100+ Free Facharzt FMH Chirurgie Practice Questions

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2026 Statistics

Key Facts: Facharzt FMH Chirurgie Exam

Basisexamen + SGC

Exam Format

SIWF / SGC Examination Regulations

100–120

Written Basisexamen MCQs

Swiss College of Surgeons (SCS)

6 Years

Postgraduate Training

SIWF Weiterbildungsprogramm

CHF 1,600

Total Exam Fees (Basis + SGC)

SGC / Basisexamen Guidelines

Lifetime

FMH Title Validity

Swiss Medical Association (FMH)

100

Practice Questions

OpenExamPrep

The Facharzt FMH Chirurgie credential certifies specialist general surgeons in Switzerland through SIWF and SGC. Examination assessment comprises the written Basisexamen Chirurgie (100–120 MCQs in English) and the SGC oral clinical board, covering visceral surgery, traumatology, surgical oncology, perioperative critical care, and vascular emergencies.

Sample Facharzt FMH Chirurgie Practice Questions

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

1A 24-year-old previously healthy male presents to the emergency department with a 14-hour history of periumbilical pain that has migrated to the right lower quadrant. He reports anorexia, low-grade fever (38.1°C), and localized tenderness with guarding at McBurney's point (Alvarado score 8). Laboratory tests show a white blood cell count of 14.5 × 10^9/L with 82% neutrophils and a CRP of 38 mg/L. Abdominal ultrasound demonstrates a non-compressible, blind-ending tubular structure in the right iliac fossa measuring 8.5 mm in outer diameter with surrounding hyperechoic fat stranding. What is the standard evidence-based management of choice?

A.Laparoscopic appendectomy within 24 hours of admission

B.Immediate right hemicolectomy with primary ileocolic anastomosis

C.Outpatient oral ciprofloxacin and metronidazole without hospital admission

D.Strict nonoperative management with high-dose intravenous corticosteroids

Explanation: Laparoscopic appendectomy is the gold-standard surgical treatment for acute uncomplicated appendicitis. According to EAES and WSES guidelines, laparoscopic appendectomy offers lower surgical site infection rates, reduced postoperative pain, shorter hospital stays, and faster return to normal activities compared to open surgery, and should be performed within 24 hours of presentation.

2A 48-year-old female presents with a 6-day history of right lower quadrant abdominal pain, fever (38.8°C), and palpable right iliac fossa fullness. She is hemodynamically stable without diffuse peritonitis. Contrast-enhanced CT reveals a perforated retrocecal appendicitis with a well-defined 5.2 cm fluid collection (abscess) containing gas bubbles, walled off by the cecum and terminal ileum. What is the most appropriate initial management strategy according to WSES guidelines?

A.Immediate emergency open right hemicolectomy with end ileostomy

B.Percutaneous image-guided catheter drainage combined with intravenous broad-spectrum antibiotics, followed by optional interval appendectomy

C.Emergency diagnostic laparoscopy with extensive blunt dissection of the inflammatory mass to perform appendectomy

D.Immediate colonoscopic transcecal stent placement into the abscess cavity

Explanation: For complicated acute appendicitis presenting with a well-circumscribed abscess >3–4 cm (appendiceal phlegmon/abscess) in a hemodynamically stable patient without generalized peritonitis, initial nonoperative management with image-guided percutaneous drainage and broad-spectrum intravenous antibiotics is recommended. Immediate surgery in the setting of severe localized inflammatory phlegmon is associated with high morbidity, extensive tissue tearing, and a significantly higher rate of unintended ileocecal resection.

3A 52-year-old woman presents to the emergency department with a 36-hour history of severe right upper quadrant colicky pain radiating to the right scapula, accompanied by nausea and fever (38.3°C). Physical examination reveals a positive Murphy's sign. Transabdominal ultrasound demonstrates gallstones, a thickened gallbladder wall (5 mm), and pericholecystic fluid. Laboratory tests show WBC 13.2 × 10^9/L, total bilirubin 18 µmol/L (normal <21), and normal liver enzymes. According to the Tokyo Guidelines 2018 (TG18), what is the optimal management?

A.Elective laparoscopic cholecystectomy after 6 to 8 weeks of outpatient oral antibiotic therapy

B.Endoscopic retrograde cholangiopancreatography (ERCP) with routine biliary sphincterotomy prior to any surgery

C.Early laparoscopic cholecystectomy during the index admission, ideally within 72 hours of symptom onset

D.Percutaneous transhepatic gallbladder drainage (cholecystostomy) as definitive curative treatment

Explanation: According to the Tokyo Guidelines 2018 (TG18) and European surgical guidelines, early laparoscopic cholecystectomy performed within 72 hours of symptom onset (or during the index admission) is the treatment of choice for acute calculous cholecystitis Grade I (mild) and Grade II (moderate) in surgical candidates. Early intervention reduces overall hospital stay, complications, and the risk of recurrent biliary events compared with delayed elective surgery.

4A 74-year-old male is admitted with a 24-hour history of severe right upper quadrant pain, high-spiking fevers with rigors (39.5°C), jaundice, confusion, and hypotension (blood pressure 82/50 mmHg, heart rate 124 bpm, refractory to fluid bolus). Laboratory evaluation reveals total bilirubin 95 µmol/L, alkaline phosphatase 420 U/L, WBC 22.0 × 10^9/L, and arterial lactate 4.1 mmol/L. Abdominal ultrasound shows common bile duct dilatation (14 mm) with an impacted stone at the distal choledochus. What is the most critical emergency intervention after initiating resuscitation and broad-spectrum antibiotics?

A.Emergency open choledochotomy and T-tube placement under general anesthesia

B.Immediate intravenous administration of high-dose corticosteroids and ursodeoxycholic acid

C.Emergent exploratory laparotomy with subtotal cholecystectomy

D.Urgent biliary decompression via Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy/stenting

Explanation: This patient presents with acute obstructive cholangitis complicated by Reynolds' pentad (fever, jaundice, RUQ pain, confusion, and septic shock; Tokyo Guidelines Grade III severe cholangitis). The cornerstone of emergency management is urgent biliary decompression, preferentially achieved via ERCP with biliary sphincterotomy and/or stent placement (or percutaneous transhepatic biliary drainage if ERCP fails). Delay in biliary decompression carries an extremely high mortality rate.

5An 81-year-old woman with a history of recurrent biliary colic presents with vomiting, crampy abdominal pain, and abdominal distension. Abdominal CT demonstrates small bowel obstruction with dilated jejunal loops, air within the intrahepatic biliary tree (pneumobilia), and a 3.5 cm calcified intraluminal mass lodged in the terminal ileum. What is the most appropriate emergency operative procedure?

A.Enterolithotomy alone via longitudinal enterotomy proximal to the stone with transverse closure

B.Emergency one-stage enterolithotomy, cholecystectomy, and cholecystoduodenal fistula takedown

C.Right hemicolectomy with primary ileocolic anastomosis

D.Endoscopic laser lithotripsy through retrograde colonoscopy

Explanation: This patient has gallstone ileus with classic Rigler's triad (pneumobilia, mechanical small bowel obstruction, and an ectopic gallstone in the terminal ileum). In elderly, often fragile patients, the standard emergency operation of choice is enterolithotomy alone: a longitudinal enterotomy is made in healthy bowel proximal to the impacted stone, the stone is extracted, and the bowel is closed transversely to prevent luminal narrowing. Attempting simultaneous one-stage cholecystectomy and fistula takedown in the emergency setting significantly increases operative time, morbidity, and mortality.

6A 54-year-old male with severe acute necrotizing pancreatitis is in the surgical ICU on day 24 of hospitalization. Over the past 48 hours, he has developed new-onset high fever (39.1°C), worsening leukocytosis (24.0 × 10^9/L), and increasing vasopressor requirements. Contrast-enhanced CT reveals a 12 cm walled-off pancreatic necrosis (WON) in the lesser sac containing multiple bubbles of retroperitoneal gas. According to the PANTER trial and international consensus guidelines (revised Atlanta / IAP-APA), what is the optimal surgical strategy?

A.Immediate emergency open necrosectomy and continuous high-volume postoperative peritoneal lavage

B.Step-up approach starting with image-guided percutaneous or endoscopic transluminal catheter drainage, followed by minimally invasive retroperitoneal necrosectomy if clinical improvement is not achieved

C.Immediate total pancreatectomy and splenectomy to eradicate the septic focus

D.Continued conservative medical therapy with high-dose intravenous imipenem without any drainage

Explanation: For infected walled-off pancreatic necrosis (WON), the landmark PANTER trial and international guidelines established the superiority of the minimally invasive 'step-up approach' over upfront open necrosectomy. The step-up approach begins with percutaneous catheter drainage or endoscopic transluminal (transgastric) drainage. In approximately 35–50% of patients, catheter drainage alone resolves the infection; those who fail to improve progress to minimally invasive necrosectomy (such as video-assisted retroperitoneal debridement [VARD] or endoscopic necrosectomy), resulting in lower rates of major complications, new-onset diabetes, and death.

7A 36-year-old male presents with sudden, catastrophic epigastric pain that began 3 hours ago. On examination, his abdomen is rigid and tender throughout ('board-like abdomen'). Upright chest radiograph demonstrates free subdiaphragmatic air (pneumoperitoneum). He is hemodynamically stable without a history of NSAID use or prior ulcer disease. Emergent diagnostic laparoscopy reveals a 5 mm perforation on the anterior wall of the first part of the duodenum with chemical peritonitis. What is the definitive surgical procedure of choice?

A.Distal gastrectomy with Roux-en-Y gastrojejunostomy and truncal vagotomy

B.Pyloroplasty with highly selective vagotomy and distal duodenal resection

C.Primary suture repair of the perforation with an omental patch (Graham patch) and thorough peritoneal lavage

D.Placement of a nasogastric tube and conservative observation with intravenous omeprazole alone

Explanation: Primary closure reinforced with a vascularized pedicled omental patch (Graham patch repair or modified Cellan-Jones technique) combined with thorough peritoneal irrigation is the standard surgical treatment for perforated anterior duodenal peptic ulcers (<2 cm). In the era of potent proton pump inhibitors (PPIs) and Helicobacter pylori eradication, definitive acid-reducing surgeries (such as vagotomy or gastrectomy) are no longer routinely indicated in acute emergency perforation.

8A 62-year-old male presents with left lower quadrant abdominal pain, localized guarding, and fever (38.5°C). Contrast-enhanced abdominal CT confirms acute sigmoid diverticulitis with a 5.5 cm well-circumscribed fluid and gas collection in the pelvis (Hinchey stage II abscess). He is hemodynamically stable without generalized peritonitis. What is the recommended management according to WSES and EAES guidelines?

A.Emergency Hartmann procedure with open sigmoid resection and end colostomy

B.Immediate colonoscopy to irrigate and drain the diverticular orifice

C.Elective sigmoid resection after 6 months of continuous oral antibiotic therapy

D.Percutaneous CT-guided catheter drainage combined with intravenous broad-spectrum antibiotic therapy

Explanation: According to the modified Hinchey classification, a distant pelvic or retroperitoneal abscess >3–4 cm corresponds to Hinchey II diverticulitis. In a hemodynamically stable patient without generalized peritonitis, image-guided (CT or ultrasound) percutaneous drainage combined with intravenous antibiotics is the preferred first-line treatment. This allows source control and sepsis resolution, often converting an emergency operation into a safe, elective single-stage laparoscopic sigmoid resection at a later date.

9A 70-year-old female presents to the resuscitation bay in septic shock (BP 75/40 mmHg, heart rate 130 bpm, arterial lactate 5.2 mmol/L) with severe diffuse abdominal rigidity and rebound tenderness. Contrast CT shows extensive free air and massive intra-abdominal fluid consistent with perforated diverticulitis and feculent peritonitis (Hinchey stage IV). Despite initial fluid resuscitation and vasopressors, she remains unstable. What is the most appropriate emergency operative intervention?

A.Hartmann's procedure (sigmoid resection with end colostomy and rectal stump closure) with extensive abdominal lavage

B.Laparoscopic peritoneal lavage and drain placement without bowel resection

C.Sigmoid resection with primary colo-rectal anastomosis and no diverting stoma

D.Primary suture repair of the sigmoid diverticular perforation and omental patch

Explanation: In perforated acute diverticulitis with diffuse feculent peritonitis (Hinchey IV) and hemodynamic instability or septic shock, the Hartmann procedure (resection of the diseased sigmoid colon, creation of a terminal end colostomy, and closure of the rectal stump) remains the safest emergency operative standard. While primary resection with anastomosis and protective loop ileostomy is an alternative in stable Hinchey III patients, unstable patients in septic shock require rapid, definitive source control without anastomosis.

10A 72-year-old male with permanent atrial fibrillation on irregular anticoagulation presents with acute, excruciating central abdominal pain of 4 hours' duration. On examination, the abdomen is soft and non-distended with minimal localized tenderness, representing pain completely out of proportion to physical signs. His serum lactate is 3.8 mmol/L. Emergent biphasic CT angiography reveals an abrupt cutoff of contrast in the proximal superior mesenteric artery (SMA) 4 cm distal to its origin, with poor enhancement of the jejunum and ileum. What is the most appropriate next step in management?

A.Immediate continuous intravenous infusion of broad-spectrum antibiotics and heparin without operative intervention

B.Immediate emergency exploratory laparotomy, surgical SMA embolectomy with a Fogarty catheter, assessment of bowel viability, and planned second-look laparotomy at 24–48 hours

C.Urgent colonoscopy to assess mucosal ischemia of the splenic flexure

D.Transcatheter thrombolysis with tissue plasminogen activator (tPA) followed by discharge to the ward

Explanation: Acute superior mesenteric artery (SMA) embolism presenting with acute abdominal pain out of proportion to physical findings requires urgent surgical revascularization. Standard management entails emergency exploratory laparotomy, transverse arteriotomy of the SMA, Fogarty balloon catheter embolectomy, assessment of intestinal viability, resection of frank necrotic segments with temporary closure or damage control, and a mandatory planned 'second-look' laparotomy in 24–48 hours to reassess borderline bowel.

About the Facharzt FMH Chirurgie Exam

The Facharzt FMH für Chirurgie (Specialist in General Surgery FMH) is the Swiss Federal specialist title granting full independent practice rights in general surgery across Switzerland. Governed by the SIWF (Swiss Institute for Postgraduate and Continuous Medical Training) and the SGC (Swiss Society of Surgery), board qualification requires completing a 6-year accredited postgraduate training program (including the 2-year Core Surgical Curriculum), passing the written Basisexamen Chirurgie as the common-trunk foundation, and successfully defending standardized clinical case vignettes at the SGC oral-practical board examination. The syllabus encompasses acute visceral surgery and the acute abdomen, emergency traumatology and ATLS principles, gastrointestinal surgical oncology, abdominal wall and hernia surgery, perioperative critical care and complication management, and essential vascular and endocrine surgical conditions. Note on format and language: While the official written Basisexamen Chirurgie is administered in English and the SGC oral examination is conducted in Swiss national languages (German/French) or English, this question bank is an English-language multiple-choice study adaptation created by OpenExamPrep—not an official SIWF/SGC examination release—specifically designed to train high-yield clinical decision-making, operative indications, trauma algorithms, and complication management.

Assessment

Two-part qualifying examination: 1) The written Basisexamen Chirurgie consisting of 100–120 multiple-choice questions administered in English by the Swiss College of Surgeons, and 2) The SGC oral-practical board examination consisting of structured clinical case discussions covering visceral surgery and traumatology before senior Swiss surgical examiners.

Time Limit

180–240 minutes written examination plus approximately 60–90 minutes structured oral examination

Passing Score

Criterion-referenced standard pass on the written Basisexamen Chirurgie (typically ~60–65% raw score) and structured passing marks across all oral examination stations assessed by the SGC examination committee

Exam Fee

Basisexamen Chirurgie fee CHF 600; SGC Oral Board Examination fee CHF 1,000; SIWF FMH Title Application fee CHF 1,000–2,500 (Schweizerisches Institut für ärztliche Weiter- und Fortbildung (SIWF / FMH) and Schweizerische Gesellschaft für Chirurgie (SGC / SSC) / Swiss College of Surgeons)

Facharzt FMH Chirurgie Exam Content Outline

25%

Visceral Surgery & Acute Abdomen

Evidence-based workup, differential diagnosis, and operative decision-making for acute appendicitis, acute cholecystitis and cholangitis (Tokyo Guidelines), acute pancreatitis (Atlanta classification and step-up necrosis management), diverticulitis (Hinchey staging and emergency resection), small and large bowel obstruction, perforated peptic ulcer, acute mesenteric ischemia, upper/lower GI bleeding, and peritonitis.

22%

Traumatology, ATLS & Damage Control Surgery

ATLS principles, primary and secondary surveys, tension pneumothorax and massive hemothorax management, emergency resuscitative thoracotomy, FAST ultrasound, nonoperative vs operative management of solid organ injuries (spleen, liver, kidney), unstable pelvic fractures with preperitoneal packing/angioembolization, damage control laparotomy, open abdomen management, and extremity/abdominal compartment syndrome.

20%

Gastrointestinal Oncology & Abdominal Wall / Hernia Surgery

Staging and oncologic resections for colorectal cancer (CME, TME, obstruction management), gastric adenocarcinoma (D2 gastrectomy, FLOT regimen), pancreatic ductal adenocarcinoma (Whipple procedure), liver metastases, GIST, and gastrointestinal polyposis syndromes. Comprehensive hernia surgery including inguinal hernia repair (TAPP, TEP, Lichtenstein), femoral hernia, incisional hernia (retromuscular sublay, component separation), and strangulated defects.

18%

Perioperative Management, Surgical Critical Care & Complications

Enhanced Recovery After Surgery (ERAS) protocols, fluid resuscitation, shock pathophysiology, massive transfusion protocols (1:1:1), thromboembolism prophylaxis, surgical site infection (SSI) prevention and CDC classification, necrotizing soft tissue infections (NSTI / Fournier gangrene), anastomotic leak detection and intervention, burst abdomen (Platzbauch), surgical nutrition (ESPEN guidelines), and Sepsis-3 resuscitation.

15%

Vascular Surgery Essentials, Endocrine Surgery & Bariatrics

Emergency and elective management of ruptured and asymptomatic abdominal aortic aneurysms (EVAR vs open repair), acute limb ischemia (6 Ps, Fogarty embolectomy, fasciotomy), carotid stenosis, thyroidectomy principles and complications (recurrent laryngeal nerve injury, hypocalcemia), primary hyperparathyroidism, adrenal incidentalomas/pheochromocytoma, and bariatric surgery (RYGB, sleeve gastrectomy, internal hernia Peterson's defect).

How to Pass the Facharzt FMH Chirurgie Exam

What You Need to Know

Passing score: Criterion-referenced standard pass on the written Basisexamen Chirurgie (typically ~60–65% raw score) and structured passing marks across all oral examination stations assessed by the SGC examination committee
Assessment: Two-part qualifying examination: 1) The written Basisexamen Chirurgie consisting of 100–120 multiple-choice questions administered in English by the Swiss College of Surgeons, and 2) The SGC oral-practical board examination consisting of structured clinical case discussions covering visceral surgery and traumatology before senior Swiss surgical examiners.
Time limit: 180–240 minutes written examination plus approximately 60–90 minutes structured oral examination
Exam fee: Basisexamen Chirurgie fee CHF 600; SGC Oral Board Examination fee CHF 1,000; SIWF FMH Title Application fee CHF 1,000–2,500

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Facharzt FMH Chirurgie Study Tips from Top Performers

1Master ATLS 10th Edition Resuscitation Algorithms: Be completely fluent in primary survey ABCDE priorities, indications for emergency cricothyroidotomy vs intubation, needle and tube thoracostomy landmarks, FAST views, pelvic binder application, and the lethal triad of hypothermia, acidosis, and coagulopathy.

2Understand Acute Abdominal Guidelines & Classifications: Know the exact criteria for Tokyo Guidelines 2018 (acute cholecystitis/cholangitis), revised Atlanta criteria for acute pancreatitis (interstitial vs necrotizing, timing of step-up drainage >4 weeks), and Hinchey classification for diverticular perforation.

3Memorize Surgical Anatomy & Hernia Planes: Understand the 'Triangle of Doom' (iliac vessels) and 'Triangle of Pain' (nerves) in laparoscopic groin hernia repairs (TAPP/TEP), Hesselbach's triangle boundaries, and abdominal wall layers for retromuscular sublay (Rives-Stoppa) and transversus abdominis release (TAR).

4Prioritize Vascular and Critical Care Emergencies: Recognize the 6 Ps of acute limb ischemia and immediate management (IV heparin, Fogarty embolectomy, fasciotomy thresholds), permissive hypotension in ruptured AAA, CDC surgical site infection definitions, and ERAS protocol elements.

5Review Oncologic Resection Standards: Understand oncologic safety margins and lymph node yields, including complete mesocolic excision (CME) with high vascular ligation (≥12 nodes), total mesorectal excision (TME) planes with circumferential margins (CRM), and D2 lymphadenectomy for gastric cancer.

Frequently Asked Questions

What is the Facharzt FMH für Chirurgie title?

The Facharzt FMH für Chirurgie is the federally recognized specialist qualification in general surgery awarded by the SIWF (Swiss Institute for Postgraduate and Continuous Medical Training) and FMH upon completing at least 6 years of structured postgraduate surgical training, passing the Basisexamen Chirurgie and SGC oral board examination, and fulfilling all surgical logbook minimums.

How is the Swiss General Surgery specialist examination structured?

The examination consists of two mandatory parts: 1) The written Basisexamen Chirurgie (administered in English, containing 100–120 MCQs assessing core surgical knowledge), and 2) The SGC oral-practical board examination, which tests clinical judgment, diagnostic prioritization, operative decision-making, and emergency management across structured case stations before senior Swiss surgical examiners.

When can surgical residents take the Basisexamen Chirurgie?

Surgical residents are recommended to take the Basisexamen Chirurgie during their second or third year of postgraduate training, after completing at least one full year of accredited clinical surgery. Passing the Basisexamen (or completing the accredited Core Surgical Curriculum certificate) is a mandatory prerequisite for registering for the final SGC oral board examination.

In what language is the examination administered?

The written Basisexamen Chirurgie is administered entirely in English across all Swiss examination centers. The subsequent SGC oral board examination is conducted in Swiss national languages (German or French) or in English upon prior agreement.

Why is this practice bank presented in English?

The official written Basisexamen Chirurgie is formulated and administered exclusively in English by the Swiss College of Surgeons. International surgical literature, ATLS guidelines, and European consensus statements are predominantly published in English. This practice bank adapts Swiss and European surgical curriculum standards into 100 high-yield English-language questions.

What are the core trauma and visceral emergencies most frequently tested?

High-yield topics include damage control resuscitation (1:1:1 transfusion and TXA), unstable pelvic fractures with preperitoneal packing, step-up necrosectomy for acute pancreatitis, Hinchey diverticulitis management, mesenteric ischemia revascularization, nonoperative vs operative management of splenic and hepatic trauma, and acute compartment syndromes.

100+ Free Facharzt FMH Chirurgie Practice Questions

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