ABS General Surgery Qualifying Exam 2026: Comprehensive Board
Certification Practice Test — Surgical Principles, Trauma, Critical
Care, Gastrointestinal Surgery, Oncology & Perioperative
Management — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Question 1
A 68-year-old man presents with a 3-cm infrarenal abdominal aortic aneurysm discovered
incidentally on CT. What is the recommended surveillance interval for this patient?
A. Every 6 months
B. Every 12 months
C. Every 2-3 years
D. No further surveillance required
Correct Answer: C
Explanation: AAA measuring 3.0-3.9 cm warrants surveillance every 2-3 years; growth risk is
low at this size, and repair is not indicated until >5.5 cm or rapid expansion.
Question 2
A 45-year-old woman undergoes laparoscopic cholecystectomy for symptomatic
cholelithiasis. During dissection, a structure is clipped that appears to be the cystic duct but
actually is the common bile duct. Which anatomic principle helps prevent this error?
A. Calot's triangle must be dissected before clipping any structure
B. The critical view of safety requires only visualization of the cystic duct
C. The cystic artery is always medial to the cystic duct
D. Infundibulum-first dissection is contraindicated
,Correct Answer: A
Explanation: Achieving the critical view of safety requires clear identification of cystic duct
and cystic artery within Calot's triangle before clipping; this prevents bile duct injury.
Question 3
A 55-year-old man presents with right upper quadrant pain, fever, and jaundice. Ultrasound
shows gallstones and a dilated common bile duct. What is the most appropriate initial
management?
A. Immediate cholecystectomy
B. ERCP with sphincterotomy and stone extraction
C. Percutaneous cholecystostomy
D. Conservative management with antibiotics alone
Correct Answer: B
Explanation: Cholangitis with dilated CBD requires urgent biliary decompression; ERCP is
first-line for stone extraction and drainage in hemodynamically stable patients.
Question 4
A 62-year-old woman with cirrhosis undergoes screening ultrasound that reveals a 2-cm
lesion in the right hepatic lobe. AFP is elevated. What imaging study is most appropriate to
confirm hepatocellular carcinoma?
A. CT with arterial and delayed phase imaging
B. MRI without contrast
C. PET-CT
D. Diagnostic laparoscopy
,Correct Answer: A
Explanation: HCC diagnosis in cirrhosis relies on characteristic arterial enhancement with
washout on delayed phase; multiphase CT or MRI is diagnostic without biopsy.
Question 5
A 50-year-old man presents with epigastric pain radiating to the back, nausea, and vomiting.
Lipase is 3x upper limit of normal. What is the most common etiology of acute pancreatitis
in the United States?
A. Alcohol
B. Gallstones
C. Hypertriglyceridemia
D. ERCP
Correct Answer: B
Explanation: Gallstones account for 40-50% of acute pancreatitis cases in the US, followed by
alcohol; ultrasound should be performed to evaluate for cholelithiasis.
Question 6
A 38-year-old woman is found to have a 1.5-cm enhancing mass in the tail of the pancreas
on CT. She is asymptomatic. What is the next best step?
A. Observation with repeat imaging in 6 months
B. Endoscopic ultrasound with FNA
C. Distal pancreatectomy
D. PET-CT
, Correct Answer: B
Explanation: Pancreatic solid lesions require EUS with FNA for tissue diagnosis; small lesions
may be neuroendocrine tumors or adenocarcinoma, guiding management.
Question 7
A 70-year-old man with atrial fibrillation presents with sudden severe abdominal pain out of
proportion to exam. CT angiography shows occlusion of the superior mesenteric artery.
What is the most appropriate management?
A. Systemic anticoagulation alone
B. Emergent laparotomy with revascularization
C. Catheter-directed thrombolysis
D. Supportive care with pain control
Correct Answer: B
Explanation: Acute SMA occlusion with peritoneal signs requires emergent surgical
revascularization; bowel viability must be assessed, and resection of infarcted bowel may be
necessary.
Question 8
A 28-year-old man presents with a 2-cm indirect inguinal hernia. He is otherwise healthy.
What is the most appropriate management?
A. Watchful waiting
B. Open mesh repair
C. Laparoscopic mesh repair
D. Tissue repair without mesh
Certification Practice Test — Surgical Principles, Trauma, Critical
Care, Gastrointestinal Surgery, Oncology & Perioperative
Management — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Question 1
A 68-year-old man presents with a 3-cm infrarenal abdominal aortic aneurysm discovered
incidentally on CT. What is the recommended surveillance interval for this patient?
A. Every 6 months
B. Every 12 months
C. Every 2-3 years
D. No further surveillance required
Correct Answer: C
Explanation: AAA measuring 3.0-3.9 cm warrants surveillance every 2-3 years; growth risk is
low at this size, and repair is not indicated until >5.5 cm or rapid expansion.
Question 2
A 45-year-old woman undergoes laparoscopic cholecystectomy for symptomatic
cholelithiasis. During dissection, a structure is clipped that appears to be the cystic duct but
actually is the common bile duct. Which anatomic principle helps prevent this error?
A. Calot's triangle must be dissected before clipping any structure
B. The critical view of safety requires only visualization of the cystic duct
C. The cystic artery is always medial to the cystic duct
D. Infundibulum-first dissection is contraindicated
,Correct Answer: A
Explanation: Achieving the critical view of safety requires clear identification of cystic duct
and cystic artery within Calot's triangle before clipping; this prevents bile duct injury.
Question 3
A 55-year-old man presents with right upper quadrant pain, fever, and jaundice. Ultrasound
shows gallstones and a dilated common bile duct. What is the most appropriate initial
management?
A. Immediate cholecystectomy
B. ERCP with sphincterotomy and stone extraction
C. Percutaneous cholecystostomy
D. Conservative management with antibiotics alone
Correct Answer: B
Explanation: Cholangitis with dilated CBD requires urgent biliary decompression; ERCP is
first-line for stone extraction and drainage in hemodynamically stable patients.
Question 4
A 62-year-old woman with cirrhosis undergoes screening ultrasound that reveals a 2-cm
lesion in the right hepatic lobe. AFP is elevated. What imaging study is most appropriate to
confirm hepatocellular carcinoma?
A. CT with arterial and delayed phase imaging
B. MRI without contrast
C. PET-CT
D. Diagnostic laparoscopy
,Correct Answer: A
Explanation: HCC diagnosis in cirrhosis relies on characteristic arterial enhancement with
washout on delayed phase; multiphase CT or MRI is diagnostic without biopsy.
Question 5
A 50-year-old man presents with epigastric pain radiating to the back, nausea, and vomiting.
Lipase is 3x upper limit of normal. What is the most common etiology of acute pancreatitis
in the United States?
A. Alcohol
B. Gallstones
C. Hypertriglyceridemia
D. ERCP
Correct Answer: B
Explanation: Gallstones account for 40-50% of acute pancreatitis cases in the US, followed by
alcohol; ultrasound should be performed to evaluate for cholelithiasis.
Question 6
A 38-year-old woman is found to have a 1.5-cm enhancing mass in the tail of the pancreas
on CT. She is asymptomatic. What is the next best step?
A. Observation with repeat imaging in 6 months
B. Endoscopic ultrasound with FNA
C. Distal pancreatectomy
D. PET-CT
, Correct Answer: B
Explanation: Pancreatic solid lesions require EUS with FNA for tissue diagnosis; small lesions
may be neuroendocrine tumors or adenocarcinoma, guiding management.
Question 7
A 70-year-old man with atrial fibrillation presents with sudden severe abdominal pain out of
proportion to exam. CT angiography shows occlusion of the superior mesenteric artery.
What is the most appropriate management?
A. Systemic anticoagulation alone
B. Emergent laparotomy with revascularization
C. Catheter-directed thrombolysis
D. Supportive care with pain control
Correct Answer: B
Explanation: Acute SMA occlusion with peritoneal signs requires emergent surgical
revascularization; bowel viability must be assessed, and resection of infarcted bowel may be
necessary.
Question 8
A 28-year-old man presents with a 2-cm indirect inguinal hernia. He is otherwise healthy.
What is the most appropriate management?
A. Watchful waiting
B. Open mesh repair
C. Laparoscopic mesh repair
D. Tissue repair without mesh
