Free Practice Questions for Iran General Surgery Board Exam

Gastrointestinal Surgery (جراحی دستگاه گوارش)

Comprehensive evaluation and operative management of disorders from the hypopharynx to the anal verge. Key topics include esophageal motor disorders (achalasia, high-resolution manometry, Heller myotomy, POEM), gastroesophageal reflux disease (Nissen vs Toupet fundoplication, magnetic sphincter augmentation, complications), Barrett esophagus and esophageal adenocarcinoma/squamous cell carcinoma (endoscopic mucosal resection, transhiatal vs Ivor Lewis esophagectomy, neoadjuvant chemoradiotherapy CROSS trial), Boerhaave syndrome and instrumental perforation, peptic ulcer disease and bleeding/perforated ulcer management (Graham patch, partial gastrectomy, truncal vagotomy), gastric adenocarcinoma (D2 lymphadenectomy, Lauren intestinal vs diffuse classification, perioperative FLOT chemotherapy), gastrointestinal stromal tumors (GIST, c-KIT/CD117, PDGFRA mutations, imatinib indications), small bowel obstruction (etiologies, strangulation signs, gastrografin challenge, laparoscopy vs laparotomy), Crohn disease (strictureplasty, ileocecal resection, terminal ileal sparing), acute mesenteric ischemia (SMA embolism vs thrombosis, non-occlusive mesenteric ischemia, surgical revascularization, second-look laparotomy), appendiceal diseases (acute appendicitis, phlegmon/abscess step-up, appendiceal carcinoid, goblet cell adenocarcinoma, pseudomyxoma peritonei), diverticular disease (Hinchey classification, Hartmann procedure vs primary resection with anastomosis and loop ileostomy), ulcerative colitis (restorative proctocolectomy with ileal pouch-anal anastomosis / IPAA), colorectal adenocarcinoma (TNM staging, total mesorectal excision / TME, neoadjuvant total neoadjuvant therapy / TNT for locally advanced rectal cancer, margin requirements), large bowel obstruction and volvulus (sigmoid vs cecal volvulus, detorsion vs urgent resection), and anorectal disease (cryptoglandular abscess, fistula-in-ano Goodsall rule, anal fissures, hemorrhoids, anal squamous cell carcinoma Nigro chemoradiation protocol).

Hepatobiliary, Pancreatic & Splenic Surgery (جراحی کبد، مجاری صفراوی، پانکراس و طحال)

Surgical diagnosis, anatomy, and operative interventions across the liver, biliary tree, pancreas, and spleen. Key topics include biliary colic and acute cholecystitis (Tokyo guidelines, critical view of safety of Strasberg, bail-out strategies like subtotal fenestrating or reconstituting cholecystectomy), choledocholithiasis and ascending cholangitis (Charcot triad, Reynolds pentad, urgent decompression via ERCP vs open/laparoscopic bile duct exploration), iatrogenic bile duct injury (Strasberg-Bismuth classification, principles of Roux-en-Y hepaticojejunostomy repair, timing of repair), gallbladder adenocarcinoma (depth of invasion, T1a vs T1b/T2 requiring extended cholecystectomy with liver wedge/bisegmentectomy and lymphadenectomy), cholangiocarcinoma (Bismuth-Corlette classification of perihilar Klatskin tumors), benign liver lesions (hemangioma, focal nodular hyperplasia, hepatic adenoma with malignant/rupture potential), liver abscesses (pyogenic drainage and antibiotics vs amebic metronidazole medical therapy), hydatid cyst of the liver (Echinococcus granulosus, WHO classification, PAIR technique vs operative cystectomy with hypertonic saline/povidone-iodine scolicidal precautions), hepatocellular carcinoma (Milan criteria for transplantation, Child-Pugh and MELD scoring, anatomic liver resections), acute pancreatitis (Revised Atlanta classification, timing of cholecystectomy in mild biliary pancreatitis, infected walled-off necrosis step-up approach), chronic pancreatitis (Frey, Beger, and Puestow-Partington procedures), pancreatic ductal adenocarcinoma (Whipple pancreaticoduodenectomy, distal pancreatectomy with splenectomy, borderline resectable criteria, vascular resection), pancreatic neuroendocrine tumors (insulinoma, gastrinoma Zollinger-Ellison syndrome, VIPoma, glucagonoma), pancreatic cystic lesions (IPMN main duct vs branch duct, mucinous cystic neoplasm vs serous cystadenoma), and splenic pathology (trauma grading, non-operative management criteria, indications for splenectomy in ITP and hereditary spherocytosis, post-splenectomy sepsis prevention with pneumococcal, meningococcal, and Haemophilus vaccines).

Surgical Oncology, Breast Disease & Endocrine Surgery (انکولوژی جراحی، پستان و غدد درون‌ریز)

Evidence-based management of benign and malignant conditions of the breast, thyroid, parathyroids, adrenals, and soft tissue. Key topics include breast masses and nipple discharge workup (triple assessment, BI-RADS classification), benign breast disease (fibroadenoma, phyllodes tumor margin requirements, intraductal papilloma, mastitis, breast abscess drainage), breast cancer (invasive ductal vs lobular carcinoma, DCIS, receptor status ER/PR/HER2, Ki-67, breast conservation therapy / lumpectomy plus radiation vs mastectomy, margin clearance, sentinel lymph node biopsy indications and ACOSOG Z0011 trial criteria for omitting axillary clearance, post-mastectomy radiation indications), thyroid nodules and cancer (Bethesda cytopathology classification, fine needle aspiration indications, papillary thyroid carcinoma surgical extent, follicular thyroid carcinoma capsular/vascular invasion, medullary thyroid carcinoma RET proto-oncogene screening and calcitonin monitoring, anaplastic thyroid carcinoma palliation, intraoperative nerve monitoring, management of postoperative hematoma, hypocalcemia, and recurrent laryngeal nerve palsy), primary hyperparathyroidism (symptomatic vs asymptomatic surgical guidelines, 99mTc-sestamibi and ultrasound localization, minimally invasive parathyroidectomy with intraoperative PTH monitoring Miami criterion, 4-gland hyperplasia in MEN syndromes), secondary and tertiary hyperparathyroidism in renal failure (subtotal parathyroidectomy vs total parathyroidectomy with autotransplantation), adrenal surgery (pheochromocytoma alpha-blockade with phenoxybenzamine prior to beta-blockade, primary aldosteronism Conn syndrome salt loading and venous sampling, Cushing disease vs adrenal adenoma, adrenocortical carcinoma open resection principles, adrenal incidentaloma size and imaging thresholds), and soft tissue sarcoma (core needle biopsy orientation, compartmental resection, margin status, perioperative radiation).

Trauma, Surgical Critical Care & Emergency Laparotomy (تروما، مراقبت‌های ویژه جراحی و لاپاراتومی اورژانس)

Acute trauma resuscitation, damage control surgery, and intensive care management of the critically ill surgical patient. Key topics include ATLS primary survey (airway control with cervical spine stabilization, surgical cricothyroidotomy vs tracheostomy, tension pneumothorax needle decompression and chest tube placement, open pneumothorax three-sided dressing, massive hemothorax thoracotomy thresholds), hemorrhagic shock physiology and classification (Classes I to IV, base deficit, serum lactate), balanced resuscitation and massive transfusion protocols (1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets; tranexamic acid administration within 3 hours), FAST examination and diagnostic peritoneal aspirate, damage control laparotomy (abbreviated initial procedure: rapid packing, visceral stapling, temporary abdominal closure, resuscitation in the ICU, scheduled second-look relaparotomy), blunt abdominal solid organ trauma (AAST grading of liver and spleen injuries, non-operative management hemodynamically stable criteria, angioembolization indications), penetrating abdominal trauma (mandatory laparotomy indications vs selective non-operative management), retroperitoneal hematoma exploration zones (Zone 1 mandatory exploration, Zone 2 and Zone 3 selective exploration), emergency department thoracotomy (penetrating trauma with witnessed cardiac arrest indications vs blunt trauma contraindications), abdominal compartment syndrome (bladder pressure measurement >20 mmHg with new organ failure, urgent decompressive laparotomy), and surgical critical care (Surviving Sepsis Campaign bundle, early goal-directed resuscitation, vasopressor selection with norepinephrine first-line, lung-protective ventilation with 6 mL/kg tidal volume in ARDS, enteral vs parenteral nutrition, stress ulcer and deep vein thrombosis prophylaxis, acute kidney injury KDIGO criteria, continuous renal replacement therapy).

Vascular Surgery & Abdominal Wall Hernias (جراحی عروق و فتق‌های جدار شکم)

Principles of vascular surgery and abdominal wall reconstruction. Key topics include chronic lower extremity peripheral artery disease (Fontaine and Rutherford classifications, ankle-brachial index / ABI, exercise therapy vs endovascular stenting vs bypass surgery), acute lower extremity limb ischemia (the 6 Ps: pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis; heparinization, urgent balloon catheter embolectomy, four-compartment calf fasciotomy to prevent reperfusion compartment syndrome), abdominal aortic aneurysms (ruptured AAA emergency open vs EVAR management, elective repair diameter thresholds 5.5 cm in men and 5.0 cm in women, rapid expansion criteria), carotid artery disease (symptomatic vs asymptomatic carotid stenosis thresholds, carotid endarterectomy / CEA vs carotid artery stenting, cranial nerve complications), acute deep vein thrombosis and pulmonary embolism (Wells score, anticoagulation protocols, catheter-directed thrombolysis, inferior vena cava filter indications), vascular access for hemodialysis (arteriovenous fistula Brescia-Cimino radiocephalic vs brachiocephalic, rule of 6s), abdominal wall anatomy (inguinal canal layers, myopectineal hole of Fruchaud, nerves at risk like iliohypogastric, ilioinguinal, and genitofemoral), inguinal hernia repairs (Lichtenstein tension-free mesh hernioplasty, Bassini and Shouldice tissue repairs, laparoscopic totally extraperitoneal / TEP and transabdominal preperitoneal / TAPP repairs), femoral hernia (high strangulation risk, McVay Cooper ligament repair, mesh plug), and ventral/incisional hernias (sublay/retromuscular Rives-Stoppa repair, transversus abdominis release / TAR, anterior component separation, loss of domain management, synthetic vs biologic mesh indications).

Pediatric Surgery, Transplantation & Perioperative Care (جراحی اطفال، پیوند اعضا و مراقبت‌های پیرامون عمل)

Pediatric surgical pathology, organ transplantation principles, and comprehensive perioperative optimization. Key topics include infantile hypertrophic pyloric stenosis (non-bilious projectile emesis, olive sign, hypochloremic hypokalemic metabolic alkalosis, fluid resuscitation prior to Ramstedt extramucosal pyloromyotomy), neonatal intestinal obstruction (bilious vomiting, duodenal atresia double-bubble sign, jejunoileal atresia, meconium ileus in cystic fibrosis), malrotation with midgut volvulus (upper GI contrast series corkscrew sign, emergency Ladd procedure), intussusception (currant jelly stool, target sign on ultrasound, air/hydrostatic enema reduction vs surgical reduction for peritonitis/lead point), Hirschsprung disease (delayed passage of meconium >48 hours, transition zone, rectal suction biopsy absence of ganglion cells, pull-through procedures), necrotizing enterocolitis (Bell staging, pneumatosis intestinalis, portal venous gas, indication for laparotomy or peritoneal drainage), congenital diaphragmatic hernia (Bochdalek vs Morgagni, pulmonary hypoplasia, delayed repair after stabilization), solid organ transplantation (brain death determination legal and clinical criteria, donor organ preservation, cold and warm ischemia times, kidney transplantation vascular and ureteral anastomosis, liver transplantation piggyback vs caval replacement), immunosuppressive regimens (calcineurin inhibitors tacrolimus/cyclosporine, antiproliferative agents mycophenolate mofetil, corticosteroids, mTOR inhibitors), graft rejection (hyperacute preformed antibodies, acute cellular T-cell mediated, chronic allograft vasculopathy), and perioperative medicine (preoperative cardiac risk stratification RCRI, pulmonary optimization, management of perioperative anticoagulants and antiplatelet drugs, perioperative antimicrobial prophylaxis timing and redosing, postoperative fever evaluation '5 Ws', and enhanced recovery after surgery / ERAS pathways).