100+ Free FRCS Gen Surg Practice Questions

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A patient with Graves' disease is being prepared for thyroidectomy. Which preoperative measure is most important to reduce the risk of a thyroid storm during surgery?

Withholding all medication on the day of surgery

Rendering the patient biochemically euthyroid with antithyroid drugs before operating

Giving radioactive iodine on the morning of surgery

Starting high-dose corticosteroids as the sole preparation

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Sample FRCS Gen Surg Practice Questions

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

1A 68-year-old man has a biopsy-proven adenocarcinoma of the upper rectum 12 cm from the anal verge. Staging MRI shows a T3 tumour with a clear circumferential resection margin and no threatened mesorectal fascia; CT shows no metastases. According to current UK practice, what is the most appropriate management?

A.Long-course chemoradiotherapy followed by total mesorectal excision

B.Primary anterior resection with total mesorectal excision

C.Abdominoperineal excision of the rectum

D.Defunctioning loop colostomy followed by palliative chemotherapy

Explanation: An upper rectal cT3 tumour with a clear mesorectal fascia and no high-risk features does not mandate neoadjuvant therapy. The standard curative option is anterior resection with total mesorectal excision (TME), achieving an oncologically complete specimen while preserving the sphincter complex.

2A 55-year-old woman has a 3 cm sigmoid adenocarcinoma confirmed on colonoscopy. Which lymphovascular pedicle must be ligated to achieve an oncologically adequate (high-tie) resection with complete mesocolic excision?

A.Ileocolic artery

B.Middle colic artery

C.Inferior mesenteric artery near its origin

D.Superior rectal artery only, preserving the inferior mesenteric trunk

Explanation: Sigmoid colon cancers drain along the sigmoid and superior rectal branches to nodes at the root of the inferior mesenteric artery (IMA). A high tie of the IMA close to its aortic origin gives the fullest nodal harvest and complete mesocolic excision for left-sided/sigmoid tumours.

3A 24-year-old man with a 10-year history of ulcerative colitis has surveillance colonoscopy showing flat high-grade dysplasia confirmed by two pathologists, with otherwise quiescent pancolitis. What is the most appropriate definitive surgical recommendation?

A.Endoscopic mucosal resection of the dysplastic area with continued surveillance

B.Increase maintenance immunomodulation and repeat colonoscopy in 6 months

C.Segmental colectomy of the affected segment

D.Restorative proctocolectomy with ileal pouch-anal anastomosis

Explanation: Confirmed flat high-grade dysplasia in chronic ulcerative colitis carries a high risk of synchronous or metachronous carcinoma across the whole at-risk mucosa. The standard curative operation is total proctocolectomy, usually as a restorative proctocolectomy with ileal pouch-anal anastomosis in a young, fit patient.

4A 40-year-old man presents with a tender, fluctuant swelling lateral to the anal margin with overlying erythema and fever. There is no obvious internal opening. What is the most appropriate immediate management?

A.Oral antibiotics and outpatient review

B.Incision and drainage under anaesthesia

C.Immediate fistulotomy

D.Endoanal ultrasound before any intervention

Explanation: A perianal abscess is a surgical emergency treated by prompt incision and drainage to relieve sepsis. Antibiotics alone are inadequate for an established collection. Searching for and laying open a fistula at the index drainage risks injury and is generally avoided.

5A 62-year-old woman presents with left iliac fossa pain, fever and a CT showing acute sigmoid diverticulitis with a 3 cm pericolic abscess but no free perforation. She is haemodynamically stable. What is the most appropriate first-line management?

A.Hartmann's procedure

B.Elective sigmoid colectomy on this admission

C.Laparoscopic lavage

D.Intravenous antibiotics with consideration of radiological (percutaneous) drainage

Explanation: A localised pericolic abscess (Hinchey Ib/II) in a stable patient is managed non-operatively with intravenous antibiotics; abscesses larger than around 3-4 cm may be drained percutaneously under image guidance. Most patients settle without acute surgery.

6A 70-year-old man presents with 3 days of abdominal distension, absolute constipation and a markedly dilated, ahaustral loop of bowel forming a coffee-bean shape pointing to the right upper quadrant on plain film. He has no peritonism. What is the most appropriate initial management?

A.Emergency laparotomy and sigmoid colectomy

B.Gastrografin enema and discharge

C.Flexible sigmoidoscopic decompression and placement of a flatus tube

D.Right hemicolectomy

Explanation: The coffee-bean sign of a sigmoid volvulus in a stable patient without peritonism is managed first by endoscopic decompression (flexible sigmoidoscopy) with insertion of a flatus tube, which untwists the loop and relieves the obstruction. Surgery is reserved for failed decompression, ischaemia or recurrence.

7A 30-year-old woman has perianal pain and bright red bleeding on defecation, with a midline posterior tear visible at the anal margin and a sentinel skin tag. Conservative measures over 8 weeks have failed. Which agent is the recommended first-line topical pharmacological treatment for a chronic anal fissure?

A.Topical glyceryl trinitrate (GTN)

B.Topical hydrocortisone

C.Topical lidocaine alone

D.Oral metronidazole

Explanation: Chronic anal fissures are perpetuated by internal sphincter hypertonia. Topical GTN (or diltiazem) reduces sphincter tone and promotes healing and is recommended first-line pharmacotherapy; lateral internal sphincterotomy is reserved for refractory cases.

8A 58-year-old man with a confirmed obstructing carcinoma at the splenic flexure presents with complete large bowel obstruction, a competent ileocaecal valve and a caecal diameter of 11 cm but no peritonism. What is the most appropriate definitive operation?

A.Loop transverse colostomy alone

B.Extended right hemicolectomy with primary anastomosis

C.Hartmann's procedure

D.Self-expanding metal stent as definitive treatment

Explanation: An obstructing splenic flexure cancer is best treated by extended right hemicolectomy, removing the tumour with its lymphatic drainage and allowing a tension-free ileocolic anastomosis on well-vascularised bowel. A closed-loop obstruction with a 11 cm caecum risks imminent caecal perforation and warrants resection.

9A 35-year-old man with Crohn's disease has a short (4 cm) symptomatic fibrotic stricture of the terminal ileum causing recurrent subacute obstruction. There is no active inflammation, abscess or fistula on imaging. What is the most appropriate surgical option to preserve bowel length?

A.Extended small bowel resection with primary anastomosis

B.Total colectomy

C.Heineke-Mikulicz strictureplasty

D.Permanent end ileostomy

Explanation: Short fibrotic Crohn's strictures without sepsis or fistulation are ideally treated by strictureplasty, which relieves obstruction while preserving bowel length and reducing the risk of short-bowel syndrome from repeated resections. The Heineke-Mikulicz technique suits short strictures.

10During a low anterior resection you perform an indocyanine green (ICG) fluorescence angiography assessment before fashioning the colorectal anastomosis. What is the principal purpose of this technique?

A.To identify the ureter and avoid injury

B.To map sentinel lymph nodes

C.To stage occult liver metastases

D.To assess perfusion of the bowel ends and reduce anastomotic leak

Explanation: ICG fluorescence angiography demonstrates real-time microvascular perfusion of the bowel ends, allowing the surgeon to select a well-perfused transection line and potentially reduce the risk of anastomotic leakage from ischaemia.

About the FRCS Gen Surg Exam

The FRCS (Gen Surg) is the UK and Ireland Intercollegiate Specialty Fellowship Examination in General Surgery, run by the JCIE for the four surgical Royal Colleges. Section 1 comprises two single best answer papers (240 questions over 4.5 hours) delivered at Pearson VUE centres, and is set to the standard of a day-one consultant in the generality of the specialty.

Assessment

Two sections. Section 1 is two computer-based single best answer (SBA) papers (240 questions total); passing Section 1 gives eligibility to proceed to Section 2, the clinical and structured oral examination.

Time Limit

Section 1: two papers of 2 hours 15 minutes each (4.5 hours total).

Passing Score

Criterion-referenced 'eligibility to proceed' standard set by examiners; no fixed published percentage pass mark.

Exam Fee

Total fee GBP 2,000 (Section 1 GBP 580; Section 2 GBP 1,420) up to 31 December 2026; GBP 2,070 from 1 January 2027. (Joint Committee on Intercollegiate Examinations (JCIE), the four UK & Ireland Royal Colleges of Surgeons)

FRCS Gen Surg Exam Content Outline

16%

Emergency Surgery & Trauma

Acute abdomen, ATLS trauma management, sepsis, haemorrhage and damage control surgery.

15%

Colorectal

Colorectal cancer, IBD, diverticular and anorectal disease and intestinal obstruction.

12%

General Surgery

Skin/soft tissue, hernia, perioperative care, nutrition and laparoscopic principles.

11%

HPB

Gallstone disease, pancreatitis and hepatobiliary and pancreatic tumours.

10%

Oesophagogastric (Upper GI)

Oesophageal and gastric cancer, reflux, motility, peptic ulcer and bariatric surgery.

10%

Breast

Benign breast disease, breast cancer treatment, axillary and risk-reducing surgery.

Endocrine

Thyroid, parathyroid and adrenal surgery and perioperative endocrine preparation.

Vascular

Aneurysms, limb ischaemia, carotid disease and vascular access.

Transplant

Transplant immunology, rejection, immunosuppression and organ donation.

Professional Standards

Consent, duty of candour, patient safety, governance and ethics.

Research and Statistics

Study design, statistical interpretation and diagnostic test performance.

General Surgery of Childhood

Paediatric conditions relevant to the general surgeon.

How to Pass the FRCS Gen Surg Exam

What You Need to Know

Passing score: Criterion-referenced 'eligibility to proceed' standard set by examiners; no fixed published percentage pass mark.
Assessment: Two sections. Section 1 is two computer-based single best answer (SBA) papers (240 questions total); passing Section 1 gives eligibility to proceed to Section 2, the clinical and structured oral examination.
Time limit: Section 1: two papers of 2 hours 15 minutes each (4.5 hours total).
Exam fee: Total fee GBP 2,000 (Section 1 GBP 580; Section 2 GBP 1,420) up to 31 December 2026; GBP 2,070 from 1 January 2027.

Keys to Passing

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

FRCS Gen Surg Study Tips from Top Performers

1Map your revision to the JCIE General Surgery Syllabus Blueprint and weight your time toward the high-yield areas of colorectal, upper GI, HPB and emergency general surgery.

2Practise single best answer questions under timed conditions to build the speed needed for 120 questions in 2 hours 15 minutes per paper, and review the rationale for every option.

3Anchor management answers to current UK standards (NICE, association guidelines and ATLS principles), since the exam tests safe, day-one-consultant decision making.

Frequently Asked Questions

How is the FRCS General Surgery Section 1 exam structured?

Section 1 consists of two computer-based single best answer papers, each with 120 questions over 2 hours 15 minutes (240 questions, 4.5 hours total), delivered at Pearson VUE centres in the UK and Ireland. Passing Section 1 gives eligibility to proceed to the Section 2 clinical and oral examination.

How much does the FRCS General Surgery exam cost?

Per the JCIE, the total examination fee is GBP 2,000 for exams up to 31 December 2026 (GBP 580 for Section 1 and GBP 1,420 for Section 2). From 1 January 2027 the total fee rises to GBP 2,070 (GBP 600 Section 1; GBP 1,470 Section 2).

What is the pass mark for FRCS General Surgery Section 1?

There is no fixed percentage pass mark. The JCIE uses criterion-referenced standard setting by trained examiners to determine the 'eligibility to proceed' mark, set at the standard of a day-one consultant in the generality of general surgery.

Who runs the FRCS General Surgery examination?

It is run by the Joint Committee on Intercollegiate Examinations (JCIE) on behalf of the four surgical Royal Colleges of the UK and Ireland (Edinburgh, England, Glasgow and the RCSI). Section 1 is delivered through Pearson VUE test centres.