General Surgery Qualifying Examination (GSQE) — Questions and Answers

Question 1: Regarding the Universal Protocol (Time-Out), which element is MANDATORY before every surgical procedure?

Verbal confirmation of patient identity, site, and procedure by all team members (Correct answer)
Completion of a pre-anesthesia pharmacology checklist
Presence of the hospital administrator
Review of the patient's insurance information

Correct answer: Verbal confirmation of patient identity, site, and procedure by all team members

The Universal Protocol requires an active verbal time-out confirming patient identity, operative site, and procedure with all team members present before incision.

Question 2: Which metric is used by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) as a primary outcome measure?

Length of ICU stay
90-day readmission rate
30-day morbidity and mortality (Correct answer)
Intraoperative complication rate

Correct answer: 30-day morbidity and mortality

ACS NSQIP tracks 30-day postoperative morbidity and mortality as its primary outcomes to allow risk-adjusted, peer-to-peer hospital comparison.

Question 3: Which principle of the ACS Code of Professional Conduct is best illustrated by a surgeon who discloses a financial conflict of interest before recommending a specific surgical implant?

Justice
Autonomy
Transparency and honesty (Correct answer)
Beneficence

Correct answer: Transparency and honesty

Disclosing conflicts of interest exemplifies transparency and honesty, a core ACS professional conduct principle.

Question 4: Which of the following is an absolute contraindication to laparoscopic appendectomy?

Pregnancy in the third trimester
Morbid obesity
Uncorrected coagulopathy (Correct answer)
Prior lower abdominal surgery

Correct answer: Uncorrected coagulopathy

Uncorrected coagulopathy is an absolute contraindication to any laparoscopic surgery due to uncontrollable bleeding risk; the other options are relative contraindications.

Question 5: A patient with a penetrating abdominal injury is found to have free air under the diaphragm on plain X-ray and is hemodynamically stable. What is the next best step?

Diagnostic peritoneal lavage
CT scan of abdomen and pelvis
Observation and repeat imaging in 6 hours
Immediate exploratory laparotomy (Correct answer)

Correct answer: Immediate exploratory laparotomy

Free air under the diaphragm following penetrating abdominal trauma is an absolute indication for immediate exploratory laparotomy regardless of hemodynamic status.

Question 6: Which artery is most commonly injured during laparoscopic cholecystectomy leading to a major vascular complication?

Cystic artery
Right hepatic artery (Correct answer)
Hepatic artery proper
Gastroduodenal artery

Correct answer: Right hepatic artery

The right hepatic artery is the most commonly injured major artery during laparoscopic cholecystectomy, often misidentified as the cystic artery in a short cystic duct scenario.

Question 7: A patient develops perioral tingling and carpopedal spasm 24 hours after total thyroidectomy. What is the most likely diagnosis?

Bilateral RLN injury
Thyroid storm
Hypocalcemia from hypoparathyroidism (Correct answer)
Wound hematoma with airway compression

Correct answer: Hypocalcemia from hypoparathyroidism

Perioral tingling and carpopedal spasm (Trousseau sign) are classic signs of hypocalcemia from inadvertent parathyroid removal or devascularization during thyroidectomy.

Question 8: The Anti-Kickback Statute (AKS) is violated when remuneration is offered to induce referrals of items or services covered by federal health care programs. The AKS differs from the Stark Law in that AKS:

Is enforced exclusively by the FDA
Applies only to physician self-referrals
Requires proof of intent and applies to all health care providers, not just physicians (Correct answer)
Is a civil statute that requires no showing of intent

Correct answer: Requires proof of intent and applies to all health care providers, not just physicians

Unlike the strict-liability Stark Law, the AKS is an intent-based criminal statute that applies broadly to any person offering or receiving remuneration to induce federal program referrals.

Question 9: Heterogeneity in a meta-analysis is quantified by the I² statistic. An I² of 75% indicates:

Minimal heterogeneity; a fixed-effects model is appropriate
Substantial heterogeneity suggesting caution in interpreting the pooled estimate (Correct answer)
Moderate heterogeneity that does not affect pooling
That 75% of studies should be excluded from the analysis

Correct answer: Substantial heterogeneity suggesting caution in interpreting the pooled estimate

I² > 50–75% indicates substantial heterogeneity, which means study results vary considerably and the pooled estimate must be interpreted cautiously.

Question 10: A 55-year-old woman undergoes laparoscopic cholecystectomy. Intraoperatively, bile is noted in the abdomen and the common bile duct appears divided. What is the most appropriate intraoperative response?

Clip both ends of the duct and abort the case
Place a drain and complete the case, repair later
Primary repair over a T-tube and proceed
Convert to open and consult hepatobiliary surgery (Correct answer)

Correct answer: Convert to open and consult hepatobiliary surgery

An intraoperative major bile duct injury should prompt immediate conversion to open laparotomy and consultation with an experienced hepatobiliary surgeon for definitive repair.

Question 11: What is the first step in risk assessment for General Surgery Board Review professionals?

Identifying potential hazards and vulnerabilities in the specific context (Correct answer)
Delegating to others
Purchasing insurance
Implementing controls immediately

Correct answer: Identifying potential hazards and vulnerabilities in the specific context

This is fundamental to General Surgery Board Review practice. Identifying potential hazards and vulnerabilities in the specific context represents the professional standard for risk management in the General Surgery Board Review certification framework.

Question 12: A patient presents with profuse secretory watery diarrhea (>3 L/day), severe hypokalemia, and achlorhydria. CT reveals a 3 cm pancreatic tail mass. What is the diagnosis?

VIPoma (WDHA syndrome) (Correct answer)
Carcinoid tumor with carcinoid syndrome
Insulinoma
Gastrinoma

Correct answer: VIPoma (WDHA syndrome)

VIPoma causes WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria), also called Verner-Morrison syndrome; VIP inhibits gastric acid secretion (achlorhydria distinguishes it from gastrinoma, which causes acid hypersecretion).

Question 13: A patient declines a blood transfusion for religious reasons despite a hemoglobin of 6.5 g/dL following major abdominal surgery. The surgeon should:

Administer blood covertly to prevent harm
Transfer care to another surgeon who will proceed with transfusion
Respect the refusal, document it, and optimize non-transfusion hemostatic measures (Correct answer)
Obtain a court order to override the patient's wishes

Correct answer: Respect the refusal, document it, and optimize non-transfusion hemostatic measures

Competent adults have the absolute right to refuse medical treatment, including transfusions; surgeons must respect this and pursue alternatives.

Question 14: A 55-year-old develops chylous ascites after an aortic aneurysm repair. What is the initial treatment?

Medium-chain triglyceride diet and octreotide (Correct answer)
Immediate re-exploration
Peritoneal-venous shunt
Total parenteral nutrition

Correct answer: Medium-chain triglyceride diet and octreotide

A medium-chain triglyceride diet reduces chyle flow by bypassing intestinal lymphatics, and octreotide decreases lymphatic output.

Question 15: What role does data analytics play in General Surgery Board Review practice?

It is only for IT professionals
It creates unnecessary complexity
It replaces professional judgment
It supports evidence-based decision making by identifying patterns and trends in relevant data (Correct answer)

Correct answer: It supports evidence-based decision making by identifying patterns and trends in relevant data

This is fundamental to General Surgery Board Review practice. It supports evidence-based decision making by identifying patterns and trends in relevant data represents the professional standard for technology in the General Surgery Board Review certification framework.

Question 16: Which of the following can happen if carbon dioxide (CO2) is quickly inhaled into the abdomen?

QT prolongation
Bradycardia (Correct answer)
Tachycardia
Peaked T waves

Correct answer: Bradycardia

Rapid insufflation of carbon dioxide (CO2) into the abdomen during laparoscopy can lead to increased vagal tone. This stimulation of the vagus nerve, often due to peritoneal stretching and CO2 absorption causing hypercapnia and acidosis, can result in bradycardia (slowing of the heart rate). This is a known physiological response during laparoscopic procedures.

Question 17: A surgical resident repeatedly arrives late to morning rounds but performs technically well in the OR. Which competency domain is most deficient?

Medical Knowledge
Systems-Based Practice
Patient Care
Professionalism (Correct answer)

Correct answer: Professionalism

Professionalism encompasses reliability, punctuality, and accountability to the team and patients.

Question 18: Which of the following is the most common cause of small bowel obstruction in adults in the United States?

Neoplasm
Incarcerated hernia
Crohn's disease
Adhesions (Correct answer)

Correct answer: Adhesions

Adhesions from prior abdominal surgery account for approximately 60-75% of small bowel obstructions in adults in the US.

Question 19: When a surgeon who holds a financial interest in a surgical center refers patients there, disclosure to patients is required by:

The Stark Law only for Medicare/Medicaid referrals (Correct answer)
State licensure boards only
No law if the center is accredited
The ACS Code only, not federal law

Correct answer: The Stark Law only for Medicare/Medicaid referrals

The Stark Law (Physician Self-Referral Law) prohibits undisclosed self-referrals for Medicare/Medicaid patients and requires disclosure of financial relationships.

Question 20: A 48-year-old woman undergoes elective laparoscopic Nissen fundoplication. On POD 2 she develops tachycardia, fever, and left shoulder pain. What is the most concerning diagnosis?

Splenic injury
Pneumonia
Esophageal perforation (Correct answer)
Pulmonary embolism

Correct answer: Esophageal perforation

Left shoulder pain (Kehr's sign), tachycardia, and fever after fundoplication suggest esophageal or gastric perforation, a serious complication requiring urgent evaluation.

Question 21: Which tool is commonly used for root cause analysis in General Surgery Board Review quality management?

Fishbone (Ishikawa) diagram to identify contributing factors systematically (Correct answer)
Profit analysis
Customer surveys only
Random sampling

Correct answer: Fishbone (Ishikawa) diagram to identify contributing factors systematically

This is fundamental to General Surgery Board Review practice. Fishbone (Ishikawa) diagram to identify contributing factors systematically represents the professional standard for quality in the General Surgery Board Review certification framework.

Question 22: What distinguishes a peer-reviewed study in General Surgery Board Review literature?

Independent experts in the field evaluated the methodology and conclusions before publication (Correct answer)
It was published in any format
It was published quickly
It was written by multiple authors

Correct answer: Independent experts in the field evaluated the methodology and conclusions before publication

This is fundamental to General Surgery Board Review practice. Independent experts in the field evaluated the methodology and conclusions before publication represents the professional standard for research in the General Surgery Board Review certification framework.

Question 23: A surgeon discovers an unexpected intraoperative finding that changes the planned procedure significantly. Before proceeding, the most appropriate step is to:

Complete the altered procedure and discuss with the patient postoperatively
Stop and wake the patient to obtain new consent
Proceed only if the change is immediately life-threatening or covered by broad consent (Correct answer)
Document the finding and convert to open technique

Correct answer: Proceed only if the change is immediately life-threatening or covered by broad consent

Surgeons may deviate from the planned procedure without new consent only when the change is necessary to address an immediate threat or was covered under the original broad consent.

Question 24: A nurse reports to the surgical resident that a patient is expressing suicidal ideation postoperatively. The resident's first action should be to:

Perform an immediate bedside assessment and activate the psychiatric consult pathway (Correct answer)
Document the report and plan to assess the patient during morning rounds
Reassure the nurse that postoperative depression is common
Notify the charge nurse to monitor the patient closely

Correct answer: Perform an immediate bedside assessment and activate the psychiatric consult pathway

Suicidal ideation requires immediate assessment and psychiatric involvement; delay risks patient harm and constitutes a failure of duty of care.

Question 25: A 45-year-old male presents with obstructive jaundice. CT shows a 2.5 cm mass at the pancreatic head with dilation of the common bile duct and pancreatic duct (double duct sign). No distant metastases are seen. CA 19-9 is 450. What is the definitive treatment if technically resectable?

ERCP with biopsy and gemcitabine chemotherapy
Pancreaticoduodenectomy (Whipple procedure) (Correct answer)
Palliative biliary stenting only
Distal pancreatectomy

Correct answer: Pancreaticoduodenectomy (Whipple procedure)

A resectable pancreatic head adenocarcinoma is treated with pancreaticoduodenectomy, which is the only potentially curative option.

Question 26: A surgeon receives an unsolicited gift from a pharmaceutical company valued at $150. According to AMA guidelines, the appropriate action is to:

Accept gifts under $200 per AMA threshold
Decline the gift regardless of its nature or value (Correct answer)
Accept if the gift is educational in nature
Accept only if disclosed to the hospital compliance office

Correct answer: Decline the gift regardless of its nature or value

AMA guidelines advise physicians to decline gifts from industry that could create real or perceived conflicts of interest, regardless of value.

Question 27: Which scoring system is specifically validated to predict 30-day morbidity and mortality in general surgery patients and is used by the ACS NSQIP surgical risk calculator?

POSSUM score
ASA Physical Status Classification
Surgical Risk Scale (SRS)
Patient-specific risk factors combined via logistic regression model (Correct answer)

Correct answer: Patient-specific risk factors combined via logistic regression model

The ACS NSQIP Surgical Risk Calculator uses a logistic regression model incorporating patient-specific factors and procedure type to generate individualized 30-day risk estimates.

Question 28: Which genetic mutation underlies hereditary medullary thyroid carcinoma in both MEN2A and MEN2B, and guides prophylactic thyroidectomy decisions in family members?

VHL tumor suppressor gene mutation
MEN1 (menin) gene mutation
PTEN tumor suppressor mutation
RET proto-oncogene mutation (Correct answer)

Correct answer: RET proto-oncogene mutation

RET proto-oncogene mutations cause hereditary MTC in MEN2A and MEN2B; first-degree relatives are offered genetic testing, and RET mutation carriers undergo prophylactic thyroidectomy at an age determined by the specific codon involved.

Question 29: Under the National Practitioner Data Bank (NPDB) regulations, a hospital is required to query the NPDB when:

A physician applies for a DEA controlled substance license
A malpractice settlement exceeds $50,000
A surgeon is named in a state medical board complaint
Granting initial medical staff privileges and at each reappointment (Correct answer)

Correct answer: Granting initial medical staff privileges and at each reappointment

Hospitals must query the NPDB when granting initial privileges and at least every two years upon reappointment to identify adverse actions or malpractice history.

Question 30: What is the primary competency framework for General Surgery Board Review professionals?

Employer-specific requirements only
Structured competency standards defined by the certifying body (Correct answer)
Self-assessed capabilities only
Ad-hoc skill development

Correct answer: Structured competency standards defined by the certifying body

This is fundamental to General Surgery Board Review practice. Structured competency standards defined by the certifying body represents the professional standard for professional standards in the General Surgery Board Review certification framework.

General Surgery Qualifying Examination (GSQE)

The American Board of Surgery General Surgery Qualifying Examination (GSQE) is a board certification exam for general surgery residents that assesses clinical knowledge and surgical judgment across major surgery subspecialties including gastrointestinal, trauma, vascular, endocrine, and breast surgery.

300

Questions

460 min

Time Limit

70%

To Pass

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Exam Rules

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