100+ Free ABPlSurg Plastic Surgery Practice Questions

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A 35-year-old presents 8 days post-bilateral DIEP flap breast reconstruction with one flap turning blue. Capillary refill is brisk. What is the most likely diagnosis?

Arterial thrombosis

Venous congestion (venous thrombosis or kinking)

Hematoma

Cellulitis

to track

2026 Statistics

Key Facts: ABPlSurg Plastic Surgery Exam

~200

MCQs on the Written Exam

ABPlSurg blueprint

~$2,470

Written Exam Fee

ABPlSurg 2026

~25%

Reconstructive — Largest Category

ABPlSurg content blueprint

ACGME

Residency Required

Integrated 6-year or independent pathway

~85-92%

First-Attempt Pass Rate

ABPlSurg published rates

500-800 hrs

Recommended Study Time

Board candidates

The ABPlSurg Plastic Surgery Written (Qualifying) Examination is administered by the American Board of Plastic Surgery (ABMS member board, not the American Board of Physician Specialties / ABPS). It is a 1-day computer-based test at Prometric centers with approximately 200 single-best-answer MCQs across aesthetic surgery (~20%), reconstructive surgery (~25%), hand (~10%), craniofacial (~10%), microsurgery (~10%), burns (~5%), pediatric plastics (~5%), basic science/anatomy (~10%), and ethics/practice management (~5%). Initial written exam fee is approximately $2,470; the oral certifying exam is a separate exam (~$300+ fee after case-log submission). First-attempt pass rates for US ACGME plastic surgery residency graduates are approximately 85-92%.

Sample ABPlSurg Plastic Surgery Practice Questions

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

1A 45-year-old woman desires augmentation mammaplasty. What is the most important factor determining implant selection for soft-tissue coverage?

A.Patient's preferred cup size

B.Pinch test of the upper pole soft tissue

C.Nipple-to-inframammary fold distance

D.Areolar diameter

Explanation: Upper pole pinch (Tebbetts' soft-tissue coverage assessment): pinch <2 cm indicates submuscular placement to avoid implant visibility and rippling. Tissue-based planning (TEPID/High Five system) uses skin stretch, pinch thickness, and parenchymal coverage to choose pocket and implant volume. Cup size is unreliable across manufacturers.

2Which nerve provides sensation to the nipple-areola complex and is at greatest risk during inferior pedicle reduction mammaplasty?

A.Lateral cutaneous branch of T3

B.Lateral cutaneous branch of T4

C.Anterior cutaneous branch of T2

D.Supraclavicular nerve (C3-C4)

Explanation: The lateral cutaneous branch of the 4th intercostal nerve (T4) is the dominant nipple-areola sensory nerve, entering the breast at the lateral border of pectoralis major at approximately the 4th rib and traveling along the deep fascia. Preserving the inferior pedicle protects this branch.

3A 30-year-old woman 3 weeks post bilateral textured implant augmentation presents with sudden unilateral swelling and a late seroma. What is the most appropriate next step?

A.Reassurance and observation

B.Empiric antibiotics

C.Ultrasound-guided aspiration with fluid sent for cytology, flow cytometry (CD30), and culture

D.Immediate en bloc capsulectomy

Explanation: Any late seroma (>1 year, or any seroma with textured implants) mandates workup for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Ultrasound-guided aspiration with cytology, flow cytometry for CD30+ cells, and culture is the standard initial evaluation per NCCN. En bloc capsulectomy is reserved for confirmed disease.

4During DIEP flap harvest for breast reconstruction, which perforator characteristic most reliably indicates a robust flap?

A.Lateral row perforator with shortest intramuscular course

B.Medial row perforator with visible pulsation and direct septocutaneous course

C.Largest-caliber perforator regardless of location

D.Multiple small perforators in series

Explanation: A single dominant perforator of largest caliber (typically >1.5 mm) with clear pulsation provides the most reliable perfusion, regardless of medial or lateral row. Medial row perforators have better contralateral (zone IV) perfusion via the subdermal plexus; lateral row perforators have shorter intramuscular course. Modern CTA helps select dominant perforators preoperatively.

5A patient with a 4 cm full-thickness scalp defect overlying intact periosteum is best reconstructed with which option?

A.Split-thickness skin graft directly on periosteum

B.Healing by secondary intention

C.Full-thickness skin graft

D.Local rotation flap

Explanation: Intact periosteum supports a split-thickness skin graft (STSG) because it is vascularized. STSG is the simplest durable option for a 4 cm scalp defect with periosteum present. Local flaps are preferred for larger defects or where exposed bone is present, but for an intact periosteum-covered defect, STSG is appropriate first-line.

6Which nerve is most commonly injured during carpal tunnel release if the incision is placed too radially?

A.Recurrent motor branch of the median nerve

B.Palmar cutaneous branch of the median nerve

C.Deep motor branch of the ulnar nerve

D.Superficial sensory branch of the radial nerve

Explanation: The palmar cutaneous branch arises 5-7 cm proximal to the wrist crease, lies between FCR and palmaris longus, and is at risk with overly radial incisions. Carpal tunnel incision should be ulnar to the thenar crease (in line with the radial border of the ring finger) to protect both the palmar cutaneous and recurrent motor branches.

7A patient presents 6 hours after a fingertip amputation distal to the lunula with no exposed bone. What is the most appropriate management?

A.Replantation

B.Cross-finger flap

C.Conservative dressing changes (semi-occlusive)

D.Volar V-Y advancement flap

Explanation: Distal fingertip amputations distal to the lunula with no exposed bone and <1 cm² area heal excellently by secondary intention with semi-occlusive dressings, preserving sensation and length. Replantation is generally indicated proximal to the FDP insertion or for multiple digits/thumb/peds.

8A 6-month-old presents for unilateral cleft lip repair. Which technique is the most widely used today for primary unilateral cleft lip repair?

A.Straight-line (Rose-Thompson) repair

B.Millard rotation-advancement

C.Tennison-Randall triangular flap

D.Skoog upper lip Z-plasty

Explanation: The Millard rotation-advancement (1957) is the most widely used technique for unilateral cleft lip repair worldwide. It rotates the medial lip downward and advances the lateral lip into the rotation gap, recreating the philtral column and Cupid's bow. Modifications (Mohler, Fisher anatomic subunit) are commonly used.

9At what age is primary palatoplasty most commonly performed in non-syndromic cleft palate?

A.Within first month of life

B.3-6 months

C.9-18 months

D.3-5 years

Explanation: Primary palatoplasty is typically performed between 9-18 months (often 10-12 months) to optimize speech development while minimizing maxillary growth restriction. Earlier repair benefits speech; later repair benefits midface growth. Most centers compromise around 12 months.

10Which suture technique is most appropriate for microvascular anastomosis of a 1 mm artery?

A.Continuous running 9-0 nylon

B.Interrupted 9-0 nylon, triangulation technique

C.Continuous 6-0 polypropylene

D.Interrupted 4-0 silk

Explanation: Microvascular anastomosis of 1 mm vessels typically uses interrupted 9-0 or 10-0 nylon with triangulation (Carrel's principle): place two stays 120 degrees apart and rotate, allowing equidistant suture placement and avoiding back-wall catch. Interrupted sutures allow growth and avoid purse-string narrowing.

About the ABPlSurg Plastic Surgery Exam

The ABPlSurg Plastic Surgery Written (Qualifying) Examination is the first of two examinations required for initial certification in plastic surgery by the American Board of Plastic Surgery, an ABMS member board (distinct from the American Board of Physician Specialties or ABPS). The 1-day computer-based exam at Prometric centers consists of approximately 200 single-best-answer MCQs covering the full plastic surgery blueprint: aesthetic surgery (face, breast, body), reconstructive surgery (head and neck, breast, trunk, upper and lower extremity), hand and peripheral nerve, craniofacial (cleft lip/palate, craniosynostosis, Le Fort fractures), microsurgery and free tissue transfer, burns, pediatric plastics, basic science (wound healing, flap classification, vascular anatomy), and ethics/practice management/patient safety. Candidates must complete an ACGME-accredited plastic surgery residency (integrated 6-year or independent pathway) before sitting the exam. After passing the written exam, candidates submit case logs and sit the separate oral certifying exam to complete initial certification.

Questions

100 scored questions

Time Limit

1-day CBT at Prometric (~5-6 hours)

Passing Score

Criterion-referenced scaled score set by ABPlSurg

Exam Fee

~$2,470 written qualifying exam fee (American Board of Plastic Surgery (ABPlSurg) / Prometric)

ABPlSurg Plastic Surgery Exam Content Outline

~20%

Aesthetic Surgery

Breast augmentation tissue-based planning, BIA-ALCL workup of late textured implant seromas (US-guided aspiration with cytology, flow CD30, culture), reduction mammaplasty pedicle and NAC viability (T4 lateral cutaneous), abdominoplasty rectus innervation T7-T12 and pseudobursa late seromas, BBL fat grafting (subcutaneous-only, ASERF/ASAPS/ASPS multi-society guidance — intramuscular contraindicated), rhinoplasty (internal nasal valve, spreader grafts), blepharoplasty (retrobulbar hematoma, lagophthalmos), rhytidectomy facial nerve injury (temporal/frontal branch most commonly injured), gender-affirming top surgery (double-incision FNG vs keyhole), and large-volume liposuction safety (~5,000 mL ASPS Practice Advisory threshold).

~25%

Reconstructive Surgery (Head/Neck, Trunk, Extremity)

Bilobed (Zitelli) for nasal tip 1-1.5 cm Mohs defects, paramedian forehead flap (supratrochlear artery axial), Karapandzic/Abbe/Estlander for lip reconstruction by defect size, deltopectoral flap (internal mammary 2nd-3rd perforators), latissimus dorsi (Mathes-Nahai V — thoracodorsal dominant), sacral pressure injury Stage IV management (excisional debridement then flap), lower extremity (reverse sural for distal third, medial gastrocnemius proximal, soleus middle), Gustilo IIIB "fix and flap" 72 hr-7 days, oral antral fistula (buccal advancement / palatal rotation), keloid combination therapy, hypertrophic scar steroid injection, and scalp STSG over intact periosteum.

~10%

Hand and Peripheral Nerve Surgery

Carpal tunnel anatomy (median nerve and 9 flexor tendons; palmar cutaneous branch at risk with radial incision; recurrent motor branch), Bennett fracture base of thumb metacarpal ORIF, scaphoid waist fracture cast vs ORIF, Dupuytren collagenase/needle aponeurotomy vs fasciectomy, Zone 2 flexor tendon timing within 72 hrs, FPL Zone 1 (only thumb IP flexor), trigger finger A1 pulley, Kanavel's signs of pyogenic flexor tenosynovitis, Whitesides delta pressure <30 mmHg fasciotomy threshold, Oberlin transfer for upper trunk brachial plexus, and TMR/RPNI for neuroma/phantom pain.

~10%

Craniofacial Surgery

Millard rotation-advancement unilateral cleft lip (and modifications: Mohler, Fisher), palatoplasty timing 9-18 months (often 10-12), Pierre Robin sequence U-shaped secondary palate cleft, FGFR3 P250R Muenke syndrome as most common single-gene craniosynostosis (vs Apert/Crouzon FGFR2 and Saethre-Chotzen TWIST1), Le Fort III as craniofacial dysjunction, fibula free flap mandibular reconstruction (plate exposure most common late complication), and vascularized vs non-vascularized bone graft selection.

~10%

Microsurgery and Free Tissue Transfer

Triangulation interrupted 9-0/10-0 nylon for 1 mm vessels, DIEP perforator selection (dominant caliber regardless of row), SIEA based on common femoral SIEA branch, radial forearm (radial artery + cephalic + venae comitantes; Allen test mandatory), gracilis Mathes-Nahai II (medial femoral circumflex — used for facial reanimation), free gracilis vs temporalis for smile reanimation, venous congestion (blue/brisk refill/dark bleeding) vs arterial thrombosis (pale/no bleeding), implantable Doppler for buried flap monitoring, tPA for thrombus (TXA/aminocaproic acid for reversal), and lymphedema (LVA + VLNT for ISL I-II).

~5%

Burns

Parkland formula 4 mL × kg × %TBSA Ringer's (half in first 8 hours), urine output 0.5 mL/kg/hr endpoint (1 mL/kg/hr in children), burn depth classification (superficial/superficial partial/deep partial/full-thickness), and Marjolin's ulcer SCC in chronic burn scars.

~5%

Pediatric Plastics

Ear molding within 2-4 weeks for deformational anomalies (Stahl, cup, lop), microtia reconstruction at 6-10 years (Brent/Nagata), syndactyly release 12-18 months (border digits 6-12 months), propranolol first-line for functionally impairing infantile hemangiomas, multiple Z-plasties for amniotic band constriction, obstetric brachial plexus palsy exploration at 3-9 months if no biceps recovery, and brachymetatarsia callotasis when symptomatic.

~10%

Basic Science and Anatomy

Wound healing phases (hemostasis minutes-hours, inflammation days 1-3, proliferation days 3-21, remodeling 3 weeks-1-2 years), tensile strength regain (~5% week 1, 20% week 3, 60% month 3, max ~80% year 1), Type I collagen predominance in mature scar, TGF-beta as dominant fibrogenic cytokine, FPL Zone 1 anatomy, lateral T4 nipple innervation, long thoracic nerve in axilla (winging), and high vs low median nerve palsy.

~5%

Ethics, Practice Management, and Patient Safety

Informed consent and autonomy, ABPS continuing certification, AAAASF/AAAHC/JC office accreditation, ASPS large-volume liposuction (~5,000 mL outpatient threshold), tumescent lidocaine (4.5 mg/kg plain, 7 mg/kg with epi, up to 35-55 mg/kg dilute tumescent), Caprini-stratified VTE prophylaxis (mechanical + LMWH for ≥5), smoking cessation 4-6 weeks preop (vasoconstriction, flap necrosis risk), bite wound management (no tight closure, amoxicillin-clavulanate, tetanus), MSSA as most common SSI organism, and expanding facelift hematoma as surgical emergency.

How to Pass the ABPlSurg Plastic Surgery Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPlSurg
Exam length: 100 questions
Time limit: 1-day CBT at Prometric (~5-6 hours)
Exam fee: ~$2,470 written qualifying exam fee

Keys to Passing

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

ABPlSurg Plastic Surgery Study Tips from Top Performers

1Map a 12-month study calendar to the ABPlSurg content blueprint. Allocate ~30% to reconstructive surgery (head/neck, breast, trunk, extremity), ~25% to aesthetic surgery, and the remainder split across hand, craniofacial, microsurgery, basic science, burns, pediatric, and ethics/practice management. Build your daily question-bank habit (40-60 questions per day) starting at least 6 months out and ramp to full timed sets in the final 8-12 weeks.

2Master Mathes-Nahai flap classification (Types I-V) with at least one prototypical flap per type — Type I (TFL — lateral femoral circumflex), Type II (gracilis — medial femoral circumflex), Type III (rectus abdominis — superior and inferior epigastrics), Type IV (sartorius — segmental), Type V (latissimus — thoracodorsal dominant + secondary segmentals). Know dominant pedicle, secondary pedicles, and indications cold.

3For aesthetic surgery, internalize the safety boundaries that come up repeatedly: BBL must be subcutaneous-only (no intramuscular fat per multi-society guidance), large-volume liposuction threshold ~5,000 mL aspirate outpatient (ASPS Practice Advisory), tumescent lidocaine up to 35-55 mg/kg dilute Klein technique, smoking cessation 4-6 weeks preop, Caprini stratification for VTE chemoprophylaxis (>=5 needs LMWH + mechanical), and BIA-ALCL workup for any late textured implant seroma.

4Drill cleft and craniofacial timing milestones: cleft lip repair ~3 months (rule of 10s — 10 weeks, 10 lbs, 10 g/dL Hgb), palatoplasty 9-18 months (often 10-12) to balance speech and midface growth, alveolar bone grafting at mixed dentition (~8-11 years), orthognathic surgery at skeletal maturity. Memorize craniosynostosis genetics — Apert and Crouzon FGFR2, Muenke FGFR3 P250R (most common single-gene cause and often bicoronal), Saethre-Chotzen TWIST1, Pfeiffer FGFR1/FGFR2.

5Pre-test, run two to three full-length timed simulations using mixed-blueprint question sets. Track topic-level performance to identify weaknesses, then revisit those areas with focused reading (Plastic Surgery 5e Neligan chapters, ASPS In-Service archives, and key landmark papers like Mathes and Nahai 1981, Hartrampf TRAM 1982, Allen and Treece DIEP 1994). The exam rewards integrated understanding of anatomy, technique, and complications, not isolated trivia.

Frequently Asked Questions

What is the ABPlSurg Plastic Surgery Written (Qualifying) Examination?

The ABPlSurg Plastic Surgery Written (Qualifying) Examination is the first of two examinations required for initial certification in plastic surgery by the American Board of Plastic Surgery, an ABMS member board. It is a 1-day computer-based test at Prometric centers consisting of approximately 200 single-best-answer MCQs covering the entire plastic surgery blueprint. After passing the written exam and submitting case logs, candidates sit the separate oral certifying exam to complete initial certification.

Is the ABPlSurg the same as the ABPS (American Board of Physician Specialties)?

No. The American Board of Plastic Surgery (ABPlSurg) is a member board of the American Board of Medical Specialties (ABMS) and is the standard board for plastic surgery certification in the US. The American Board of Physician Specialties (ABPS) is a separate, non-ABMS certification body that offers some specialty certifications but is not considered equivalent to ABPlSurg for plastic surgery certification.

Who is eligible to take the ABPlSurg Written exam?

Candidates must have completed an ACGME-accredited Plastic Surgery residency program — either an integrated 6-year program (entered directly from medical school) or an independent program (completed after prerequisite training in general surgery, ENT, or oral surgery). An unrestricted US medical license, program director attestation of satisfactory clinical competence, and application within the ABPlSurg eligibility window after graduation are also required.

How much does the ABPlSurg Written exam cost in 2026?

The written qualifying examination fee is approximately $2,470 for 2026 (confirm current fee on the ABPlSurg site). The separate oral certifying examination has an additional fee (~$300+) and requires submission of a one-year case log. Review courses, question banks, and study materials typically add $1,500-$3,000.

What topics carry the most weight on the exam?

Reconstructive surgery (~25%) is the largest single category, followed by aesthetic surgery (~20%), then hand/peripheral nerve (~10%), craniofacial (~10%), microsurgery (~10%), basic science/anatomy (~10%), pediatric plastics (~5%), burns (~5%), and ethics/practice management/patient safety (~5%). Within these, classic high-yield topics include: Mathes-Nahai flap classification, free flap selection and monitoring, BIA-ALCL workup, BBL safety, large-volume liposuction guidelines, brachial plexus reconstruction (Oberlin transfer), cleft lip/palate timing, craniosynostosis syndromes (FGFR2/FGFR3/TWIST1), and Parkland formula.

How long should I study for the ABPlSurg Written exam?

Most candidates report 500-800 hours of focused study over 12-24 months during PGY-5/6 of integrated residency and the year after graduation. A common approach is to use the ASPS In-Service Examination question bank and review materials as a backbone, supplement with comprehensive textbooks (Plastic Surgery 5e by Neligan, Grabb and Smith's), and complete 2-3 timed full-length mock exams in the months before the test.

What is the pass rate for the ABPlSurg Written exam?

First-attempt pass rates for US ACGME plastic surgery residency graduates are approximately 85-92% in recent years. Pass rates are typically lower for retakers and for candidates further removed from residency. ABPlSurg publishes annual pass rate statistics on its website.

What happens after I pass the Written exam?

After passing the Written (Qualifying) exam, candidates submit a year-long case log to ABPlSurg and then sit the separate Oral (Certifying) examination, which involves discussion of submitted cases and standardized unknown cases with examiners. Successful completion of both exams confers initial ABPlSurg certification, which is currently a 10-year time-limited certification with Continuous Certification (CC) requirements thereafter.