scores by logging into the NBME Services Portal 48-72 hours after test administration.

A 37-year-old man is brought to the emergency department after his motorcycle ran into the back of a truck at high speed. He was wearing a helmet. On arrival, his neck is immobilized in a cervical collar, and intravenous fluids are being administered. Paramedics report that at the scene he appeared to be intoxicated. He is alert and talking. His breath smells of alcohol. His pulse is 130/min, respirations are 30/min, and blood pressure is 100/60 mm Hg. The lungs are clear to auscultation. Heart sounds are normal. The abdomen is distended and tender. There is blood at the urethral meatus. Ultrasonography shows blood in the abdomen. An x-ray of the pelvis shows fractures of the pubic rami and ischial and ilial fractures on the right. Which of the following is the most appropriate next step in management?

  1. Cystography
  2. Intravenous pyelography
  3. Retrograde urethrography
  4. Placement of a urinary catheter
  5. Diagnostic peritoneal lavage


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