100+ Free ABCRS Practice Questions

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Question 1

Score: 0/0

A 58-year-old man has a 4 cm rectal adenocarcinoma at 6 cm from the anal verge. MRI shows tumor invading through the muscularis propria into perirectal fat with 3 suspicious mesorectal nodes. Which TNM 8th edition stage describes this tumor?

cT2N1M0 (Stage IIIA)

cT3N1M0 (Stage IIIB)

cT4aN1M0 (Stage IIIB)

cT3N0M0 (Stage IIA)

to track

2026 Statistics

Key Facts: ABCRS Exam

2-Part

Exam Format

Qualifying (written) + Certifying (oral)

$3,400

Total Cost

App + written + oral fees

ABS + CRS

Prerequisites

ABS cert + ACGME CRS fellowship

Pearson VUE

Written Exam Site

March annually

Dallas, TX

Oral Exam Site

ABOG Testing Center, October

10 yrs

Certification Cycle

Continuous Certification (MOC)

ABCRS is the board certification for colon & rectal surgeons after ABS general surgery certification and a 1-year ACGME CRS fellowship. Two parts: Qualifying (written, Pearson VUE, ~6h) and Certifying (oral, Dallas, ~4h, 4 examiner panels). Total cost ~$3,400. Application due Aug 15. Maintained via 10-year Continuous Certification (MOC).

Sample ABCRS Practice Questions

Try these sample questions to test your ABCRS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man has a 4 cm rectal adenocarcinoma at 6 cm from the anal verge. MRI shows tumor invading through the muscularis propria into perirectal fat with 3 suspicious mesorectal nodes. Which TNM 8th edition stage describes this tumor?

A.cT2N1M0 (Stage IIIA)

B.cT3N1M0 (Stage IIIB)

C.cT4aN1M0 (Stage IIIB)

D.cT3N0M0 (Stage IIA)

Explanation: Invasion through the muscularis propria into perirectal fat defines T3. Three suspicious mesorectal nodes is N1 (1-3 regional nodes). No distant metastasis is M0. In the AJCC 8th edition, T3N1M0 is Stage IIIB. This stage is an indication for total neoadjuvant therapy (TNT).

2Current NCCN and ASCO guidelines recommend testing for mismatch repair (MMR) deficiency or microsatellite instability (MSI) in which colorectal cancer patients?

A.Only patients under age 50

B.Only patients with a family history of cancer

C.All patients with colorectal cancer (universal screening)

D.Only patients with right-sided tumors

Explanation: Universal tumor testing for dMMR/MSI is recommended for ALL newly diagnosed colorectal cancers. This identifies Lynch syndrome candidates for genetic testing and identifies MSI-H/dMMR tumors that have prognostic and therapeutic implications (no benefit from 5-FU monotherapy in stage II; eligibility for immunotherapy in metastatic disease).

3In the OPRA trial, patients with locally advanced rectal cancer were randomized to induction chemotherapy followed by chemoradiation vs. chemoradiation followed by consolidation chemotherapy. What was the key finding?

A.Induction chemo improved overall survival

B.Consolidation chemo after CRT produced higher rates of organ preservation

C.No difference in complete clinical response

D.Consolidation chemo had higher toxicity and worse DFS

Explanation: The OPRA trial demonstrated that consolidation chemotherapy (CRT followed by chemo) produced higher rates of organ preservation (sustained TME-free survival) than induction chemotherapy (chemo followed by CRT), at approximately 53% vs 41% at 3 years. Both arms are accepted TNT regimens, but consolidation favors watch-and-wait eligibility.

4The RAPIDO trial compared short-course radiation (5x5 Gy) followed by chemotherapy and TME versus long-course chemoradiation and TME for locally advanced rectal cancer. What was the primary outcome advantage?

A.Improved overall survival in the experimental arm

B.Reduced disease-related treatment failure in the experimental arm

C.Reduced local recurrence in the standard arm

D.No difference in any outcome

Explanation: RAPIDO showed that short-course RT followed by 18 weeks of chemotherapy (CAPOX x6 or FOLFOX x9) before TME reduced disease-related treatment failure (distant metastasis and treatment-related death) compared to standard CRT + adjuvant chemo. Pathologic complete response was doubled (28% vs 14%). Long-term data showed slightly higher local recurrence with RAPIDO, prompting ongoing debate.

5Total mesorectal excision (TME) for rectal cancer is based on sharp dissection in which anatomic plane?

A.Between the mesorectal fascia and the rectal muscularis propria

B.Between the mesorectal fascia (fascia propria) and the presacral (Waldeyer) fascia

C.Deep to the presacral fascia on the sacral periosteum

D.Through the mesorectum parallel to the rectum

Explanation: TME is performed by sharp dissection in the avascular 'holy plane' between the fascia propria of the rectum (enveloping the mesorectum) and the parietal presacral (Waldeyer's) fascia. Staying in this plane removes the entire mesorectum intact, preserves hypogastric nerves, avoids presacral venous bleeding, and minimizes local recurrence.

6Complete mesocolic excision (CME) for right-sided colon cancer requires high ligation of which vascular pedicle at its origin?

A.Ileocolic artery at the SMA

B.Middle colic artery at the SMA

C.Right colic and middle colic at their origins from the SMA/SMV, with ileocolic high ligation

D.Only the marginal artery

Explanation: CME (as described by Hohenberger) emphasizes dissection in the embryologic mesocolic plane with central vascular ligation. For right-sided cancers, this means high ligation of the ileocolic, right colic (if present), and right branch of the middle colic at their origins from the SMA/SMV to maximize lymph node yield (>=12, ideally >25) and reduce local recurrence.

7A 62-year-old with a cT3N1 mid-rectal cancer completes TNT with consolidation FOLFOX and achieves a complete clinical response (no visible tumor on endoscopy, no DRE abnormality, no restaging MRI residual tumor). What is the recommended next step?

A.Immediate TME

B.Observation with structured watch-and-wait surveillance

C.Abdominoperineal resection

D.Local excision

Explanation: For patients with a sustained complete clinical response (cCR) after TNT, watch-and-wait (W&W) is a reasonable alternative to immediate TME. Structured surveillance includes q3-month DRE, endoscopy, MRI, and CEA for 2-3 years. The IWWD and OPRA data show ~30% local regrowth rate, but most regrowths remain salvageable with TME. Patients must accept this risk and strict follow-up.

8A 55-year-old with pathologically confirmed Stage III (T3N1) colon cancer after right hemicolectomy is referred for adjuvant chemotherapy. Based on IDEA trial data for low-risk stage III (T1-3N1), what is the recommended regimen?

A.6 months of FOLFOX

B.3 months of CAPOX

C.6 months of capecitabine monotherapy

D.No adjuvant therapy

Explanation: The IDEA collaboration (6 pooled trials) showed that for low-risk stage III (T1-3N1) colon cancer, 3 months of CAPOX is non-inferior to 6 months of CAPOX with less neurotoxicity. For high-risk stage III (T4 or N2), 6 months of FOLFOX or CAPOX remains standard. This low-risk patient qualifies for the abbreviated 3-month CAPOX regimen.

9A 65-year-old with a right colon cancer and 3 synchronous liver metastases confined to the right lobe (all <5 cm, resectable) is evaluated. What is the best management approach?

A.Palliative chemotherapy only; liver metastases are inoperable

B.Colon resection, systemic chemotherapy, and staged or simultaneous hepatic resection

C.Hepatic resection first, then observation

D.Radiation therapy to liver lesions

Explanation: Oligometastatic colorectal cancer with resectable liver metastases is potentially curable, with 5-year survival of 30-50% after R0 resection. Management requires multidisciplinary evaluation: primary colectomy + systemic chemotherapy (FOLFOX or FOLFIRI +/- biologic) + hepatic resection (staged or simultaneous depending on extent). Perioperative chemotherapy is supported by EORTC 40983.

10A 72-year-old with metastatic colon cancer is found to be MSI-high/dMMR. What first-line systemic therapy is now preferred?

A.FOLFOX + bevacizumab

B.FOLFIRI + cetuximab

C.Pembrolizumab (immune checkpoint inhibitor) monotherapy

D.Capecitabine monotherapy

Explanation: The KEYNOTE-177 trial showed that pembrolizumab monotherapy dramatically improved progression-free survival and response durability compared to standard chemotherapy in MSI-H/dMMR metastatic colorectal cancer. First-line pembrolizumab (or nivolumab/ipilimumab) is now the standard for MSI-H/dMMR mCRC.

About the ABCRS Exam

The ABCRS certification is a two-part board examination for colon and rectal surgeons. Part I (Qualifying, written) is a multiple-choice exam delivered at Pearson VUE test centers covering the breadth of colorectal surgery: colorectal cancer (TNM 8th ed, TNT/TME, CME, watch-and-wait, MSI/dMMR), anorectal disease (hemorrhoids, fissure, Parks fistula classification, anal SCC Nigro protocol), IBD and pouch surgery (IPAA, strictureplasty, pouchitis), diverticular disease (Hinchey I-IV, Hartmann), pelvic floor (rectal prolapse, SNS for incontinence), polyps (Haggitt/Kikuchi/SMS), and hereditary syndromes (Lynch, FAP, Peutz-Jeghers). Part II (Certifying, oral) is a 4-panel structured oral examination at the ABOG Testing Center in Dallas, TX where candidates manage complex case scenarios.

Questions

250 scored questions

Time Limit

Written ~6h (Pearson VUE) + Oral ~4h (Dallas)

Passing Score

Criterion-referenced (not publicly disclosed)

Exam Fee

$400 application + $1,200 written + $1,200 oral (~$3,400) (ABCRS (American Board of Colon and Rectal Surgery))

ABCRS Exam Content Outline

~30%

Colorectal Cancer

TNM 8th ed, TNT (OPRA/RAPIDO), TME/CME principles, watch-and-wait, adjuvant FOLFOX/CAPEOX, MSI/dMMR testing, liver oligometastases

~25%

Anorectal Disease

Hemorrhoid grading/banding/excision, chronic fissure (medical → botox → LIS), Parks fistula classification, Goodsall rule, LIFT/flap/plug, anal SCC Nigro, pilonidal

~15%

IBD & Pouch Surgery

UC vs Crohn's pathology, IPAA vs IRA, pouchitis (cipro/metronidazole), perianal Crohn's (MRI, seton), strictureplasty, rectovaginal fistula

~15%

Diverticular & Benign Colon

Hinchey I-IV, percutaneous drainage vs Hartmann, sigmoid/cecal volvulus, ischemic colitis, lower GI bleeding, stents

~10%

Pelvic Floor & Functional

Rectal prolapse (Altemeier/ventral mesh rectopexy/Frykman-Goldberg), SNS for incontinence, obstructed defecation, LARS, slow transit constipation

~5%

Polyps & Hereditary

Adenoma surveillance, malignant polyp Haggitt/Kikuchi/SMS, sessile serrated lesions, Lynch/FAP/Peutz-Jeghers

How to Pass the ABCRS Exam

What You Need to Know

Passing score: Criterion-referenced (not publicly disclosed)
Exam length: 250 questions
Time limit: Written ~6h (Pearson VUE) + Oral ~4h (Dallas)
Exam fee: $400 application + $1,200 written + $1,200 oral (~$3,400)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABCRS Study Tips from Top Performers

1Master TNM 8th edition staging for colon and rectal cancer — know exact T/N/M definitions, stage groupings, and implications (T3N1M0 = Stage IIIB → TNT)

2Know the landmark trials cold: OPRA and RAPIDO (TNT regimens), KEYNOTE-177 (MSI-H mCRC), IDEA (3 vs 6 mo adjuvant), COST/CLASICC (laparoscopic), ACOSOG Z6051/ALaCaRT (laparoscopic TME)

3Memorize Parks classification (inter/trans/supra/extrasphincteric), Goodsall rule, and LIFT/advancement flap/plug indications — highly testable on both written and oral

4For IBD: know UC vs Crohn's histologic/gross features, IPAA vs IRA indications, when to avoid IPAA in Crohn's, and pouchitis first-line (cipro/metronidazole)

5Build a pelvic floor framework: rectal prolapse operations (Altemeier for frail, ventral mesh rectopexy for fit, Frykman-Goldberg for chronic constipation), SNS for incontinence, and LARS management

Frequently Asked Questions

Who is eligible for the ABCRS exam?

Candidates must hold ABS (American Board of Surgery) general surgery certification, have completed a 1-year ACGME-accredited colon and rectal surgery fellowship, hold a full and unrestricted medical license, and apply within 3 years of fellowship completion. The entire certification process must be completed within 7 years.

What is the ABCRS exam format?

Two parts: (1) Qualifying (written) exam at Pearson VUE testing centers, approximately 250 multiple-choice questions over ~6 hours; (2) Certifying (oral) exam at the ABOG Testing Center in Dallas, TX, with 4 examiner panels testing structured case scenarios, ~4 hours. Candidates must pass Part I before being admitted to Part II.

How much does the ABCRS certification cost?

$400 application fee + $1,200 written exam fee + $1,200 oral exam fee = ~$3,400 total for on-time applications. Late fees add $200-$600. Application deadline is August 15 each year.

What is the ABCRS pass rate?

Historical pass rates are approximately 75-85% for first-time takers on both Part I (written) and Part II (oral). Repeat takers have lower pass rates, especially on the oral exam. Exact statistics are not publicly disclosed.

When are the ABCRS exams offered?

Part I (written) is offered annually in March at Pearson VUE centers (e.g., March 10-27, 2027). Part II (oral) is offered annually in October at the ABOG Testing Center in Dallas, TX (e.g., October 17, 2026).

Is the ABCRS exam lifelong or does it require recertification?

ABCRS certification is valid for 10 years. Continuous Certification (MOC) requires ongoing CME, practice improvement activities, and periodic assessments to maintain board certification.

What is the best study approach for the ABCRS exam?

Start during fellowship with the ASCRS Textbook of Colon and Rectal Surgery (4th ed), CARSEP self-assessment, ASCRS clinical practice guidelines, and review articles on TNM 8th ed, TNT trials (OPRA, RAPIDO), and watch-and-wait. Practice questions are essential. For Part II oral, practice case scenarios with attending-led mock orals.

What topics does the oral exam (Certifying) emphasize?

The oral exam uses 4 examiner panels covering: colorectal cancer and complex oncology, IBD and pouch surgery, anorectal and pelvic floor, and emergency/general CRS (obstruction, bleeding, trauma). Examiners probe judgment, complication management, and multidisciplinary decisions.