Prometric Exam Questions for General Surgery Specialists 2026: 15 Practice MCQs with Answers and Rationale for the GEN5341 Paper

The general surgery specialist paper (GEN5341) is written for the surgical registrar on call: the acute abdomen, the trauma bay, the perioperative ward, and the clinic decisions on breast, colorectal, hepatobiliary and endocrine disease. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60 to 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale. The paper asks for the next best step more often than the diagnosis, so learn management pathways as sequences.

For titles and the route, read the general surgeon guide. For timed papers use the General Surgery specialist bank.

The acute abdomen

Question 1

A 25-year-old man has 24 hours of periumbilical pain migrating to the right iliac fossa, fever and localised peritonism. The most appropriate management is:

1. Discharge with analgesia
2. Intravenous antibiotics and appendicectomy, laparoscopic where available, after resuscitation
3. CT in one week
4. Oral antibiotics only and review in a month

Answer: B. The clinical picture is acute appendicitis. Imaging is used when the diagnosis is uncertain, especially in women of reproductive age and the elderly. Antibiotic-only treatment is an option in selected uncomplicated cases but surgery remains standard.

Question 2

A 70-year-old presents with colicky abdominal pain, distension, absolute constipation and a tympanic abdomen. Plain films show a coffee-bean-shaped loop from the pelvis. The first-line treatment is:

1. Immediate laparotomy
2. Endoscopic (flexible sigmoidoscopic) decompression, then elective sigmoid colectomy to prevent recurrence
3. Barium enema
4. Observation alone

Answer: B. Sigmoid volvulus without peritonitis is decompressed endoscopically first; surgery is for failed decompression, ischaemia or perforation, and electively because recurrence is common.

Question 3

A patient with severe acute pancreatitis has a CT showing extensive necrosis. Which statement about management is correct?

1. Early surgical debridement in the first week improves survival
2. Supportive care with fluids, analgesia and early enteral nutrition; intervention is delayed and reserved for infected necrosis, ideally after four weeks using a step-up approach
3. Prophylactic antibiotics are routinely indicated
4. Oral intake must be withheld for two weeks

Answer: B. Early surgery increases mortality. Sterile necrosis is managed conservatively; infected necrosis is treated with antibiotics and a step-up approach of percutaneous or endoscopic drainage before minimally invasive necrosectomy.

Trauma and surgical critical care

Question 4

A trauma patient has a blood pressure of 85/50 mmHg, a positive FAST and a pelvic fracture. The appropriate resuscitation strategy is:

1. Large-volume crystalloid to normalise blood pressure before theatre
2. Permissive hypotension with early balanced blood products, tranexamic acid within three hours, pelvic binder, and rapid transfer to theatre or angioembolisation
3. Vasopressors first
4. CT before any intervention

Answer: B. Damage control resuscitation limits crystalloid, gives blood products in balanced ratios, controls haemorrhage early and avoids the lethal triad of acidosis, hypothermia and coagulopathy.

Question 5

A patient has a stab wound to the anterior abdomen with evisceration of omentum but stable observations. The management is:

1. Push the omentum back and discharge
2. Laparotomy, because evisceration is an indication for exploration
3. Serial examination only
4. Local wound exploration under local anaesthetic

Answer: B. Evisceration, peritonitis and haemodynamic instability are absolute indications for laparotomy after penetrating abdominal trauma. Selective non-operative management applies to stable patients without these signs.

Question 6

Two days after a laparotomy for perforated diverticulitis, a patient on a ventilator has a bladder pressure of 28 mmHg, rising airway pressures and oliguria. The diagnosis and treatment are:

1. Abdominal compartment syndrome; decompressive laparotomy after optimising sedation and fluid balance
2. Acute kidney injury; furosemide
3. Pneumonia; antibiotics
4. Normal postoperative course

Answer: A. Intra-abdominal pressure above 20 mmHg with new organ dysfunction defines abdominal compartment syndrome. Medical measures (sedation, paralysis, decompression of gut, fluid removal) are tried, but surgical decompression is definitive.

Hernia, breast and endocrine

Question 7

A 60-year-old man has an irreducible, tender groin lump with vomiting for 6 hours. The management is:

1. Forceful manual reduction and discharge
2. Resuscitation and urgent surgical exploration for a strangulated inguinal hernia, with bowel resection if non-viable
3. Elective repair in three months
4. Antibiotics only

Answer: B. Tenderness, irreducibility and obstruction indicate strangulation. Forceful reduction risks reducing dead bowel. Mesh is generally avoided in a contaminated field.

Question 8

A 48-year-old woman has a 2 cm breast lump, grade 2 invasive ductal carcinoma, ER positive, HER2 negative, with a clinically and ultrasound-negative axilla. The axillary management is:

1. Axillary clearance in all cases
2. Sentinel lymph node biopsy
3. No axillary assessment
4. Axillary radiotherapy alone

Answer: B. Sentinel node biopsy stages the clinically negative axilla with far less morbidity than clearance. Clearance is reserved for proven nodal disease beyond the low-volume thresholds in current trials.

Question 9

A 40-year-old woman has a 2.5 cm thyroid nodule with a fine-needle aspirate reported as Bethesda VI (malignant, papillary carcinoma). Appropriate surgery is:

1. Observation
2. Thyroid lobectomy or total thyroidectomy depending on size, nodal status and risk features, with central neck assessment
3. Radioactive iodine without surgery
4. Enucleation of the nodule

Answer: B. Papillary carcinoma under 4 cm without extrathyroidal extension or nodes may be treated with lobectomy; larger, multifocal or node-positive disease needs total thyroidectomy with radioiodine for higher-risk cases. Recurrent laryngeal nerve and parathyroid protection are key.

Colorectal and hepatobiliary

Question 10

A 68-year-old presents with right upper quadrant pain, fever, jaundice and hypotension. Ultrasound shows a dilated common bile duct with a stone. The management is:

1. Elective cholecystectomy in six weeks
2. Resuscitation, intravenous antibiotics and urgent biliary decompression by ERCP, with cholecystectomy later in the same admission or soon after
3. Oral antibiotics
4. Immediate open bile duct exploration as first line

Answer: B. Charcot's triad with hypotension is severe acute cholangitis (Reynolds' pentad with confusion). Source control by ERCP within 24 hours is life-saving; percutaneous drainage is the alternative when ERCP fails.

Question 11

A 55-year-old has a rectal adenocarcinoma 8 cm from the anal verge, staged T3 N1 on MRI with a threatened circumferential resection margin. The treatment sequence is:

1. Immediate anterior resection
2. Neoadjuvant chemoradiotherapy (or total neoadjuvant therapy), restaging, then total mesorectal excision
3. Palliative stent only
4. Local excision

Answer: B. Locally advanced rectal cancer with a threatened margin is downstaged before surgery to reduce local recurrence. Total mesorectal excision remains the standard operation.

Question 12

A patient has acute left iliac fossa pain, fever and a CT showing sigmoid diverticulitis with a 3 cm pericolic abscess. The management is:

1. Emergency Hartmann's procedure
2. Intravenous antibiotics, with percutaneous drainage if the abscess does not respond or is larger; surgery for failure, perforation or peritonitis
3. Colonoscopy today
4. Oral antibiotics and discharge immediately

Answer: B. Uncomplicated and small-abscess diverticulitis are managed with antibiotics, drainage for larger collections, and surgery for failure or faecal peritonitis. Colonoscopy is delayed about six weeks to exclude malignancy.

Perioperative care

Question 13

Which patient most needs pharmacological VTE prophylaxis after surgery?

1. A 25-year-old having a 20-minute day-case procedure
2. A 65-year-old having a 3-hour laparotomy for colorectal cancer
3. A patient with active bleeding
4. A patient having local anaesthetic lipoma excision

Answer: B. Major abdominal or pelvic cancer surgery is high risk: low-molecular-weight heparin plus mechanical prophylaxis, often extended for 28 days after cancer surgery. Active bleeding is a contraindication to pharmacological prophylaxis.

Question 14

A diabetic patient on metformin is scheduled for a major elective operation. Which perioperative instruction is correct?

1. Continue metformin throughout, including the morning of surgery
2. Omit metformin on the day of surgery (and around contrast or renal impairment), use variable-rate insulin for prolonged fasting, and restart when eating and renal function are stable
3. Stop all diabetes medication for a week before
4. Double the dose to prevent hyperglycaemia

Answer: B. Metformin is held on the day of major surgery because of lactic acidosis risk with hypoperfusion and contrast; perioperative glucose is controlled with insulin where fasting is prolonged.

Question 15

On day 5 after an anterior resection, a patient develops fever, tachycardia, abdominal pain and a rising CRP. The investigation of choice is:

1. Plain abdominal x-ray
2. CT abdomen and pelvis with contrast, including rectal contrast if an anastomotic leak is suspected
3. Barium swallow
4. No imaging; antibiotics only

Answer: B. Anastomotic leak classically presents between days 3 and 7. CT identifies free gas, collections and contrast extravasation, guiding antibiotics, drainage or re-laparotomy with defunctioning stoma.

How to use these questions

• Learn management as pathways: appendicitis, cholangitis, pancreatitis, diverticulitis, obstruction, trauma.
• Know current oncology sequencing for breast, rectal and thyroid cancer; the exam follows guidelines, not local habit.
• Do not skip perioperative medicine: VTE, diabetes, anticoagulation and critical care appear on every paper.
• Practise under time in the General Surgery bank with the error-log method.

Other surgical specialties have their own banks: orthopaedics, urology, vascular and plastic surgery. The full catalogue is in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the general surgery Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60 to 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include trauma and critical care?

Yes, including damage control resuscitation, abdominal compartment syndrome and perioperative complications.

Can an MS or FCPS in surgery skip the exam?

Sometimes, depending on the authority's recognition list and the title; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.