FLORIDA BOARD OF MEDICINE SURGERY
CERTIFICATION EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. A 68-year-old man presents with severe, constant epigastric pain
radiating to the back, vomiting, and a serum lipase level 8 times
the upper limit of normal. CT demonstrates pancreatic edema and
peripancreatic inflammatory changes without necrosis. He is
tachycardic but normotensive. Which initial management strategy
is most appropriate?
A. Immediate exploratory laparotomy
B. Aggressive early enteral nutrition, appropriate IV fluid resuscitation,
analgesia, and monitoring
C. Prophylactic broad-spectrum antibiotics and urgent ERCP
D. Total parenteral nutrition and prolonged bowel rest
Answer: B. Aggressive early enteral nutrition, appropriate IV fluid
resuscitation, analgesia, and monitoring
Rationale: Acute pancreatitis is primarily managed with supportive
care, including appropriate fluid resuscitation, analgesia, electrolyte
management, and early oral or enteral nutrition as tolerated. Routine
prophylactic antibiotics are not indicated for sterile necrotizing
pancreatitis. ERCP is reserved for specific indications such as
persistent biliary obstruction or cholangitis.
1
, 2. A 72-year-old woman with atrial fibrillation develops abrupt
severe abdominal pain that appears disproportionate to the
relatively benign abdominal examination. She subsequently
develops metabolic acidosis and an elevated serum lactate level.
Which diagnosis should be suspected most strongly?
A. Acute appendicitis
B. Acute mesenteric ischemia
C. Acute cholecystitis
D. Perforated diverticulitis
Answer: B. Acute mesenteric ischemia
Rationale: Acute mesenteric ischemia classically presents with severe
abdominal pain out of proportion to the physical examination,
particularly in patients with embolic risk factors such as atrial
fibrillation. Rising lactate, metabolic acidosis, and eventual peritoneal
signs suggest progression to bowel infarction. Rapid vascular imaging
and surgical/vascular consultation are essential.
3. A 55-year-old man undergoes an elective colectomy. On
postoperative day 5, he develops fever, tachycardia, increasing
abdominal pain, and leukocytosis. CT demonstrates extraluminal
contrast and a localized collection adjacent to the colorectal
anastomosis. What is the most likely complication?
A. Postoperative ileus
B. Anastomotic leak
C. Acute pancreatitis
D. Deep venous thrombosis
Answer: B. Anastomotic leak
Rationale: Anastomotic leakage commonly presents several days after
colorectal surgery with fever, tachycardia, abdominal pain,
2
,leukocytosis, sepsis, or failure to progress clinically. CT findings of
extraluminal contrast or a perianastomotic fluid collection strongly
support the diagnosis. Management depends on the patient's stability
and degree of contamination and may range from antibiotics and
drainage to urgent operative intervention.
4. A 24-year-old woman presents with right lower-quadrant pain,
anorexia, nausea, and fever. Examination reveals localized
tenderness at McBurney point. CT demonstrates an enlarged
appendix with periappendiceal inflammatory changes. Which
diagnosis is most likely?
A. Acute appendicitis
B. Crohn disease
C. Ovarian torsion
D. Acute pancreatitis
Answer: A. Acute appendicitis
Rationale: The classic clinical presentation combined with CT
evidence of an enlarged inflamed appendix establishes acute
appendicitis. In an otherwise healthy patient with uncomplicated
appendicitis, appendectomy remains a standard definitive treatment,
although selected patients may be considered for antibiotic-based
management under appropriate circumstances.
5. A 61-year-old man with a history of smoking presents with
painless jaundice, dark urine, pale stools, weight loss, and a
palpable nontender gallbladder. Imaging demonstrates a mass in
the pancreatic head. Which diagnosis is most likely?
A. Chronic pancreatitis
B. Pancreatic adenocarcinoma
3
, C. Acute cholecystitis
D. Hepatocellular carcinoma
Answer: B. Pancreatic adenocarcinoma
Rationale: A pancreatic head malignancy can obstruct the distal
common bile duct, producing painless obstructive jaundice, dark
urine, acholic stools, and weight loss. A palpable nontender
gallbladder in the setting of malignant obstruction is classically
associated with Courvoisier sign.
6. A 70-year-old man develops sudden severe chest pain followed by
hypotension and respiratory distress. He has a new harsh systolic
murmur and signs of acute pulmonary edema several days after an
acute myocardial infarction. Which mechanical complication
should be suspected?
A. Ventricular septal rupture
B. Chronic pericarditis
C. Aortic dissection
D. Stable angina
Answer: A. Ventricular septal rupture
Rationale: Ventricular septal rupture is an acute mechanical
complication of myocardial infarction that can produce sudden
hemodynamic deterioration, a new harsh holosystolic murmur, and
pulmonary edema. Other mechanical complications include papillary
muscle rupture and free-wall rupture. Urgent echocardiography and
surgical/cardiovascular intervention are required.
7. A patient develops severe abdominal pain and abdominal
distention after surgery. Four days later, he has nausea, vomiting,
absent bowel sounds, and diffuse gaseous distention involving both
4
CERTIFICATION EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
1. A 68-year-old man presents with severe, constant epigastric pain
radiating to the back, vomiting, and a serum lipase level 8 times
the upper limit of normal. CT demonstrates pancreatic edema and
peripancreatic inflammatory changes without necrosis. He is
tachycardic but normotensive. Which initial management strategy
is most appropriate?
A. Immediate exploratory laparotomy
B. Aggressive early enteral nutrition, appropriate IV fluid resuscitation,
analgesia, and monitoring
C. Prophylactic broad-spectrum antibiotics and urgent ERCP
D. Total parenteral nutrition and prolonged bowel rest
Answer: B. Aggressive early enteral nutrition, appropriate IV fluid
resuscitation, analgesia, and monitoring
Rationale: Acute pancreatitis is primarily managed with supportive
care, including appropriate fluid resuscitation, analgesia, electrolyte
management, and early oral or enteral nutrition as tolerated. Routine
prophylactic antibiotics are not indicated for sterile necrotizing
pancreatitis. ERCP is reserved for specific indications such as
persistent biliary obstruction or cholangitis.
1
, 2. A 72-year-old woman with atrial fibrillation develops abrupt
severe abdominal pain that appears disproportionate to the
relatively benign abdominal examination. She subsequently
develops metabolic acidosis and an elevated serum lactate level.
Which diagnosis should be suspected most strongly?
A. Acute appendicitis
B. Acute mesenteric ischemia
C. Acute cholecystitis
D. Perforated diverticulitis
Answer: B. Acute mesenteric ischemia
Rationale: Acute mesenteric ischemia classically presents with severe
abdominal pain out of proportion to the physical examination,
particularly in patients with embolic risk factors such as atrial
fibrillation. Rising lactate, metabolic acidosis, and eventual peritoneal
signs suggest progression to bowel infarction. Rapid vascular imaging
and surgical/vascular consultation are essential.
3. A 55-year-old man undergoes an elective colectomy. On
postoperative day 5, he develops fever, tachycardia, increasing
abdominal pain, and leukocytosis. CT demonstrates extraluminal
contrast and a localized collection adjacent to the colorectal
anastomosis. What is the most likely complication?
A. Postoperative ileus
B. Anastomotic leak
C. Acute pancreatitis
D. Deep venous thrombosis
Answer: B. Anastomotic leak
Rationale: Anastomotic leakage commonly presents several days after
colorectal surgery with fever, tachycardia, abdominal pain,
2
,leukocytosis, sepsis, or failure to progress clinically. CT findings of
extraluminal contrast or a perianastomotic fluid collection strongly
support the diagnosis. Management depends on the patient's stability
and degree of contamination and may range from antibiotics and
drainage to urgent operative intervention.
4. A 24-year-old woman presents with right lower-quadrant pain,
anorexia, nausea, and fever. Examination reveals localized
tenderness at McBurney point. CT demonstrates an enlarged
appendix with periappendiceal inflammatory changes. Which
diagnosis is most likely?
A. Acute appendicitis
B. Crohn disease
C. Ovarian torsion
D. Acute pancreatitis
Answer: A. Acute appendicitis
Rationale: The classic clinical presentation combined with CT
evidence of an enlarged inflamed appendix establishes acute
appendicitis. In an otherwise healthy patient with uncomplicated
appendicitis, appendectomy remains a standard definitive treatment,
although selected patients may be considered for antibiotic-based
management under appropriate circumstances.
5. A 61-year-old man with a history of smoking presents with
painless jaundice, dark urine, pale stools, weight loss, and a
palpable nontender gallbladder. Imaging demonstrates a mass in
the pancreatic head. Which diagnosis is most likely?
A. Chronic pancreatitis
B. Pancreatic adenocarcinoma
3
, C. Acute cholecystitis
D. Hepatocellular carcinoma
Answer: B. Pancreatic adenocarcinoma
Rationale: A pancreatic head malignancy can obstruct the distal
common bile duct, producing painless obstructive jaundice, dark
urine, acholic stools, and weight loss. A palpable nontender
gallbladder in the setting of malignant obstruction is classically
associated with Courvoisier sign.
6. A 70-year-old man develops sudden severe chest pain followed by
hypotension and respiratory distress. He has a new harsh systolic
murmur and signs of acute pulmonary edema several days after an
acute myocardial infarction. Which mechanical complication
should be suspected?
A. Ventricular septal rupture
B. Chronic pericarditis
C. Aortic dissection
D. Stable angina
Answer: A. Ventricular septal rupture
Rationale: Ventricular septal rupture is an acute mechanical
complication of myocardial infarction that can produce sudden
hemodynamic deterioration, a new harsh holosystolic murmur, and
pulmonary edema. Other mechanical complications include papillary
muscle rupture and free-wall rupture. Urgent echocardiography and
surgical/cardiovascular intervention are required.
7. A patient develops severe abdominal pain and abdominal
distention after surgery. Four days later, he has nausea, vomiting,
absent bowel sounds, and diffuse gaseous distention involving both
4
