ABSITE PRACTICE EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains:
1. Gastrointestinal & Abdominal Surgery
2. Surgical Critical Care & Trauma
3. Endocrine & Breast Surgery
4. Vascular & Thoracic Surgery
5. Surgical Oncology & Pathophysiology
6. Hepatobiliary & Pancreatic Surgery
7. Surgical Ethics, Legal, & Professional Standards
8. Fluid, Electrolyte, & Nutrition Management
9. Transplant & Immunosuppression
10. Surgical Technology & Patient Safety
Introduction
This comprehensive assessment is designed to rigorously evaluate your
preparedness for the American Board of Surgery In-Training Examination (ABSITE).
It assesses a broad spectrum of surgical knowledge, from foundational physiological
principles to complex clinical decision-making. The exam is structured in a multiple-
choice and scenario-based format, challenging your ability to apply theoretical
knowledge to real-world clinical situations. Each question emphasizes critical
thinking, patient safety, and adherence to the highest professional and ethical
standards. The following questions are crafted to mirror the complexity and depth
of the actual exam, focusing on the integration of basic science with perioperative
management and surgical technique. This practice tool is intended to reinforce key
concepts and refine your test-taking strategies.
,SECTION ONE: QUESTIONS 1-100
1. A 45-year-old male with a history of chronic pancreatitis presents with a 5-cm
cystic lesion in the head of the pancreas. ERCP reveals communication between
the cyst and the pancreatic duct. What is the most appropriate initial
management for this patient?
A. Endoscopic ultrasound-guided fine-needle aspiration
B. Octreotide therapy
C. Observation with serial imaging
D. Surgical resection
🟢D
🔴 Explanation: A cystic lesion communicating with the pancreatic duct in the
setting of chronic pancreatitis is consistent with a pseudocyst. However, a 5-cm
lesion in the head of the pancreas, particularly in a patient with chronic
inflammation, has a high risk of being a neoplastic cyst (e.g., IPMN). Surgical
resection is indicated to rule out malignancy and alleviate symptoms.
2. A patient with a perforated duodenal ulcer undergoes an omental patch
repair. On post-operative day 5, he develops a fever and a sudden onset of
severe right upper quadrant pain. An ultrasound reveals a fluid collection in the
subhepatic space. What is the most likely diagnosis?
A. Atelectasis
B. Subphrenic abscess
C. Wound infection
D. Acute cholecystitis
🟢B
🔴 Explanation: Post-operative fever and right upper quadrant pain following a
perforated ulcer repair are highly suggestive of a subphrenic or subhepatic
abscess. The perforation likely led to intra-abdominal contamination, which can
organize into an abscess. Atelectasis can cause fever but not localized pain, and
acute cholecystitis is less directly related to the procedure.
,3. A 32-year-old woman with a BMI of 38 presents with right upper quadrant
pain, nausea, and vomiting after a fatty meal. Ultrasound reveals a 2-cm
gallstone within the gallbladder, which has a thickened wall. What is the
definitive treatment of choice?
A. Ursodeoxycholic acid therapy
B. Laparoscopic cholecystectomy
C. Open cholecystectomy
D. ERCP with sphincterotomy
🟢B
🔴 Explanation: This patient has symptomatic cholelithiasis. The definitive
treatment is laparoscopic cholecystectomy, which is the gold standard. Medical
dissolution therapy is reserved for small radiolucent stones in patients who
cannot undergo surgery, and ERCP is for bile duct stones, not gallbladder stones.
4. A 68-year-old male with a history of diverticulosis presents with 3 days of
left lower quadrant pain, fever (38.5°C), and a white blood cell count of 15,000.
A CT scan with contrast shows a 4-cm pericolic abscess. What is the most
appropriate initial management?
A. Intravenous antibiotics and observation
B. Percutaneous drainage and intravenous antibiotics
C. Urgent laparoscopic sigmoidectomy
D. Hartmann's procedure
🟢B
🔴 Explanation: A 4-cm abscess from acute diverticulitis is amenable to
percutaneous drainage. This, combined with IV antibiotics, is the standard of care
for Hinchey II diverticulitis. Surgery is reserved for failure of conservative
management, free perforation, or generalized peritonitis.
5. A patient with Crohn's disease presents with a 2-week history of right lower
quadrant pain, fever, and a tender, palpable mass. A CT scan shows a thickened
terminal ileum with a phlegmon. The patient is started on broad-spectrum
, antibiotics. What is the most important next step in management?
A. Immediate surgical resection of the terminal ileum
B. Initiation of biologic therapy
C. Nasogastric tube decompression
D. Close monitoring and supportive care
🟢D
🔴 Explanation: Crohn's disease complicated by a phlegmon is managed
conservatively with antibiotics, bowel rest, and close observation. Surgery is
avoided due to high recurrence rates and anastomotic leak risks. Biologic therapy
may be considered after the acute phase is controlled.
6. During a laparoscopic appendectomy, the surgeon notices a mass at the base
of the cecum. Intraoperative frozen section confirms an adenocarcinoma. What
is the most appropriate surgical management?
A. Complete the appendectomy and close
B. Convert to open right hemicolectomy
C. Laparoscopic right hemicolectomy
D. Appendectomy with adjuvant chemotherapy
🟢B
🔴 Explanation: An adenocarcinoma found at the base of the cecum necessitates
an oncologically adequate resection. A right hemicolectomy is the standard, and
while it can be done laparoscopically by an experienced surgeon, conversion to
an open procedure or performing a formal laparoscopic right hemicolectomy is
appropriate. A simple appendectomy is inadequate, and chemotherapy is not the
primary treatment.
7. A 55-year-old male with a history of a 40-pack-year smoking history presents
with hoarseness. On laryngoscopy, a lesion is found on his left vocal cord.
Biopsy reveals squamous cell carcinoma. What is the most significant risk factor
for this patient's cancer?
A. Alcohol consumption
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains:
1. Gastrointestinal & Abdominal Surgery
2. Surgical Critical Care & Trauma
3. Endocrine & Breast Surgery
4. Vascular & Thoracic Surgery
5. Surgical Oncology & Pathophysiology
6. Hepatobiliary & Pancreatic Surgery
7. Surgical Ethics, Legal, & Professional Standards
8. Fluid, Electrolyte, & Nutrition Management
9. Transplant & Immunosuppression
10. Surgical Technology & Patient Safety
Introduction
This comprehensive assessment is designed to rigorously evaluate your
preparedness for the American Board of Surgery In-Training Examination (ABSITE).
It assesses a broad spectrum of surgical knowledge, from foundational physiological
principles to complex clinical decision-making. The exam is structured in a multiple-
choice and scenario-based format, challenging your ability to apply theoretical
knowledge to real-world clinical situations. Each question emphasizes critical
thinking, patient safety, and adherence to the highest professional and ethical
standards. The following questions are crafted to mirror the complexity and depth
of the actual exam, focusing on the integration of basic science with perioperative
management and surgical technique. This practice tool is intended to reinforce key
concepts and refine your test-taking strategies.
,SECTION ONE: QUESTIONS 1-100
1. A 45-year-old male with a history of chronic pancreatitis presents with a 5-cm
cystic lesion in the head of the pancreas. ERCP reveals communication between
the cyst and the pancreatic duct. What is the most appropriate initial
management for this patient?
A. Endoscopic ultrasound-guided fine-needle aspiration
B. Octreotide therapy
C. Observation with serial imaging
D. Surgical resection
🟢D
🔴 Explanation: A cystic lesion communicating with the pancreatic duct in the
setting of chronic pancreatitis is consistent with a pseudocyst. However, a 5-cm
lesion in the head of the pancreas, particularly in a patient with chronic
inflammation, has a high risk of being a neoplastic cyst (e.g., IPMN). Surgical
resection is indicated to rule out malignancy and alleviate symptoms.
2. A patient with a perforated duodenal ulcer undergoes an omental patch
repair. On post-operative day 5, he develops a fever and a sudden onset of
severe right upper quadrant pain. An ultrasound reveals a fluid collection in the
subhepatic space. What is the most likely diagnosis?
A. Atelectasis
B. Subphrenic abscess
C. Wound infection
D. Acute cholecystitis
🟢B
🔴 Explanation: Post-operative fever and right upper quadrant pain following a
perforated ulcer repair are highly suggestive of a subphrenic or subhepatic
abscess. The perforation likely led to intra-abdominal contamination, which can
organize into an abscess. Atelectasis can cause fever but not localized pain, and
acute cholecystitis is less directly related to the procedure.
,3. A 32-year-old woman with a BMI of 38 presents with right upper quadrant
pain, nausea, and vomiting after a fatty meal. Ultrasound reveals a 2-cm
gallstone within the gallbladder, which has a thickened wall. What is the
definitive treatment of choice?
A. Ursodeoxycholic acid therapy
B. Laparoscopic cholecystectomy
C. Open cholecystectomy
D. ERCP with sphincterotomy
🟢B
🔴 Explanation: This patient has symptomatic cholelithiasis. The definitive
treatment is laparoscopic cholecystectomy, which is the gold standard. Medical
dissolution therapy is reserved for small radiolucent stones in patients who
cannot undergo surgery, and ERCP is for bile duct stones, not gallbladder stones.
4. A 68-year-old male with a history of diverticulosis presents with 3 days of
left lower quadrant pain, fever (38.5°C), and a white blood cell count of 15,000.
A CT scan with contrast shows a 4-cm pericolic abscess. What is the most
appropriate initial management?
A. Intravenous antibiotics and observation
B. Percutaneous drainage and intravenous antibiotics
C. Urgent laparoscopic sigmoidectomy
D. Hartmann's procedure
🟢B
🔴 Explanation: A 4-cm abscess from acute diverticulitis is amenable to
percutaneous drainage. This, combined with IV antibiotics, is the standard of care
for Hinchey II diverticulitis. Surgery is reserved for failure of conservative
management, free perforation, or generalized peritonitis.
5. A patient with Crohn's disease presents with a 2-week history of right lower
quadrant pain, fever, and a tender, palpable mass. A CT scan shows a thickened
terminal ileum with a phlegmon. The patient is started on broad-spectrum
, antibiotics. What is the most important next step in management?
A. Immediate surgical resection of the terminal ileum
B. Initiation of biologic therapy
C. Nasogastric tube decompression
D. Close monitoring and supportive care
🟢D
🔴 Explanation: Crohn's disease complicated by a phlegmon is managed
conservatively with antibiotics, bowel rest, and close observation. Surgery is
avoided due to high recurrence rates and anastomotic leak risks. Biologic therapy
may be considered after the acute phase is controlled.
6. During a laparoscopic appendectomy, the surgeon notices a mass at the base
of the cecum. Intraoperative frozen section confirms an adenocarcinoma. What
is the most appropriate surgical management?
A. Complete the appendectomy and close
B. Convert to open right hemicolectomy
C. Laparoscopic right hemicolectomy
D. Appendectomy with adjuvant chemotherapy
🟢B
🔴 Explanation: An adenocarcinoma found at the base of the cecum necessitates
an oncologically adequate resection. A right hemicolectomy is the standard, and
while it can be done laparoscopically by an experienced surgeon, conversion to
an open procedure or performing a formal laparoscopic right hemicolectomy is
appropriate. A simple appendectomy is inadequate, and chemotherapy is not the
primary treatment.
7. A 55-year-old male with a history of a 40-pack-year smoking history presents
with hoarseness. On laryngoscopy, a lesion is found on his left vocal cord.
Biopsy reveals squamous cell carcinoma. What is the most significant risk factor
for this patient's cancer?
A. Alcohol consumption
