ABSITE 2026/2027 COMPLETE EXAM REVIEW: 200 PRACTICE
QUESTIONS WITH ANSWERS AND RATIONALES ACROSS ALL
TESTED DOMAINS
1. A 72-year-old diabetic man presents with a nonhealing infected ulcer on the volar aspect of
his left second distal phalanx that has failed oral antibiotics. Cultures reveal polymicrobial
infection. What is the most appropriate next step?
a.) IV antibiotics alone
b.) Tight glucose control and IV antibiotics
c.) Single toe amputation
d.) Single toe amputation and IV antibiotics – (Correct Answer)-(d)
Rationale: In a diabetic patient with a nonhealing infected ulcer and polymicrobial infection that
has failed oral antibiotics, surgical debridement or amputation combined with IV antibiotics is
the standard of care. Antibiotics alone or with glucose control are insufficient when infection
involves deep tissue or bone.
2. An opera singer who recently underwent total thyroidectomy reports voice fatigue and
inability to sing high notes. Her total calcium level is 9.1 mg/dL (normal 9-10.5). This
complication could have been prevented by:
a.) Use of an intraoperative nerve stimulator to localize the recurrent laryngeal nerve
b.) Ligation of individual branches of the superior thyroid artery at the level of the thyroid
capsule – (Correct Answer)-(b)
c.) Performing careful dissection to avoid injury to the parathyroid glands
d.) Routine postoperative calcium supplementation
Rationale: Voice fatigue and inability to sing high notes after thyroidectomy suggest injury to the
external branch of the superior laryngeal nerve. This nerve runs with the superior thyroid artery
and can be injured when the artery is ligated high. Ligation of individual branches at the thyroid
capsule helps prevent this injury.
3. A 45-year-old undergoes laparoscopic cholecystectomy. Intraoperative cholangiogram
shows a filling defect in the distal common bile duct. What is the next best step?
,a.) Conversion to open cholecystectomy
b.) Laparoscopic common bile duct exploration – (Correct Answer)-(b)
c.) Postoperative ERCP
d.) Termination of procedure and observation
Rationale: Single-stage management (laparoscopic cholecystectomy + common bile duct
exploration) is preferred over postoperative ERCP for choledocholithiasis when the surgeon is
skilled, as it reduces procedures, length of stay, and cost.
4. A 60-year-old presents with painless jaundice, weight loss, and a palpable gallbladder
(Courvoisier's sign). Most likely diagnosis:
a.) Choledocholithiasis
b.) Pancreatic head cancer – (Correct Answer)-(b)
c.) Gallbladder cancer
d.) Primary sclerosing cholangitis
Rationale: Courvoisier's sign (painless jaundice with palpable gallbladder) suggests malignant
biliary obstruction, most commonly pancreatic head cancer or distal cholangiocarcinoma.
Choledocholithiasis typically presents with painful jaundice.
5. A 30-year-old with blunt abdominal trauma is hemodynamically unstable with a FAST exam
positive for free fluid in Morrison's pouch. Which are indicated?
a.) Immediate laparotomy and diagnostic peritoneal aspiration – (Correct Answer)-(a, c)
b.) CT abdomen/pelvis only
c.) Angiography with embolization only
d.) Observation with serial exams
Rationale: Unstable blunt trauma with positive FAST indicates immediate laparotomy. Diagnostic
peritoneal aspiration can confirm hemoperitoneum if FAST is equivocal. CT or angiography
would delay life-saving surgery.
6. A 55-year-old with severe acute pancreatitis (necrotizing) develops fever and hypotension
on day 10. CT shows gas bubbles within necrosis. Next step:
a.) Continue conservative management
b.) Immediate surgical necrosectomy – (Correct Answer)-(b)
c.) IV antibiotics alone
d.) Percutaneous drainage
,Rationale: Gas bubbles within pancreatic necrosis in a patient with fever and hypotension
indicate infected necrosis, which requires intervention. Surgical necrosectomy is the definitive
treatment, though step-up approaches may be considered.
7. Which nutrient is poorly absorbed in achlorhydria?
a.) Vitamin D
b.) Vitamin B12 – (Correct Answer)-(b)
c.) Bile salts
d.) Proteins
e.) Fats
Rationale: Gastric acid and pepsin are required to release vitamin B12 from dietary protein,
allowing it to bind to intrinsic factor. In achlorhydria, B12 cannot be liberated from food, leading
to malabsorption.
8. Hypophosphatemia has been associated with all of the following EXCEPT:
a.) Impaired diaphragmatic contractility
b.) Treated diabetic ketoacidosis
c.) Malabsorption coupled with carbohydrate refeeding
d.) Chronic alcoholism
e.) Respiratory muscle hyperresponsiveness – (Correct Answer)-(e)
Rationale: Hypophosphatemia is seen in chronic alcoholism, diabetic ketoacidosis, sepsis, and
malnutrition after carbohydrate refeeding. It causes muscle weakness affecting the diaphragm,
leading to respiratory failure. Respiratory muscle hyperresponsiveness is not associated.
9. What is the main nutrient for colonocytes?
a.) Glutamine
b.) Alanine
c.) Short chain fatty acids – (Correct Answer)-(c)
d.) Glucose
Rationale: Colonocytes preferentially use short chain fatty acids (primarily butyrate) as their
main energy source. In contrast, enterocytes of the small intestine primarily use glutamine.
10. What chemotherapy agent leads to pulmonary fibrosis?
a.) Doxorubicin
b.) Methotrexate
c.) Bleomycin – (Correct Answer)-(c)
, d.) Vincristine
e.) Cyclophosphamide
Rationale: Bleomycin is well known for causing pulmonary fibrosis as a dose-limiting toxicity.
Doxorubicin causes cardiotoxicity, methotrexate causes hepatotoxicity, and cyclophosphamide
causes hemorrhagic cystitis.
11. What is the most useful serum marker for cancer screening?
a.) PSA – (Correct Answer)-(a)
b.) CEA
c.) AFP
d.) CA 19-9
e.) CA 15-3
Rationale: PSA is the only serum marker widely used for population-based cancer screening
(prostate cancer). CEA, AFP, CA 19-9, and CA 15-3 are used for follow-up, monitoring, or
diagnosis, not screening.
12. What is the embryologic origin of the inferior parathyroid gland?
a.) 4th arch
b.) 4th pouch
c.) 3rd arch
d.) 3rd pouch – (Correct Answer)-(d)
Rationale: Derivatives of the 3rd pharyngeal pouch include the inferior parathyroid glands and
the thymus. The superior parathyroid glands come from the 4th pouch. The main nerve supply
is the glossopharyngeal nerve.
13. What is the cause of hypotension and decreased EtCO2 during laparoscopic surgery?
a.) Tension pneumothorax
b.) Inferior vena cava compression
c.) CO2 embolus – (Correct Answer)-(c)
d.) Anesthetic overdose
Rationale: A CO2 embolus during laparoscopic surgery causes hypotension, decreased EtCO2,
and cardiovascular collapse. Tension pneumothorax and IVC compression cause different
hemodynamic patterns.
14. Increased levels of glutamine are associated with all of the following EXCEPT:
QUESTIONS WITH ANSWERS AND RATIONALES ACROSS ALL
TESTED DOMAINS
1. A 72-year-old diabetic man presents with a nonhealing infected ulcer on the volar aspect of
his left second distal phalanx that has failed oral antibiotics. Cultures reveal polymicrobial
infection. What is the most appropriate next step?
a.) IV antibiotics alone
b.) Tight glucose control and IV antibiotics
c.) Single toe amputation
d.) Single toe amputation and IV antibiotics – (Correct Answer)-(d)
Rationale: In a diabetic patient with a nonhealing infected ulcer and polymicrobial infection that
has failed oral antibiotics, surgical debridement or amputation combined with IV antibiotics is
the standard of care. Antibiotics alone or with glucose control are insufficient when infection
involves deep tissue or bone.
2. An opera singer who recently underwent total thyroidectomy reports voice fatigue and
inability to sing high notes. Her total calcium level is 9.1 mg/dL (normal 9-10.5). This
complication could have been prevented by:
a.) Use of an intraoperative nerve stimulator to localize the recurrent laryngeal nerve
b.) Ligation of individual branches of the superior thyroid artery at the level of the thyroid
capsule – (Correct Answer)-(b)
c.) Performing careful dissection to avoid injury to the parathyroid glands
d.) Routine postoperative calcium supplementation
Rationale: Voice fatigue and inability to sing high notes after thyroidectomy suggest injury to the
external branch of the superior laryngeal nerve. This nerve runs with the superior thyroid artery
and can be injured when the artery is ligated high. Ligation of individual branches at the thyroid
capsule helps prevent this injury.
3. A 45-year-old undergoes laparoscopic cholecystectomy. Intraoperative cholangiogram
shows a filling defect in the distal common bile duct. What is the next best step?
,a.) Conversion to open cholecystectomy
b.) Laparoscopic common bile duct exploration – (Correct Answer)-(b)
c.) Postoperative ERCP
d.) Termination of procedure and observation
Rationale: Single-stage management (laparoscopic cholecystectomy + common bile duct
exploration) is preferred over postoperative ERCP for choledocholithiasis when the surgeon is
skilled, as it reduces procedures, length of stay, and cost.
4. A 60-year-old presents with painless jaundice, weight loss, and a palpable gallbladder
(Courvoisier's sign). Most likely diagnosis:
a.) Choledocholithiasis
b.) Pancreatic head cancer – (Correct Answer)-(b)
c.) Gallbladder cancer
d.) Primary sclerosing cholangitis
Rationale: Courvoisier's sign (painless jaundice with palpable gallbladder) suggests malignant
biliary obstruction, most commonly pancreatic head cancer or distal cholangiocarcinoma.
Choledocholithiasis typically presents with painful jaundice.
5. A 30-year-old with blunt abdominal trauma is hemodynamically unstable with a FAST exam
positive for free fluid in Morrison's pouch. Which are indicated?
a.) Immediate laparotomy and diagnostic peritoneal aspiration – (Correct Answer)-(a, c)
b.) CT abdomen/pelvis only
c.) Angiography with embolization only
d.) Observation with serial exams
Rationale: Unstable blunt trauma with positive FAST indicates immediate laparotomy. Diagnostic
peritoneal aspiration can confirm hemoperitoneum if FAST is equivocal. CT or angiography
would delay life-saving surgery.
6. A 55-year-old with severe acute pancreatitis (necrotizing) develops fever and hypotension
on day 10. CT shows gas bubbles within necrosis. Next step:
a.) Continue conservative management
b.) Immediate surgical necrosectomy – (Correct Answer)-(b)
c.) IV antibiotics alone
d.) Percutaneous drainage
,Rationale: Gas bubbles within pancreatic necrosis in a patient with fever and hypotension
indicate infected necrosis, which requires intervention. Surgical necrosectomy is the definitive
treatment, though step-up approaches may be considered.
7. Which nutrient is poorly absorbed in achlorhydria?
a.) Vitamin D
b.) Vitamin B12 – (Correct Answer)-(b)
c.) Bile salts
d.) Proteins
e.) Fats
Rationale: Gastric acid and pepsin are required to release vitamin B12 from dietary protein,
allowing it to bind to intrinsic factor. In achlorhydria, B12 cannot be liberated from food, leading
to malabsorption.
8. Hypophosphatemia has been associated with all of the following EXCEPT:
a.) Impaired diaphragmatic contractility
b.) Treated diabetic ketoacidosis
c.) Malabsorption coupled with carbohydrate refeeding
d.) Chronic alcoholism
e.) Respiratory muscle hyperresponsiveness – (Correct Answer)-(e)
Rationale: Hypophosphatemia is seen in chronic alcoholism, diabetic ketoacidosis, sepsis, and
malnutrition after carbohydrate refeeding. It causes muscle weakness affecting the diaphragm,
leading to respiratory failure. Respiratory muscle hyperresponsiveness is not associated.
9. What is the main nutrient for colonocytes?
a.) Glutamine
b.) Alanine
c.) Short chain fatty acids – (Correct Answer)-(c)
d.) Glucose
Rationale: Colonocytes preferentially use short chain fatty acids (primarily butyrate) as their
main energy source. In contrast, enterocytes of the small intestine primarily use glutamine.
10. What chemotherapy agent leads to pulmonary fibrosis?
a.) Doxorubicin
b.) Methotrexate
c.) Bleomycin – (Correct Answer)-(c)
, d.) Vincristine
e.) Cyclophosphamide
Rationale: Bleomycin is well known for causing pulmonary fibrosis as a dose-limiting toxicity.
Doxorubicin causes cardiotoxicity, methotrexate causes hepatotoxicity, and cyclophosphamide
causes hemorrhagic cystitis.
11. What is the most useful serum marker for cancer screening?
a.) PSA – (Correct Answer)-(a)
b.) CEA
c.) AFP
d.) CA 19-9
e.) CA 15-3
Rationale: PSA is the only serum marker widely used for population-based cancer screening
(prostate cancer). CEA, AFP, CA 19-9, and CA 15-3 are used for follow-up, monitoring, or
diagnosis, not screening.
12. What is the embryologic origin of the inferior parathyroid gland?
a.) 4th arch
b.) 4th pouch
c.) 3rd arch
d.) 3rd pouch – (Correct Answer)-(d)
Rationale: Derivatives of the 3rd pharyngeal pouch include the inferior parathyroid glands and
the thymus. The superior parathyroid glands come from the 4th pouch. The main nerve supply
is the glossopharyngeal nerve.
13. What is the cause of hypotension and decreased EtCO2 during laparoscopic surgery?
a.) Tension pneumothorax
b.) Inferior vena cava compression
c.) CO2 embolus – (Correct Answer)-(c)
d.) Anesthetic overdose
Rationale: A CO2 embolus during laparoscopic surgery causes hypotension, decreased EtCO2,
and cardiovascular collapse. Tension pneumothorax and IVC compression cause different
hemodynamic patterns.
14. Increased levels of glutamine are associated with all of the following EXCEPT:
