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Saudi Board Part One Examination – General Surgery: free practice test

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Practice test questions with answers and explanations

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01A 5-day-old neonate who had normal feeding begins bilious vomiting. The abdomen is initially soft and not distended. Which anatomical abnormality places this infant at risk of losing the entire midgut?

Practice question Unit: Surgical Anatomy

  1. AHypertrophy of the pyloric circular muscle

    Pyloric stenosis causes non-bilious vomiting at 3–6 weeks and does not threaten the midgut.

  2. BA narrow mesenteric base that allows twisting around the SMA ✓ Correct answer

    In malrotation the duodenojejunal flexure and caecum lie close together, so the narrow mesenteric pedicle can volve around the SMA and infarct the midgut.

  3. CAn annular pancreas encircling the second part of the duodenum

    Annular pancreas can obstruct the duodenum but does not cause volvulus of the midgut.

  4. DAbsent ganglion cells in a short segment of the distal rectum

    Hirschsprung disease presents with delayed meconium and distension, not acute midgut ischaemia.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 1: Surgical Anatomy, p. 3; Sabiston Textbook of Surgery, 20th ed., chapter: Pediatric Surgery

02On day 2 after an upper abdominal operation, a 64-year-old woman has a PaO2 of 7.5 kPa (56 mmHg) on 40% oxygen. Increasing to 100% oxygen produces little rise in PaO2. Chest radiograph shows collapse of the left lower lobe. What is the main mechanism of her hypoxaemia?

Practice question Unit: Surgical Physiology and Pathology

  1. AIncreased alveolar dead space from pulmonary embolism

    Dead space mainly impairs CO2 removal, and the radiograph shows lobar collapse.

  2. BIntrapulmonary shunt through unventilated alveoli ✓ Correct answer

    Blood perfusing collapsed alveoli never meets inspired oxygen, so hypoxaemia from shunt responds poorly to more oxygen.

  3. CDiffusion impairment from thickened alveolar membranes

    Diffusion limitation responds well to oxygen and does not fit acute collapse.

  4. DAlveolar hypoventilation from opioid analgesia

    Hypoventilation hypoxaemia corrects readily with supplemental oxygen.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 2: Surgical Physiology and Pathology, p. 3; Schwartz's Principles of Surgery, 11th ed. (2019), chapter: Physiologic Monitoring of the Surgical Patient

03A 70 kg man with a stab wound to the thigh has a pulse of 130/min, blood pressure 85/60 mmHg, respiratory rate 32/min and is anxious and confused. Which haemorrhage class and blood loss best fit?

Practice question Unit: Trauma, Systemic Response to Injury and Metabolic Support

  1. AClass I, up to 15% blood volume

    Class I has nearly normal vital signs.

  2. BClass III, 30–40% blood volume ✓ Correct answer

    Hypotension, marked tachycardia and confusion indicate class III, about 1500–2000 mL in a 70 kg adult.

  3. CClass II, 15–30% blood volume

    Systolic pressure is usually maintained in class II.

  4. DClass IV, more than 40% blood volume

    Class IV usually causes lethargy, a very low pressure and negligible urine output.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 3: Trauma, Systemic Response to Injury and Metabolic Support, p. 3; ATLS Student Course Manual (American College of Surgeons), chapter: Shock

04A 50-year-old woman with pyelonephritis has warm peripheries, a bounding pulse, blood pressure 82/40 mmHg and a low central venous pressure. Cardiac output is high. What is the main haemodynamic abnormality?

Practice question Unit: Shock, Fluid and Electrolyte Management of Surgical Patient

  1. ALow systemic vascular resistance ✓ Correct answer

    Early septic shock is distributive: vasodilatation lowers resistance and cardiac output rises.

  2. BPrimary myocardial failure

    Cardiac output is high, not low.

  3. CObstruction of right ventricular outflow

    Obstruction raises venous pressure and lowers output.

  4. DLoss of red cell mass from bleeding

    There is no bleeding, and haemorrhage causes high resistance.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 4: Shock, Fluid and Electrolyte Management of Surgical Patient, p. 3; Schwartz's Principles of Surgery, 11th ed. (2019), chapter: Shock; Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock (2021)

05In the cell-based model of coagulation, where does the large 'thrombin burst' mainly occur?

Practice question Unit: Haemostasis, Surgical Bleeding, and Transfusion

  1. AOn tissue factor-bearing cells

    Tissue factor-bearing cells start coagulation with a small amount of thrombin; the large burst happens on activated platelets.

  2. BFree in the plasma, away from cells

    The model stresses that coagulation occurs on cell surfaces.

  3. COn activated platelets at the injury site ✓ Correct answer

    Initiation on tissue factor cells makes a little thrombin, which activates platelets; propagation on their surface produces the burst.

  4. DOn intact, healthy endothelium

    Healthy endothelium is anticoagulant.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 5: Haemostasis, Surgical Bleeding, and Transfusion, p. 3; Schwartz's Principles of Surgery, 11th ed. (2019), chapter: Hemostasis, Surgical Bleeding, and Transfusion

06A randomised trial of 849 patients undergoing clean-contaminated surgery found SSI rates of 9.5% with chlorhexidine-alcohol versus 16.1% with povidone-iodine skin preparation. What is the number needed to treat to prevent one SSI?

Practice question Unit: Surgical Infection

  1. AAbout 1.7

    1.7 is the ratio of the two rates (16.1 ÷ 9.5), not the NNT.

  2. BAbout 6

    1 ÷ 0.161 ≈ 6 uses the control rate alone, not the difference.

  3. CAbout 10

    1 ÷ 0.095 ≈ 10 uses the treated rate alone.

  4. DAbout 15 ✓ Correct answer

    The absolute risk reduction is 6.6%, so the NNT is 1/0.066, about 15.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 6: Surgical Infection, p. 3; Darouiche et al., Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis (NEJM 2010)

07A 45-year-old heavy smoker is listed for an elective abdominal wall reconstruction. What advice best reduces his wound complications?

Practice question Unit: Burn and Wound Healing

  1. ACut down to five cigarettes a day for a month

    Reduction helps less than complete cessation, which is what lowers wound complications.

  2. BStop smoking 1 week before surgery

    One week is too short for wound benefit; at least 4 weeks reduces wound complications.

  3. CSwitch to nicotine patches the day before

    Starting nicotine replacement only the day before does not provide several weeks of smoking cessation; NRT may still support an earlier cessation plan.

  4. DStop smoking at least 4 weeks before ✓ Correct answer

    Nicotine and carbon monoxide impair perfusion and oxygen delivery; stopping 4 or more weeks before reduces complications.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 7: Burn and Wound Healing, p. 3; Sabiston Textbook of Surgery, 20th ed., chapter: Wound Healing; WHO: Tobacco and postsurgical outcomes (2020)

08A man who is 180 cm tall and weighs 110 kg is ventilated for ARDS. What initial tidal volume at 6 mL/kg predicted body weight is appropriate?

Practice question Unit: Surgical Critical Care and Bedside Surgical Procedures

  1. AAbout 300 mL

    300 mL is 4 mL/kg PBW, the floor used only if plateau pressure stays above 30 cmH₂O; the stem asks for 6 mL/kg.

  2. BAbout 375 mL

    375 mL is 5 mL/kg PBW; the stem asks for 6 mL/kg.

  3. CAbout 425 mL

    425 mL uses the female formula (45.5 + 0.91 × (height − 152.4) ≈ 70.6 kg); for a man the constant is 50.

  4. DAbout 450 mL ✓ Correct answer

    PBW = 50 + 0.91 × (180 − 152.4) ≈ 75 kg; 6 × 75 ≈ 450 mL. Using actual weight (6 × 110 = 660 mL) is the classic error.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 9: Surgical Critical Care and Bedside Surgical Procedures, p. 3; ATS Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with ARDS (2017) and its 2024 update

09A 78-year-old woman with exertional syncope and an ejection systolic murmur is listed for an elective colectomy for a large benign polyp. Echo shows severe aortic stenosis. What is the best plan?

Practice question Unit: Principles of Pre-operative, Operative, Anesthesia, and Pain Management

  1. AColectomy now under spinal anaesthesia

    Spinal-induced vasodilation is dangerous in severe AS.

  2. BColectomy now with a beta-blocker

    This does not address the valve.

  3. CDefer surgery and treat the valve first ✓ Correct answer

    Symptomatic severe aortic stenosis carries high perioperative risk; valve intervention (TAVI or surgical replacement) should precede elective non-cardiac surgery (ESC 2022).

  4. DDefer surgery and give 3 months of medical therapy

    Medical therapy does not improve severe symptomatic aortic stenosis; the valve is treated first, then the elective operation.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 10: Principles of Pre-operative, Operative, Anesthesia, and Pain Management, p. 3; ESC/ESA Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery (2022)

10Ten days after splenectomy, a patient has a swinging fever, left shoulder-tip pain and a left pleural effusion. Chest examination is otherwise unremarkable. What is the most likely diagnosis and next step?

Practice question Unit: Surgical Complications

  1. ASubphrenic abscess; CT abdomen ✓ Correct answer

    A left subphrenic collection irritates the diaphragm, causing referred pain and a sympathetic effusion; CT guides drainage.

  2. BPulmonary embolism; start heparin

    Swinging fever suggests pus.

  3. CPneumonia; oral antibiotics

    The setting suggests a collection.

  4. DReactive effusion; aspirate the pleural fluid

    A reactive effusion often accompanies a subphrenic collection; draining the chest misses the source, so the abdomen is imaged.

Reference: SCFHS Saudi Board Part One Exam Blueprint – General Surgery/Plastic and Reconstructive Surgery (24-27, v.1), Section 11: Surgical Complications, p. 3; Sabiston Textbook of Surgery, 20th ed., chapter: Surgical Complications

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