100+ Free ABS General Surgery Practice Questions
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A 28-year-old otherwise healthy man presents with 18 hours of periumbilical pain that has migrated to the right lower quadrant, anorexia, and a temperature of 38.2 C. He has focal tenderness at McBurney point with involuntary guarding, WBC 14,200, and a CT confirms a 9 mm non-perforated appendix with periappendiceal fat stranding. What is the most appropriate next step?
Key Facts: ABS General Surgery Exam
~300
Total MCQ Items
ABS General Surgery Qualifying Examination
~8 hr
Total Exam Time
1-day computer-based test including breaks
~20%
Alimentary Tract Weight
Largest single domain on 2026 ABS content outline
~$1,750
2026 Combined QE/CE Fee
ABS (verify current schedule)
5 yr
Residency Training
ACGME-accredited general surgery residency
~85-90%
First-Time Pass Rate
ABS annual statistics (U.S. residency graduates)
The ABS General Surgery Qualifying Exam is a 1-day computer-based test from the American Board of Surgery comprising approximately 300 single-best-answer MCQs over ~8 hours at Pearson VUE. Content spans alimentary tract (~20%), abdomen (~12%), applied science/perioperative (~13%), surgical critical care (~10%), vascular (~8-10%), trauma (~8%), breast/skin/soft tissue (~8-10%), endocrine (~5-7%), surgical oncology (~5%), thoracic (~3-5%), pediatric (~3%), MIS/endoscopy (~3-5%), head and neck (~3%), transplant (~2%), and ethics/biostats (~2-3%). Combined QE/CE application fee is ~$1,750; requires completion of an ACGME-accredited general surgery residency (5 years).
Sample ABS General Surgery Practice Questions
Try these sample questions to test your ABS General Surgery exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 28-year-old otherwise healthy man presents with 18 hours of periumbilical pain that has migrated to the right lower quadrant, anorexia, and a temperature of 38.2 C. He has focal tenderness at McBurney point with involuntary guarding, WBC 14,200, and a CT confirms a 9 mm non-perforated appendix with periappendiceal fat stranding. What is the most appropriate next step?
2A 55-year-old woman presents with postprandial right upper quadrant pain, no fever, WBC 7,000, normal LFTs, and ultrasound shows cholelithiasis without wall thickening or pericholecystic fluid. She has had three similar episodes over the past six months. What is the best management?
3A 62-year-old man with gallstone pancreatitis has resolved abdominal pain, normalizing lipase, and mild improvement of LFTs on hospital day 3. MRCP shows no retained common bile duct stone. What is the most appropriate timing for cholecystectomy?
4During elective laparoscopic cholecystectomy, the surgeon identifies Calot triangle but the anatomy is unclear and the gallbladder is severely inflamed. Which action best minimizes the risk of common bile duct injury?
5A 48-year-old man with a prior midline laparotomy presents with 24 hours of crampy abdominal pain, bilious emesis, and obstipation. Abdomen is distended and tender without peritonitis. CT shows dilated small bowel loops to a transition point in the mid-abdomen with decompressed distal bowel, no pneumatosis or free air, and no closed loop. Lactate is normal. What is the most appropriate initial management?
6In the AJCC 8th edition TNM staging of colon cancer, a tumor that has invaded through the muscularis propria into pericolorectal tissues with 4 positive regional lymph nodes and no distant metastases is staged as:
7A 65-year-old man has a biopsy-proven adenocarcinoma of the sigmoid colon. CT shows no metastases. Preoperative CEA is 8.2 ng/mL. Per NCCN 2026 guidelines for colon cancer resection, what is the minimum number of lymph nodes that should be examined to adequately stage the tumor?
8A 58-year-old man presents with a reducible right groin bulge that appears with straining. Exam confirms an inguinal hernia; he has no prior groin surgery. Which repair is considered the gold standard for primary unilateral inguinal hernia in an adult male in most open-repair settings?
9Which structure forms the medial border of the Hesselbach triangle?
10A 70-year-old man undergoes pancreaticoduodenectomy (Whipple) for a 2.5 cm pancreatic head adenocarcinoma. Postoperative pathology shows a negative margin, 2 of 18 lymph nodes positive. According to NCCN 2026, which adjuvant regimen offers the best overall survival in fit patients?
About the ABS General Surgery Exam
The ABS General Surgery Qualifying Examination (QE) is the written, computer-based portion of initial ABS certification in general surgery. Content spans alimentary tract (esophagus, stomach, small/large bowel, rectum, anorectal, bariatric), abdomen (hernia, biliary, pancreas, spleen), applied science and perioperative care (fluids/electrolytes, nutrition, wound healing, transfusion, pharmacology, anesthesia, immunology), surgical critical care (Surviving Sepsis Campaign 2021, ARDSnet ventilation, abdominal compartment syndrome), trauma (ATLS 10th edition, MTP 1:1:1, AAST organ grading, damage control), vascular (AAA, CEA, PAD, acute limb ischemia, mesenteric ischemia, aortic dissection), breast/skin/soft tissue (NCCN breast cancer, melanoma AJCC 8, sarcoma, necrotizing soft-tissue infection), endocrine (thyroid, parathyroid, adrenal, pancreatic NETs, MEN), head and neck, thoracic (NSCLC staging, SPN, pneumothorax, mediastinal masses), pediatric surgery basics, surgical oncology, transplantation basics, minimally invasive surgery and endoscopy, and ethics/biostatistics. Requires completion of an ACGME-accredited general surgery residency (5 years).
Questions
300 scored questions
Time Limit
1-day CBT (~8 hours including breaks)
Passing Score
Criterion-referenced scaled score set by ABS (modified Angoff standard)
Exam Fee
~$1,750 combined QE/CE application fee (ABS 2026 — verify current schedule) (American Board of Surgery (ABS) / Pearson VUE)
ABS General Surgery Exam Content Outline
Alimentary Tract
Esophagus (GERD, hiatal/paraesophageal hernia, achalasia — Heller myotomy + Dor fundoplication, Barrett's esophagus, esophageal cancer — NCCN staging and neoadjuvant), stomach (PUD, gastric cancer, GIST — imatinib for KIT/PDGFRA), small bowel (SBO, Crohn's — bowel-sparing, Meckel's diverticulum rule of 2s, carcinoid), colon (diverticulitis Hinchey classification, ulcerative colitis, colorectal cancer NCCN — screening age 45, CEA surveillance), rectum (TME, neoadjuvant chemoradiation, TAMIS/TEM for early T1), anorectal (hemorrhoids Goligher, fissure, fistula Parks, abscess), bariatric (ASMBS 2022 guidelines — RYGB, sleeve, SADI-S; deficiencies — B12, iron, thiamine Wernicke, calcium/vitamin D).
Applied Science & Perioperative Care
Preoperative risk (ASA, RCRI, NSQIP calculator, frailty), antibiotic prophylaxis (SCIP — cefazolin within 60 min, redose every 4 hr or blood loss >1,500 mL), VTE prophylaxis (Caprini), glycemic control, ERAS protocols; fluids/electrolytes (hypo/hypernatremia, K, Ca, Mg, acid-base); nutrition (enteral > parenteral when gut works, refeeding syndrome — phosphate, thiamine; immunonutrition); wound healing (phases, diabetic/vascular/pressure ulcers, NPWT); transfusion (MTP 1:1:1, TRALI, TACO, DIC, TEG); pharmacology; anesthesia (LAST, MH — dantrolene); immunology.
Abdomen — Hernia, Biliary, Pancreas, Spleen
Inguinal hernia (Lichtenstein, TEP, TAPP), ventral/incisional hernia (anterior/posterior component separation, TAR, Rives-Stoppa; mesh — synthetic vs biologic), hiatal/paraesophageal hernia, biliary (cholecystitis Tokyo Guidelines 2018, choledocholithiasis, Mirizzi syndrome, gallbladder cancer incidental, cholangiocarcinoma — Bismuth-Corlette), pancreas (acute pancreatitis revised Atlanta — interstitial vs necrotizing, walled-off necrosis; chronic pancreatitis; pancreatic adenocarcinoma — Whipple; IPMN — Fukuoka high-risk stigmata; pancreatic NETs including insulinoma/gastrinoma), spleen (trauma AAST, ITP, hereditary spherocytosis, post-splenectomy vaccines — pneumococcus, meningococcus, H. influenzae type b).
Surgical Critical Care
Shock classification, Surviving Sepsis Campaign 2021 hour-1 bundle (lactate, cultures before abx, broad-spectrum abx within 1 hr, 30 mL/kg crystalloid for hypotension/lactate ≥4, vasopressor — norepinephrine first-line, target MAP ≥65), mechanical ventilation (ARDSnet 6 mL/kg IBW, plateau <30, prone >12 hr for P/F <150, ECMO), hemodynamic monitoring (lactate clearance, ScvO2), AKI (KDIGO stages), abdominal compartment syndrome (WSACS — IAP >20 with new organ dysfunction), delirium (CAM-ICU, limit benzos), rhabdomyolysis, stress ulcer prophylaxis, ICU infections (VAP, CLABSI, CAUTI).
Vascular Surgery
AAA (USPSTF screening — men 65-75 ever-smokers; repair ≥5.5 cm, rapid expansion >0.5 cm/6 mo, symptomatic; EVAR vs open), carotid stenosis (CEA for symptomatic ≥50% within 2 wk, asymptomatic ≥70%; CREST — CEA vs CAS), PAD (ABI <0.9, claudication, CLI Rutherford 4-6, WIfI), acute limb ischemia (6 Ps — pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia; Rutherford I-III), mesenteric ischemia (SMA embolus most common; NOMI; mesenteric venous thrombosis; chronic — postprandial pain, sitophobia), aortic dissection (Stanford A — surgical; B — medical ± TEVAR for complicated), DVT/PE (IVC filter indications), hemodialysis access (AV fistula > graft > catheter).
Breast, Skin & Soft Tissue
Breast cancer NCCN — screening mammography age 40-50 start, BRCA1/2 testing criteria and prophylactic mastectomy, lumpectomy + RT equivalent survival to mastectomy (NSABP B-06), SLNB (Z0011 — T1-T2 cN0 with 1-2+ SLN may skip ALND), neoadjuvant for triple-negative/HER2+ (KEYNOTE-522 pembrolizumab), endocrine therapy (tamoxifen premenopausal, AIs postmenopausal); DCIS (VNPI), LCIS, inflammatory breast cancer, Paget's, fibroadenoma/phyllodes; melanoma (Breslow, AJCC 8, SLNB ≥0.8 mm or thin high-risk; WLE 0.5-2 cm; adjuvant anti-PD-1); SCC/BCC (Mohs for H-zone); soft-tissue sarcoma (extremity — limb-sparing + RT; retroperitoneal — en bloc); necrotizing soft tissue infection (LRINEC, emergency debridement).
Trauma
ATLS 10th edition primary/secondary survey (ABCDE), airway (RSI, surgical cricothyroidotomy), hemorrhagic shock classes I-IV, massive transfusion protocol (1:1:1 plasma:platelets:RBC), FAST/E-FAST, pelvic binder for unstable pelvis, damage control surgery and resuscitation (permissive hypotension, TXA within 3 hr — CRASH-2), blunt vs penetrating abdominal trauma, zones of neck trauma (I/II/III), thoracic (tension pneumothorax — needle decompression 5th ICS anterior axillary, cardiac tamponade — Beck's triad, ED thoracotomy for penetrating loss of vitals in transit), AAST liver/spleen/kidney grading, TBI (Monro-Kellie, CPP = MAP − ICP), extremity (Gustilo-Anderson open fx, compartment syndrome ΔP <30).
Endocrine Surgery
Thyroid (TIRADS, Bethesda cytology I-VI; papillary most common; follicular; medullary — calcitonin, RET proto-oncogene, MEN2A/2B; anaplastic; Hurthle cell; lobectomy vs total thyroidectomy; central/lateral neck dissection; RLN and parathyroid preservation), hyperparathyroidism (primary — single adenoma 80%, sestamibi-SPECT, intraoperative PTH — Miami criterion >50% drop at 10 min), adrenal (incidentaloma workup — biochemical functional assessment; pheochromocytoma — alpha blockade before beta, 24-hr metanephrines or plasma free metanephrines; Cushing's; Conn's — aldosterone/renin; adrenocortical carcinoma — mitotane), pancreatic neuroendocrine (insulinoma Whipple's triad, gastrinoma — Zollinger-Ellison with MEN1), MEN1 (3 Ps), MEN2A/2B.
Surgical Oncology
Cancer biology (oncogenes, tumor suppressors p53/RB/APC, MMR deficiency and MSI-H — Lynch syndrome, HER2), staging principles (AJCC 8, TNM), sentinel lymph node concept and pathways, surgical margins by tumor type, neoadjuvant vs adjuvant therapy, PET-CT and advanced imaging, immunotherapy (anti-PD-1 pembrolizumab/nivolumab, anti-CTLA-4 ipilimumab), targeted therapy (imatinib for GIST, trastuzumab for HER2+, BRAF/MEK inhibitors for melanoma), multidisciplinary decision-making per NCCN.
Thoracic Surgery
NSCLC (TNM 8, lobectomy + mediastinal nodal dissection > sublobar for peripheral ≤2 cm; VATS/RATS; induction for N2; SBRT for medically inoperable early stage), SCLC (limited vs extensive — chemoradiation), solitary pulmonary nodule (Fleischner Society — size, morphology, risk-based follow-up), spontaneous pneumothorax (indications for VATS — recurrence, persistent air leak, bilateral, high-risk occupation), pleural effusion (Light's criteria), empyema stages (exudative, fibrinopurulent, organizing — VATS decortication), mediastinal masses (anterior 4 Ts — thymoma, teratoma, thyroid, terrible lymphoma), chest wall trauma (flail chest).
Minimally Invasive Surgery & Endoscopy
Laparoscopy (CO2 pneumoperitoneum — physiologic effects on cardiac, pulmonary, renal; Veress needle vs Hasson; subcutaneous emphysema), port placement, energy devices (monopolar, bipolar, ultrasonic, advanced bipolar), robotic surgery basics, SAGES safe cholecystectomy — critical view of safety (2 structures entering gallbladder, cleared hepatocystic triangle, lower 1/3 liver bed exposed), endoscopy (EGD, colonoscopy screening/surveillance, ERCP for choledocholithiasis/cholangitis, EUS for staging), advanced therapeutic endoscopy (EMR, ESD, esophageal/duodenal stenting).
Head & Neck
Neck masses (branchial cleft cyst level II, thyroglossal duct cyst midline moves with swallow, cystic hygroma), salivary gland (parotid — pleomorphic adenoma most common benign, Warthin bilateral, mucoepidermoid most common malignant; facial nerve preservation), oral cavity and oropharyngeal SCC (HPV-associated better prognosis), laryngeal cancer staging, neck dissection levels I-VI, parathyroid exploration.
Pediatric Surgery
Congenital diaphragmatic hernia (Bochdalek posterolateral more common; delayed repair after stabilization), esophageal atresia/TEF (Gross type C most common), hypertrophic pyloric stenosis (Ramstedt pyloromyotomy, correct hypochloremic hypokalemic metabolic alkalosis first), intussusception (air/contrast reduction first-line), malrotation and midgut volvulus (Ladd's procedure), Hirschsprung disease (rectal suction biopsy — absent ganglion cells), necrotizing enterocolitis (pneumatosis intestinalis), biliary atresia (Kasai portoenterostomy <8 wk), Wilms tumor, neuroblastoma, inguinal hernia (high ligation), undescended testis.
Ethics, Biostatistics & Outcomes
Informed consent and shared decision-making, disclosure of complications, end-of-life care and goals-of-care conversations, surrogate decision-making, WHO surgical safety checklist, never events, biostatistics (sensitivity/specificity, PPV/NPV, LR+/LR−, NNT, relative vs absolute risk reduction), study design (RCT, cohort, case-control, cross-sectional, meta-analysis), NSQIP-based outcomes research, quality improvement and M&M conferences, root cause analysis.
Transplantation
Organ allocation (UNOS, MELD for liver — bilirubin, INR, creatinine, sodium; KDPI for kidney), brain death criteria and ancillary testing, DCD vs DBD, immunosuppression (induction — basiliximab/ATG; maintenance — calcineurin inhibitors tacrolimus/cyclosporine, antimetabolites mycophenolate/azathioprine, steroids, mTOR inhibitors sirolimus/everolimus), acute cellular vs antibody-mediated rejection, CMV and BK virus monitoring, post-transplant lymphoproliferative disease (EBV-driven).
How to Pass the ABS General Surgery Exam
What You Need to Know
- Passing score: Criterion-referenced scaled score set by ABS (modified Angoff standard)
- Exam length: 300 questions
- Time limit: 1-day CBT (~8 hours including breaks)
- Exam fee: ~$1,750 combined QE/CE application fee (ABS 2026 — verify current schedule)
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
ABS General Surgery Study Tips from Top Performers
Frequently Asked Questions
What is the ABS General Surgery Qualifying Examination?
The ABS General Surgery Qualifying Examination (QE) is the written, computer-based portion of initial board certification in general surgery administered by the American Board of Surgery. It is the first of two required examinations (Qualifying, then Certifying/Oral) for initial ABS certification. The QE tests breadth of knowledge across alimentary tract, abdomen, applied science and perioperative care, surgical critical care, trauma, vascular, breast/skin/soft tissue, endocrine, head and neck, thoracic, pediatric surgery basics, surgical oncology, transplantation, minimally invasive surgery and endoscopy, and ethics/biostatistics.
Who is eligible to take the ABS Qualifying Examination?
Candidates must satisfactorily complete an ACGME-accredited general surgery residency (5 clinical years) with program director attestation of clinical performance, professionalism, and ethics. A valid unrestricted medical license is required, along with submission of an operative experience report documenting the required ABS case minimums across alimentary tract, abdomen, vascular, trauma, endocrine, breast/skin/soft tissue, pediatric, and other defined index categories.
What is the format of the ABS QE?
The ABS Qualifying Exam is a 1-day computer-based examination administered at Pearson VUE test centers, comprising approximately 300 single-best-answer multiple-choice questions over roughly 8 hours including breaks. Items commonly include clinical vignettes, imaging (CT, ultrasound, endoscopy), intraoperative photographs, and laboratory data. The exam is blueprinted to the ABS content outline and aligned with the SCORE curriculum.
How much does the 2026 ABS QE cost?
The 2026 ABS combined Qualifying/Certifying Examination application fee is approximately $1,750 — always verify the current schedule on the ABS website. This fee covers the application for both QE and CE. Cancellation and refund policies follow the ABS schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and fee payment within the allowed qualification window.
When is the 2026 exam administered?
The ABS Qualifying Examination is typically offered each year — historically in the late summer or fall. Applications generally open several months before the administration window with a strict submission deadline. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABS examinations page.
How is the exam scored?
ABS uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail outcome depends on performance relative to the fixed cut-score, not on other candidates. Score reports include domain-level feedback. Candidates must pass the QE before becoming eligible for the Certifying (Oral) Examination.
What are the highest-yield topics?
Highest-yield topics include alimentary tract (especially colorectal cancer NCCN, diverticulitis Hinchey, IBD, rectal cancer TME with neoadjuvant), biliary (Tokyo Guidelines cholecystitis, choledocholithiasis, gallbladder cancer), pancreatic disease (revised Atlanta, IPMN Fukuoka, Whipple), hernia, bariatric surgery (ASMBS), ATLS 10th edition trauma algorithms with AAST grading, MTP 1:1:1, Surviving Sepsis Campaign 2021 hour-1 bundle, ARDSnet ventilation, abdominal compartment syndrome, AAA/CEA/PAD thresholds, mesenteric ischemia, breast cancer NCCN (Z0011, BRCA, neoadjuvant), melanoma AJCC 8 with SLNB thresholds, thyroid/parathyroid/adrenal including MEN syndromes, SAGES critical view of safety, and NSQIP-based outcomes and biostatistics.
How should I study for this exam?
Use a structured 12-18 month plan layered on residency. Map to the ABS content outline and SCORE curriculum: start with alimentary tract, abdomen, and perioperative care; then trauma, critical care, and vascular; then breast/endocrine/oncology/thoracic; finish with MIS/endoscopy, pediatric, transplant, and ethics/biostats. Integrate textbooks (Sabiston, Greenfield, Cameron's Current Surgical Therapy), SCORE modules, ABSITE review materials, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams. Drill NCCN, ATLS 10th ed, Surviving Sepsis 2021, ASMBS, and AAST organ grading.