Free Intercollegiate Specialty Examination in General Surgery — Section 1 Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Intercollegiate Specialty Examination in General Surgery — Section 1 practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An adult has a changing 7 mm pigmented lesion on the upper arm. Melanoma is suspected, and removing the whole lesion is feasible without functional or cosmetic difficulty. Which initial tissue-sampling approach is preferred?

   1. A.Incisional biopsy
   2. B.Excisional biopsyCorrect answer: B
   3. C.Skin punch biopsy
   4. D.Shave skin biopsy

   Explanation: The manual recommends "excisional biopsy preferred when feasible". Removing this small, accessible lesion provides tissue for histological diagnosis and assessment of invasion. Partial sampling is less appropriate when complete diagnostic excision is straightforward.

   Reference: MSD Manual Professional: Melanoma — Diagnosis of Melanoma, initial biopsy

2. 2A patient develops rapidly progressive perineal swelling, skin discolouration, crepitus and systemic toxicity. Necrotising soft-tissue infection is strongly suspected and resuscitation and broad-spectrum antibiotics have begun. Which procedure provides the required source control?

   1. A.Image-guided catheter drainage
   2. B.Superficial incision and drainage
   3. C.Operative exploration and debridementCorrect answer: C
   4. D.Image-guided needle aspiration

   Explanation: The source states, "Immediate surgical exploration and debridement are done" The infection extends along necrotic tissue planes. Drainage techniques used for a localised collection do not remove the involved fascia; operative source control should proceed without waiting for imaging.

   Reference: Merck Manual Professional: Necrotizing Soft-Tissue Infection — Treatment, initial surgical management

3. 3A patient continues to have typical heartburn despite an adequate proton pump inhibitor trial. Endoscopy is normal, and objective confirmation of reflux is needed before invasive treatment. Which investigation best addresses this question?

   1. A.Ambulatory oesophageal pH monitoringCorrect answer: A
   2. B.High-resolution oesophageal manometry
   3. C.Videofluoroscopic swallowing assessment
   4. D.Gastric emptying scintigraphy

   Explanation: The source states "should undergo advanced pH testing". Reflux monitoring establishes abnormal acid exposure when endoscopy has not established the diagnosis. Manometry measures motility; swallowing and gastric-emptying studies answer different physiological questions.

   Reference: MSD Manual Professional: Gastroesophageal Reflux Disease — Diagnosis of GERD

4. 4Objective reflux has been established, and antireflux surgery is being considered. Which preoperative test evaluates oesophageal peristalsis and helps identify a coexisting major motility disorder?

   1. A.Ambulatory pH monitoring
   2. B.Gastric emptying scintigraphy
   3. C.Oesophageal manometryCorrect answer: C
   4. D.Contrast-enhanced thoracic CT

   Explanation: The source states "Esophageal manometry is used to evaluate esophageal peristalsis before surgical treatment.". The question concerns motor function before surgery, rather than confirmation of acid reflux. Manometry directly measures the relevant oesophageal pressure and peristaltic pattern.

   Reference: MSD Manual Professional: Gastroesophageal Reflux Disease — Diagnosis of GERD

5. 5A woman recalled to an NHS breast screening assessment clinic has a suspicious solid lesion visible on ultrasound and accessible to needle sampling. Which initial sampling method is preferred to establish invasive status and receptor information?

   1. A.Fine-needle aspiration cytology
   2. B.Ultrasound-guided core needle biopsyCorrect answer: B
   3. C.Open incisional biopsy
   4. D.Open excisional biopsy

   Explanation: The source states "Significant breast abnormalities should be assessed by core biopsy or vacuum- assisted biopsy (VAB).". Core biopsy provides histological and receptor information. In this accessible lesion it is preferred to relying on cytology alone or proceeding initially to open diagnostic surgery.

   Reference: NHS Breast Screening Programme: Clinical Guidance for Breast Cancer Screening Assessment — Needle biopsy of breast

6. 6An otherwise well adult has longstanding mild hypercalcaemia, nonsuppressed PTH and normal renal function. A parent has similar findings. Which measurement helps distinguish familial hypocalciuric hypercalcaemia from primary hyperparathyroidism?

   1. A.Serum alkaline phosphatase
   2. B.Serum thyroid-stimulating hormone
   3. C.Twenty-four-hour urinary calciumCorrect answer: C
   4. D.Plasma metanephrine

   Explanation: The source states "Further testing with 24-hour urine calcium is used". Low urinary calcium supports familial hypocalciuric hypercalcaemia in this context. The other measurements do not make this specific distinction before considering parathyroid surgery.

   Reference: MSD Manual Professional: Hyperparathyroidism — Primary hyperparathyroidism, differential diagnosis

7. 7A haemodialysis patient develops hand pain and cool discoloured fingers after creation of a high-flow arteriovenous fistula. Distal perfusion improves when the fistula is compressed. Which complication explains the findings?

   1. A.Venous outflow stenosis
   2. B.Dialysis access infection
   3. C.Dialysis access steal syndromeCorrect answer: C
   4. D.Access pseudoaneurysm

   Explanation: The source states "fistula compression increases inflow to the symptomatic distal extremity". The distal ischaemia and improvement with compression support access-related steal. Outflow stenosis causes venous hypertension, infection gives inflammatory signs, and a pseudoaneurysm is a focal access-wall complication.

   Reference: StatPearls: Arteriovenous Fistula — Complications, Arterial insufficiency

8. 8During exposure of the common femoral artery just below the inguinal ligament, which major structure lies immediately medial to the artery and must be protected?

   1. A.Femoral veinCorrect answer: A
   2. B.Femoral nerve
   3. C.Sartorius muscle
   4. D.Lateral femoral cutaneous nerve

   Explanation: The source states "the femoral nerve, femoral artery, femoral vein, and lymphatics". The lateral-to-medial arrangement places the femoral vein medial to the artery. The femoral nerve and the sartorius boundary are lateral; the lateral femoral cutaneous nerve is not the medial vascular neighbour.

   Reference: StatPearls: Anatomy, Abdomen and Pelvis, Femoral Triangle — Introduction, arrangement of contents

9. 9After a blow to the temple, a patient briefly loses consciousness, recovers, and then deteriorates. CT shows a lentiform extra-axial hyperdense collection adjacent to a temporal fracture. Which diagnosis is most likely?

   1. A.Acute subdural haematoma
   2. B.Epidural haematomaCorrect answer: B
   3. C.Traumatic subarachnoid haemorrhage
   4. D.Diffuse axonal injury

   Explanation: The source states "classically lenticular-shaped and located over the middle meningeal artery". The lucid interval, temporal fracture and lentiform collection support an epidural haematoma. Subdural collections are typically crescentic; subarachnoid blood and diffuse axonal injury have different CT distributions.

   Reference: Merck Manual Professional: Traumatic Brain Injury — Common Types of Traumatic Brain Injury, Epidural hematoma

10. 10During initial resuscitation after high-energy blunt trauma, an unstable pelvic-ring injury is suspected and a pelvic binder is indicated. At which anatomical level should the binder be centred?

    1. A.Iliac crests
    2. B.Anterior superior iliac spines
    3. C.Greater trochantersCorrect answer: C
    4. D.Lesser trochanters

    Explanation: The source states "A pelvic binder applied over the greater trochanters". The binder should act at the greater-trochanter level. Placement over the iliac crests or other landmarks fails to provide the intended pelvic-ring compression.

    Reference: NHS Lothian: Severe Pelvic Fractures — Principles, haemorrhage control