General Surgery Prometric exam questions with answers

1. Question 1Fluid, Electrolyte, Acid-Base and Surgical Nutritioneasy

   A 70 kg adult is nil by mouth after surgery and has no ongoing losses or electrolyte abnormalities. Which daily maintenance prescription is most appropriate?

   1. AAbout 3 L of 0.9% sodium chloride with no added glucose
   2. BAbout 1 L of water with 140 mmol of sodium and 10 mmol of potassium
   3. CAbout 2 L of water with about 70 mmol each of sodium and potassium and 50 to 100 g of glucose
   4. DAbout 4 L of water with 300 mmol of sodium and no potassium
   Show answer and explanation▾

   Answer: C. About 2 L of water with about 70 mmol each of sodium and potassium and 50 to 100 g of glucose

   Adult maintenance requirements are roughly 25 to 30 mL/kg/day of water, about 1 mmol/kg/day each of sodium, potassium and chloride, and 50 to 100 g/day of glucose to limit starvation ketosis, which for 70 kg is about 2 litres. Three litres of 0.9% saline delivers about 460 mmol of sodium and chloride, causing sodium overload and hyperchloraemic acidosis. Too little water risks dehydration and too much risks hyponatraemia and oedema.

2. Question 2Shock, Haemostasis, Transfusion and Coagulationmedium

   A 30-year-old man is hypotensive and bleeding 90 minutes after a stab wound to the abdomen, and the major haemorrhage protocol is activated. How should tranexamic acid be used?

   1. A1 g IV over 10 minutes, then 1 g infused over 8 hours
   2. BGive it only if the fibrinogen is below 1.5 g/L
   3. CWithhold it because more than 1 hour has passed since injury
   4. DGive 2 g IV only after surgical haemostasis is achieved
   Show answer and explanation▾

   Answer: A. 1 g IV over 10 minutes, then 1 g infused over 8 hours

   The CRASH-2 trial showed that tranexamic acid reduces death from bleeding in trauma when given within 3 hours of injury, using a 1 g loading dose over 10 minutes followed by 1 g over 8 hours; benefit is greatest the earlier it is given. After 3 hours it appears not to help and may be harmful, but 90 minutes is well within the window. Its use does not depend on fibrinogen levels.

3. Question 3Surgical Infection, Sepsis and Antimicrobial Stewardshipeasy

   For an elective colectomy, when should intravenous antibiotic prophylaxis (such as cefazolin plus metronidazole) be given?

   1. AWithin 60 minutes before skin incision, redosing cefazolin if surgery exceeds about 4 hours
   2. BOnly if bowel contamination occurs during the procedure
   3. CThe evening before surgery and continued for 5 days
   4. DAt the end of the operation, once the wound is closed
   Show answer and explanation▾

   Answer: A. Within 60 minutes before skin incision, redosing cefazolin if surgery exceeds about 4 hours

   Prophylactic antibiotics are most effective when tissue levels are adequate at the time of incision, so they should be given within 60 minutes beforehand and redosed during prolonged procedures or major blood loss (about every 4 hours for cefazolin). Doses after wound closure do not reduce surgical site infection. Extending prophylaxis for days adds resistance and Clostridioides difficile risk without benefit.

4. Question 4Surgical Infection, Sepsis and Antimicrobial Stewardshiphard

   A 52-year-old man underwent laparoscopic washout and repair of a perforated duodenal ulcer with adequate source control. On day 4 of intravenous antibiotics he is afebrile, his white cell count has normalised and he is eating. What is the most appropriate antibiotic plan?

   1. ASwitch to oral antibiotics for a further 10 days
   2. BContinue intravenous antibiotics to complete 14 days
   3. CContinue antibiotics until CRP is completely normal
   4. DStop antibiotics now, after about 4 days of therapy
   Show answer and explanation▾

   Answer: D. Stop antibiotics now, after about 4 days of therapy

   The STOP-IT trial showed that, after adequate source control of complicated intra-abdominal infection, a fixed course of about 4 days of antibiotics gave outcomes similar to treating until physiological abnormalities resolved, with less antibiotic exposure. Prolonged courses add toxicity, resistance and C. difficile risk without benefit. CRP often lags behind clinical recovery and is a poor sole stopping criterion.

5. Question 5Perioperative Care, Anaesthesia, Pain and Surgical Complicationsmedium

   Twenty minutes after induction with sevoflurane and suxamethonium, a 24-year-old man develops masseter rigidity, a rising end-tidal CO2 despite increased ventilation, tachycardia and a temperature of 39.2 C. Volatile agents are stopped and help is called. What is the specific treatment?

   1. AIntravenous paracetamol and external cooling only
   2. BIntravenous dantrolene 2.5 mg/kg, repeated as needed
   3. CIntravenous propranolol to control the tachycardia
   4. DIntravenous rocuronium to relieve the rigidity
   Show answer and explanation▾

   Answer: B. Intravenous dantrolene 2.5 mg/kg, repeated as needed

   These features indicate malignant hyperthermia, a hypermetabolic reaction to volatile agents and suxamethonium in susceptible patients. Dantrolene, which reduces calcium release from the sarcoplasmic reticulum, is the specific treatment, given as 2.5 mg/kg and repeated until signs resolve, together with active cooling and treatment of hyperkalaemia and acidosis. Non-depolarising relaxants do not relieve the muscle rigidity, and cooling alone does not stop the hypermetabolic process.

6. Question 6Trauma and Surgical Critical Caremedium

   A 35-year-old injured in a road traffic collision has respiratory distress, hypotension, absent breath sounds and hyperresonance on the left side, and tracheal deviation to the right. According to current ATLS guidance, where should needle decompression be performed?

   1. ASixth intercostal space in the mid-clavicular line
   2. BFourth or fifth intercostal space just anterior to the mid-axillary line
   3. CSecond intercostal space in the mid-clavicular line
   4. DSeventh intercostal space in the posterior axillary line
   Show answer and explanation▾

   Answer: B. Fourth or fifth intercostal space just anterior to the mid-axillary line

   Tension pneumothorax is a clinical diagnosis requiring immediate decompression; the ATLS 10th edition recommends the fourth or fifth intercostal space just anterior to the mid-axillary line in adults, because the chest wall there is thinner and the needle is more likely to reach the pleural space. The second intercostal space in the mid-clavicular line remains an option in children. Definitive treatment is a chest tube.

7. Question 7Trauma and Surgical Critical Carehard

   A 28-year-old man has blunt abdominal trauma. He is haemodynamically stable after 1 litre of crystalloid and has no peritonitis. CT shows a grade III splenic laceration with an active contrast blush and moderate haemoperitoneum. What is the most appropriate management?

   1. AWard observation without any intervention
   2. BEmergency laparotomy and splenectomy
   3. CSplenic angioembolisation with close monitoring
   4. DLaparoscopic splenic repair
   Show answer and explanation▾

   Answer: C. Splenic angioembolisation with close monitoring

   Haemodynamically stable patients with splenic injury are managed non-operatively, but an active contrast blush indicates ongoing arterial bleeding and a high risk of failure, so angioembolisation is recommended as part of non-operative management in a unit with monitoring and theatre availability. Splenectomy is reserved for haemodynamic instability or failure of non-operative management. Observation alone with a blush has a higher failure rate.

8. Question 8Breast and Endocrine Surgerymedium

   Four hours after a total thyroidectomy, a 50-year-old woman develops rapidly increasing neck swelling, stridor and distress. What is the most appropriate immediate action?

   1. AArrange an urgent CT scan of the neck
   2. BGive intravenous calcium gluconate
   3. CGive nebulised adrenaline and observe
   4. DOpen the wound and evacuate the haematoma at the bedside
   Show answer and explanation▾

   Answer: D. Open the wound and evacuate the haematoma at the bedside

   An expanding haematoma beneath the strap muscles causes venous and lymphatic congestion and laryngeal oedema, threatening the airway. The wound skin and strap muscle sutures should be opened immediately at the bedside to evacuate the clot (the 'SCOOP' approach) before definitive control in theatre. Imaging delays life-saving decompression, and hypocalcaemia causes tetany or laryngospasm rather than neck swelling.

9. Question 9Breast and Endocrine Surgerymedium

   A 45-year-old woman has a 4 cm adrenal mass and plasma free metanephrines five times the upper limit of normal. She is scheduled for laparoscopic adrenalectomy. Which preoperative preparation is most appropriate?

   1. AProceed to surgery without specific medical preparation
   2. BAlpha-blockade for 1 to 2 weeks, adding a beta-blocker if tachycardic, with liberal salt and fluid
   3. CHydrocortisone cover as the main preoperative preparation
   4. DBeta-blockade first, adding alpha-blockade once heart rate is controlled
   Show answer and explanation▾

   Answer: B. Alpha-blockade for 1 to 2 weeks, adding a beta-blocker if tachycardic, with liberal salt and fluid

   Phaeochromocytoma requires preoperative alpha-adrenergic blockade (for example doxazosin or phenoxybenzamine) for 7 to 14 days to control blood pressure and restore intravascular volume, with a high-salt diet and fluids, and a beta-blocker added only after alpha-blockade to control tachycardia. Starting a beta-blocker first leaves alpha-mediated vasoconstriction unopposed and can precipitate a hypertensive crisis. Hydrocortisone does not prevent catecholamine surges.

10. Question 10Hernia, Abdominal Wall, Skin and Soft Tissueeasy

    A 68-year-old woman has a small, irreducible, non-tender groin lump lying below and lateral to the pubic tubercle. What is the most appropriate management?

    1. AUltrasound surveillance every 6 months
    2. BEarly surgical repair because of the high risk of strangulation
    3. CRepair only if the lump becomes painful
    4. DWatchful waiting with a truss
    Show answer and explanation▾

    Answer: B. Early surgical repair because of the high risk of strangulation

    A lump below and lateral to the pubic tubercle is typical of a femoral hernia, which has a narrow, rigid neck and a high risk of incarceration and strangulation. All femoral hernias should therefore be repaired promptly, even if asymptomatic. Watchful waiting is an option for minimally symptomatic inguinal hernias, not femoral hernias.

11. Question 11Colorectal, Appendix and Perianal Surgerymedium

    An 82-year-old nursing home resident has gross abdominal distension and absolute constipation. Radiographs show a large 'coffee bean' loop arising from the pelvis. He has no peritonitis, and CT shows no features of ischaemia or perforation. What is the most appropriate initial management?

    1. AIntravenous neostigmine infusion
    2. BEmergency Hartmann procedure
    3. CGastrografin enema as definitive treatment
    4. DEndoscopic decompression with flexible sigmoidoscopy and a flatus tube
    Show answer and explanation▾

    Answer: D. Endoscopic decompression with flexible sigmoidoscopy and a flatus tube

    Uncomplicated sigmoid volvulus is first managed by endoscopic detorsion and decompression, which succeeds in most patients, followed by consideration of elective sigmoid resection because recurrence is common. Emergency resection is reserved for peritonitis, ischaemia, perforation or failed decompression. Neostigmine is used for acute colonic pseudo-obstruction, not mechanical volvulus.

12. Question 12Acute Abdomen and Gastrointestinal Bleedinghard

    A 74-year-old man passes large volumes of fresh red blood per rectum. After initial resuscitation his shock index (heart rate divided by systolic blood pressure) remains above 1. An upper GI source is considered unlikely. What is the most appropriate next investigation?

    1. ACT angiography to localise bleeding before targeted embolisation
    2. BCapsule endoscopy
    3. CUrgent unprepared colonoscopy within 1 hour
    4. DTechnetium-labelled red cell scan
    Show answer and explanation▾

    Answer: A. CT angiography to localise bleeding before targeted embolisation

    In lower GI bleeding that remains unstable after resuscitation (shock index above 1), current guidance recommends CT angiography to localise the bleeding point rapidly, followed by catheter angiography and embolisation, or surgery if this fails. Colonoscopy is preferred for stable patients after bowel preparation, as visibility is poor in an unprepared colon during heavy bleeding. Red cell scans and capsule endoscopy are too slow or unsuitable for unstable bleeding.

13. Question 13Hepatobiliary, Pancreas and Spleenmedium

    A 48-year-old woman has mild acute gallstone pancreatitis that settles within 3 days. There is no cholangitis or peripancreatic collection. When should cholecystectomy be performed?

    1. AAfter 6 to 8 weeks to allow inflammation to settle
    2. BOnly if she has a second attack
    3. CDuring the same admission, once she has recovered
    4. DNot at all if an ERCP sphincterotomy is performed
    Show answer and explanation▾

    Answer: C. During the same admission, once she has recovered

    After mild gallstone pancreatitis, same-admission cholecystectomy reduces recurrent gallstone-related complications compared with delayed surgery, as shown in the PONCHO trial, without increasing operative difficulty. Waiting several weeks exposes patients to recurrence, which can be severe. Sphincterotomy reduces recurrent pancreatitis but not cholecystitis or biliary colic, so cholecystectomy is still advised in fit patients.

14. Question 14Subspecialty Surgery (Vascular, Paediatric, Thoracic, Plastic) and Transplantationhard

    A 70-year-old man with atrial fibrillation who is not anticoagulated has 5 hours of a cold, pale right leg. There is sensory loss extending above the toes and mild weakness of ankle dorsiflexion. Arterial Doppler signals at the ankle are inaudible and venous signals are present. Intravenous heparin has been given. What is the most appropriate management?

    1. AImmediate revascularisation, such as surgical embolectomy
    2. BCatheter-directed thrombolysis over 24 to 48 hours
    3. CPrimary amputation
    4. DCT angiography as an outpatient within 1 week
    Show answer and explanation▾

    Answer: A. Immediate revascularisation, such as surgical embolectomy

    Sensory loss beyond the toes with mild motor weakness and absent arterial but present venous Doppler signals define Rutherford class IIb (immediately threatened) acute limb ischaemia, which needs immediate revascularisation; in an embolic occlusion, surgical embolectomy is the usual option. Catheter-directed thrombolysis takes too long for an immediately threatened limb and is more suitable for class IIa. Primary amputation is reserved for irreversible ischaemia with profound paralysis and absent venous signals.

15. Question 15Professionalism, Ethics, Patient Safety and Evidence-Based Surgeryeasy

    In a randomised controlled trial comparing two hernia repair techniques, what is the main purpose of random allocation?

    1. ATo guarantee that results apply to all populations
    2. BTo increase the number of patients recruited
    3. CTo balance known and unknown confounding factors between the groups
    4. DTo ensure the surgeons do not know which repair they perform
    Show answer and explanation▾

    Answer: C. To balance known and unknown confounding factors between the groups

    Randomisation ensures that, on average, both measured and unmeasured prognostic factors are distributed equally between groups, so differences in outcome can be attributed to the intervention. Concealing allocation from participants or assessors is blinding, which is a different safeguard and usually impossible for the operating surgeon. Randomisation does not increase recruitment or guarantee generalisability.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.