Free General Surgery Practice Questions

Question 1

A 48-year-old woman is admitted with recurrent right upper-quadrant pain. She is afebrile and hemodynamically stable; her leukocyte count and lipase are normal. Total bilirubin is 3.4 mg/dL and alkaline phosphatase is 286 U/L. Ultrasonography shows gallbladder stones and a 9-mm common bile duct, but no duct stone or gallbladder-wall inflammation. Her pain improves with analgesia. Which investigation should precede a decision about endoscopic duct clearance?

Accepted Answer

MRCP of the bile ducts

Answer

ERCP with biliary sphincterotomy

Answer

Hepatobiliary scintigraphy to assess cystic-duct patency

Answer

Repeat transabdominal ultrasonography after 48 hours

Question 2

Lumpectomy for a unifocal, 1.7-cm invasive lobular carcinoma leaves a single close margin: tumor is 0.6 mm from the lateral inked surface but does not touch ink. All other margins exceed 4 mm, sentinel nodes are negative, and imaging and pathology account for the entire lesion. There is no associated DCIS. Whole-breast irradiation and endocrine therapy are planned. What should the surgeon recommend about the lateral margin?

Accepted Answer

No further breast excision

Answer

Re-excision to obtain a margin of at least 2 mm

Answer

Re-excision to obtain a margin of at least 5 mm

Answer

Completion mastectomy because of the lobular histology

Question 3

After a high-speed collision, a 29-year-old man has a patent airway, symmetric breath sounds, and no major external bleeding. His blood pressure rises from 76/42 to 112/68 mm Hg during transfusion of two units of whole blood, then falls to 82/46 mm Hg within minutes. FAST shows free fluid in the right upper quadrant and pelvis. The abdomen is increasingly distended. While blood-product resuscitation continues, where should he go next?

Accepted Answer

The operating room for exploratory laparotomy

Answer

CT for contrast-enhanced imaging of the abdomen and pelvis

Answer

Angiography for localization and embolization of abdominal bleeding

Answer

The intensive care unit for serial examinations during further transfusion

Question 4

Endoscopy for recurrent hematemesis identifies a deep ulcer on the posterior wall of the duodenal bulb. Brisk arterial bleeding resumes despite endoscopic hemostasis, and the interventional radiologist is asked to plan embolization. Which artery lies immediately behind this ulcer and is the principal suspected source?

Accepted Answer

Gastroduodenal artery

Answer

Left gastric artery

Answer

Splenic artery

Answer

Right gastroepiploic artery

Question 5

A man with postoperative pneumonia develops ARDS and is passively ventilated. His actual weight is 120 kg and his height-derived predicted body weight is 70 kg. Current settings include a tidal volume of 700 mL and PEEP of 8 cm H2O. Plateau pressure is 34 cm H2O; arterial pH is 7.29 and PaCO2 is 53 mm Hg. Which tidal-volume adjustment best addresses the immediate risk of ventilator-induced lung injury?

Accepted Answer

Reduce to 420 mL based on predicted body weight

Answer

Reduce to 600 mL, using 5 mL/kg of actual weight

Answer

Maintain 700 mL and increase respiratory rate to normalize PaCO2

Answer

Increase to 840 mL to correct the respiratory acidosis

Question 6

Evaluation of a thyroid nodule establishes medullary thyroid carcinoma in a 41-year-old woman with a pathogenic RET variant. She also reports episodic headache and palpitations. Plasma free metanephrines are six times the upper limit of normal, and CT shows a unilateral adrenal mass. There is no airway compression or other urgent thyroid complication. Which treatment sequence avoids the most important preventable operative hazard?

Accepted Answer

Alpha blockade, then adrenalectomy before thyroidectomy

Answer

Thyroidectomy first, then alpha blockade before adrenalectomy

Answer

Beta blockade first, then adrenalectomy followed by thyroidectomy

Answer

Alpha blockade, then thyroidectomy before treating the adrenal tumor

Question 7

A 6-week-old boy with ultrasound-confirmed pyloric stenosis has had several days of forceful nonbilious vomiting. He is dehydrated, with sodium 134 mEq/L, potassium 2.8 mEq/L, chloride 86 mEq/L, bicarbonate 38 mEq/L, and arterial pH 7.51. His urine pH is 5.0. What accounts for acidic urine despite the systemic alkalosis?

Accepted Answer

Sodium conservation with increased renal hydrogen secretion

Answer

Bicarbonate excretion in response to the systemic alkalosis

Answer

Hydrogen retention caused by reduced aldosterone activity

Answer

Reduced proximal bicarbonate reabsorption from tubular injury

Question 8

An excisional biopsy of a pigmented lesion on the upper back shows a nonulcerated melanoma with a Breslow thickness of 2.4 mm. The diagnostic biopsy margins are clear. A healthy 52-year-old patient has no palpable regional adenopathy or evidence of distant disease. Which operation provides the appropriate definitive local treatment and regional nodal staging?

Accepted Answer

Wide excision with a 2-cm margin and sentinel-node biopsy

Answer

Wide excision with a 1-cm margin and sentinel-node biopsy

Answer

Wide excision with a 2-cm margin and clinical nodal surveillance alone

Answer

Wide excision with a 2-cm margin and elective regional node dissection

Question 9

Six weeks after an episode of necrotizing pancreatitis, a patient undergoes MRI for persistent early satiety. An 8-cm collection has a complete enhancing capsule and contains both liquid and substantial nonenhancing solid debris. The radiology report calls it a pseudocyst. Under the Revised Atlanta classification, what is the more accurate diagnosis?

Accepted Answer

Walled-off necrosis

Answer

Acute necrotic collection

Answer

Acute peripancreatic fluid collection

Answer

Pancreatic pseudocyst

Question 10

On postoperative day 2 after a right colectomy, a woman with type 2 diabetes develops nausea and deep, rapid breathing. She took empagliflozin until the evening before surgery. Blood pressure is 118/72 mm Hg, lactate 1.2 mmol/L, glucose 164 mg/dL, bicarbonate 11 mEq/L, anion gap 25 mEq/L, and beta-hydroxybutyrate 6.8 mmol/L. She had eaten normally until the preoperative fast. Which diagnosis unifies the medication exposure and laboratory findings?

Accepted Answer

SGLT2 inhibitor-associated euglycemic ketoacidosis

Answer

Lactic acidosis from occult anastomotic sepsis

Answer

Hyperchloremic acidosis from perioperative saline

Answer

Uncomplicated starvation ketosis from overnight fasting

Free General Surgery Practice Questions

Domain 1: Abdominal 17% of exam

Question 1

Question 2

Domain 2: Alimentary Tract 19% of exam

Question 3

Domain 4: Breast 9% of exam

Question 4

Domain 5: Endocrine 3% of exam

Question 5

Domain 15: Pediatric Surgery 3% of exam

Question 6

Domain 17: Pre-operative Evaluation and Peri-operative Care 3% of exam

Question 7

Domain 18: Skin and Soft Tissue 4% of exam

Question 8

Domain 19: Surgical Critical Care 3% of exam

Question 9

Domain 23: Trauma 8% of exam

Question 10

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