General Surgery Qualifying Examination (GSQE) — Questions and Answers

Question 1: A patient in the surgical ICU lacks decision-making capacity. No advance directive exists, and both a spouse and an adult child disagree about continuing aggressive care. The most appropriate step is to:

Convene a family meeting facilitated by the palliative care or ethics team (Correct answer)
Defer to the spouse as the default legal next-of-kin
Allow the surgeon to make the unilateral decision to avoid conflict
Continue current treatment until legal guidance is obtained

Correct answer: Convene a family meeting facilitated by the palliative care or ethics team

Ethics consultation and facilitated family meetings help resolve surrogate disagreements while centering the patient's best interests.

Question 2: A 55-year-old man presents with painless hematuria. Cystoscopy reveals a sessile bladder mass. Biopsy confirms transitional cell carcinoma invading the muscularis propria. What is the appropriate treatment?

Intravesical BCG therapy
Radical cystectomy with urinary diversion (Correct answer)
Transurethral resection of bladder tumor (TURBT) alone
External beam radiation therapy alone

Correct answer: Radical cystectomy with urinary diversion

Muscle-invasive bladder cancer (T2 or higher) is treated with radical cystectomy with urinary diversion, often preceded by neoadjuvant cisplatin-based chemotherapy.

Question 3: How do General Surgery Board Review professionals contribute to advancing their field?

By maintaining current practices
By conducting research, sharing outcomes, mentoring others, and participating in professional forums (Correct answer)
Individual contribution is not possible
By competing with colleagues

Correct answer: By conducting research, sharing outcomes, mentoring others, and participating in professional forums

This is fundamental to General Surgery Board Review practice. By conducting research, sharing outcomes, mentoring others, and participating in professional forums represents the professional standard for research in the General Surgery Board Review certification framework.

Question 4: During a standard Whipple procedure (pancreaticoduodenectomy), which structure is NOT routinely resected?

Head of pancreas
Body and tail of pancreas (Correct answer)
Gallbladder
Duodenum

Correct answer: Body and tail of pancreas

The standard Whipple removes the pancreatic head, duodenum, gallbladder, distal common bile duct, and sometimes the distal stomach; the body and tail of the pancreas are preserved.

Question 5: A patient develops fever, tachycardia, hypotension, and CT findings of free intraperitoneal air on POD 3 after a sigmoid colectomy. What is the next step?

Immediate return to the operating room for exploratory laparotomy (Correct answer)
Nasogastric tube decompression and observation
Serial abdominal exams and NPO
IV antibiotics and CT-guided percutaneous drainage

Correct answer: Immediate return to the operating room for exploratory laparotomy

Free intraperitoneal air with hemodynamic instability indicates an anastomotic leak with peritonitis, requiring immediate operative exploration and repair or fecal diversion.

Question 6: What is a risk mitigation strategy in General Surgery Board Review practice?

Implementing controls that reduce the likelihood or impact of identified risks (Correct answer)
Only addressing risks after they occur
Transferring all responsibility
Ignoring low-probability risks

Correct answer: Implementing controls that reduce the likelihood or impact of identified risks

This is fundamental to General Surgery Board Review practice. Implementing controls that reduce the likelihood or impact of identified risks represents the professional standard for risk management in the General Surgery Board Review certification framework.

Question 7: How should General Surgery Board Review professionals evaluate new technology tools?

Adopt all new technology immediately
Avoid all new technology
Assess functionality, reliability, security, cost-effectiveness, and alignment with professional needs (Correct answer)
Wait until competitors adopt first

Correct answer: Assess functionality, reliability, security, cost-effectiveness, and alignment with professional needs

This is fundamental to General Surgery Board Review practice. Assess functionality, reliability, security, cost-effectiveness, and alignment with professional needs represents the professional standard for technology in the General Surgery Board Review certification framework.

Question 8: Surgical resection of a hilar cholangiocarcinoma (Klatskin tumor) typically requires which operative approach?

Liver transplantation as the standard first-line treatment
Whipple procedure for all cases
Cholecystectomy with bile duct excision alone
Major hepatectomy with extrahepatic bile duct excision and biliary reconstruction (Correct answer)

Correct answer: Major hepatectomy with extrahepatic bile duct excision and biliary reconstruction

Resection of Klatskin tumors requires major hepatectomy (usually right or left with caudate lobe) combined with extrahepatic bile duct excision and hepaticojejunostomy for curative intent.

Question 9: How has digital technology transformed General Surgery Board Review practice?

It only affects large organizations
It has enhanced data collection, analysis, communication, and operational efficiency (Correct answer)
It has replaced all traditional methods
It has had no impact

Correct answer: It has enhanced data collection, analysis, communication, and operational efficiency

This is fundamental to General Surgery Board Review practice. It has enhanced data collection, analysis, communication, and operational efficiency represents the professional standard for technology in the General Surgery Board Review certification framework.

Question 10: A surgeon must disclose a retained surgical sponge discovered on postoperative imaging. Which communication strategy is most appropriate?

Notify risk management first and let them communicate with the patient
Document the finding and schedule a routine follow-up appointment
Meet with the patient and family promptly, disclose the event honestly, and outline next steps (Correct answer)
Await legal counsel before saying anything to the patient

Correct answer: Meet with the patient and family promptly, disclose the event honestly, and outline next steps

Prompt, honest disclosure of serious adverse events is ethically mandatory and is required by most accreditation standards, including The Joint Commission.

Question 11: On CT scan, which finding in a pancreatic head mass most reliably indicates unresectability in pancreatic ductal adenocarcinoma?

Pancreatic duct dilation greater than 3 mm
Dilated common bile duct (>8 mm)
Superior mesenteric vein or portal vein encasement greater than 180 degrees (Correct answer)
Atrophy of the pancreatic body and tail

Correct answer: Superior mesenteric vein or portal vein encasement greater than 180 degrees

Encasement >180 degrees of the superior mesenteric artery, celiac axis, or SMV/portal vein that cannot be reconstructed indicates locally advanced, borderline, or unresectable disease per NCCN criteria.

Question 12: A patient undergoing surgery for a perforated ulcer loses capacity intraoperatively due to hemodynamic instability. The surgeon discovers a synchronous cecal mass. The ethically appropriate intraoperative decision is to:

Resect the cecal mass immediately to spare the patient a second surgery
Address the life-threatening perforation only and defer elective resection for informed consent (Correct answer)
Place a note in the chart and resect the mass at the same operation
Contact the family by phone for consent before proceeding

Correct answer: Address the life-threatening perforation only and defer elective resection for informed consent

Emergency doctrine allows only life-saving interventions when a patient lacks capacity; an incidental elective finding does not meet the threshold for unconsented surgery.

Question 13: What is the most effective communication approach for General Surgery Board Review professionals?

Minimizing all communications
Only written communication
Using technical language exclusively
Adapting communication style to the audience while maintaining accuracy and clarity (Correct answer)

Correct answer: Adapting communication style to the audience while maintaining accuracy and clarity

This is fundamental to General Surgery Board Review practice. Adapting communication style to the audience while maintaining accuracy and clarity represents the professional standard for communication in the General Surgery Board Review certification framework.

Question 14: What is the significance of a code of conduct for General Surgery Board Review professionals?

It applies only to new practitioners
It establishes expected behaviors and ethical standards that protect the public and profession (Correct answer)
It limits professional freedom
It is merely symbolic

Correct answer: It establishes expected behaviors and ethical standards that protect the public and profession

This is fundamental to General Surgery Board Review practice. It establishes expected behaviors and ethical standards that protect the public and profession represents the professional standard for professional standards in the General Surgery Board Review certification framework.

Question 15: Charcot's triad of fever, jaundice, and right upper quadrant pain is pathognomonic for which condition?

Ascending cholangitis (Correct answer)
Choledocholithiasis without biliary infection
Pyogenic liver abscess
Acute cholecystitis

Correct answer: Ascending cholangitis

Charcot's triad indicates ascending cholangitis caused by biliary obstruction with bacterial infection; Reynolds' pentad adds hypotension and altered mental status indicating suppurative cholangitis.

Question 16: A patient with papillary thyroid carcinoma has clinically apparent lateral neck lymphadenopathy (N1b disease). Which surgical procedure is required for the lateral neck?

Central neck dissection (Level VI) only
Total lateral neck dissection including Level VII
Therapeutic lateral neck dissection (Levels II-V) (Correct answer)
Level I node dissection only

Correct answer: Therapeutic lateral neck dissection (Levels II-V)

N1b disease requires a therapeutic lateral neck dissection encompassing Levels II through V, as these compartments represent the lymphatic drainage of the lateral neck.

Question 17: A 55-year-old male presents with painless jaundice, weight loss, and a palpable gallbladder. Which of the following is the most likely diagnosis?

Pancreatic head carcinoma (Correct answer)
Choledocholithiasis
Primary sclerosing cholangitis
Acute cholecystitis

Correct answer: Pancreatic head carcinoma

Painless jaundice with a palpable, nontender gallbladder (Courvoisier's sign) in the setting of weight loss is classic for pancreatic head carcinoma obstructing the bile duct.

Question 18: A media outlet contacts the hospital requesting comment on a high-profile patient's surgical outcome. The surgeon's correct response is to:

Provide a brief statement confirming the patient is doing well
Confirm the patient's identity but decline clinical details
Provide a written statement to show transparency
Decline all comment and direct inquiries to the hospital's public affairs office (Correct answer)

Correct answer: Decline all comment and direct inquiries to the hospital's public affairs office

All media inquiries regarding patients must be handled by the designated public affairs or communications office; any surgeon comment risks HIPAA violation.

Question 19: A patient develops perioral tingling and carpopedal spasm 24 hours after total thyroidectomy. What is the most likely diagnosis?

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

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 20: How does a General Surgery Board Review professional communicate risks to stakeholders?

Using technical jargon only
By presenting risks clearly with context, potential impacts, and recommended actions (Correct answer)
Through annual reports only
By minimizing all risks

Correct answer: By presenting risks clearly with context, potential impacts, and recommended actions

This is fundamental to General Surgery Board Review practice. By presenting risks clearly with context, potential impacts, and recommended actions represents the professional standard for risk management in the General Surgery Board Review certification framework.

Question 21: Which of the following is the most common cause of hypercalcemia in ambulatory outpatients?

Primary hyperparathyroidism (Correct answer)
Malignancy-associated hypercalcemia
Sarcoidosis
Vitamin D toxicity

Correct answer: Primary hyperparathyroidism

Primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient setting, caused by a solitary parathyroid adenoma in ~85% of cases.

Question 22: When obtaining informed consent from a non-English-speaking patient for an elective cholecystectomy, the correct approach is to:

Use a qualified medical interpreter service (Correct answer)
Postpone surgery until the patient learns enough English
Use the patient's bilingual family member as interpreter
Proceed using simple English and written diagrams

Correct answer: Use a qualified medical interpreter service

Professional medical interpreters ensure accurate communication of risks, benefits, and alternatives, satisfying both ethical and legal standards for informed consent.

Question 23: Which artery is most commonly injured during laparoscopic cholecystectomy leading to a major vascular complication?

Right hepatic artery (Correct answer)
Cystic artery
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 24: Within the femoral triangle, structures are arranged from lateral to medial in which order?

Nerve, vein, artery
Artery, vein, nerve
Vein, artery, nerve
Nerve, artery, vein (Correct answer)

Correct answer: Nerve, artery, vein

The mnemonic 'NAVY' (Nerve, Artery, Vein, Y-front/empty space) describes the lateral-to-medial arrangement within the femoral triangle.

Question 25: What distinguishes quality assurance from quality control in General Surgery Board Review practice?

They are identical concepts
QA focuses on preventing defects through process improvement while QC detects defects through inspection (Correct answer)
QC is more important than QA
QA applies only to manufacturing

Correct answer: QA focuses on preventing defects through process improvement while QC detects defects through inspection

This is fundamental to General Surgery Board Review practice. QA focuses on preventing defects through process improvement while QC detects defects through inspection represents the professional standard for quality in the General Surgery Board Review certification framework.

Question 26: A surgical trainee disagrees with an attending's operative plan and believes a different approach is safer. What is the most professional course of action?

Alert the OR charge nurse to document the disagreement
Remain silent and comply with the plan intraoperatively
Raise the concern privately with the attending before the operation (Correct answer)
Request immediate reassignment from the case

Correct answer: Raise the concern privately with the attending before the operation

Raising safety concerns directly with the attending before surgery respects hierarchy while fulfilling the trainee's duty to patient safety.

Question 27: The Revised Cardiac Risk Index (RCRI) includes all of the following EXCEPT:

History of congestive heart failure
Preoperative creatinine >2.0 mg/dL
Uncontrolled hypertension (Correct answer)
History of ischemic heart disease

Correct answer: Uncontrolled hypertension

The six RCRI factors are: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent diabetes, and creatinine >2.0 mg/dL — uncontrolled hypertension is not included.

Question 28: During informed consent for a high-risk hepatic resection, the patient asks 'what would you do if you were in my position?' The most appropriate response is to:

Provide statistical data only and avoid personal statements
Defer the question to the referring physician
Share your personal perspective while making clear the decision ultimately belongs to the patient (Correct answer)
Deflect by saying personal opinions are inappropriate

Correct answer: Share your personal perspective while making clear the decision ultimately belongs to the patient

Sharing a personal professional perspective when sincerely asked is ethically appropriate and builds trust, provided patient autonomy is clearly preserved.

Question 29: What is the preferred initial imaging modality for localizing a parathyroid adenoma before first-time parathyroid exploration?

CT scan of the neck with contrast
F-18 FDG PET scan
99mTc-sestamibi scintigraphy (Correct answer)
MRI of the neck without contrast

Correct answer: 99mTc-sestamibi scintigraphy

99mTc-sestamibi scintigraphy (alone or combined with SPECT/neck ultrasound) is the preferred preoperative localization study, exploiting the high mitochondrial content of parathyroid adenoma cells.

Question 30: During a multidisciplinary tumor board meeting, a radiologist and surgeon disagree about the resectability of a pancreatic mass. The optimal approach to resolve this conflict is to:

Schedule a repeat scan to avoid the conflict
Review the imaging together and seek additional specialist input if needed (Correct answer)
Defer to the most senior physician present
Allow the surgeon to make the final decision as the treating physician

Correct answer: Review the imaging together and seek additional specialist input if needed

Collaborative review of evidence and seeking additional expert input ensures patient-centered decision-making and resolves clinical disagreements constructively.

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.

Questions

45 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

absurgery.org — Test delivery, eligibility, passing score, retake policy, score release, time limit, score validity, exam format, exam information · verified Oct 2026
pearsonvue.com — Test delivery · verified Oct 2026