AMC MCQ Surgery Questions: 10 Free Practice MCQs
Ten AMC MCQ-style surgery questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 149 surgery questions and many more across every topic.
1 / 10
A 5-year-old boy weighing 20 kg is admitted with osteomyelitis of the right tibia. He has no allergies and no complications, and local guidelines follow the RCH antimicrobial recommendations.
Which intravenous antibiotic regimen is appropriate?
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Answer: D. Cefazolin 50 mg/kg (maximum 2 g) every 8 hours
Why: In uncomplicated osteomyelitis and septic arthritis the RCH guideline recommends empirical cefazolin 50 mg/kg, to a maximum of 2 g, given intravenously every 8 hours, with the choice adjusted to local susceptibility patterns and clinical context. A subtherapeutic dose would under-treat a serious bone infection, gentamicin monotherapy is not standard first-line therapy, and oral cefalexin is reserved for the later step-down phase once the child has improved. Blood cultures should be taken before antibiotics when possible, and treatment is refined by organism and response.
- A. This dose is far below the paediatric cefazolin dose recommended by the RCH guideline for bone and joint infection and would risk under-treatment.
- B. Oral cefalexin at 45 mg/kg every 8 hours is the RCH step-down option once the child has improved and should not be used as initial therapy.
- C. Gentamicin is not the recommended first-line monotherapy for uncomplicated paediatric osteomyelitis and carries nephrotoxic and ototoxic risk.
Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guideline: Bone and joint infection. RCH, 2021.
2 / 10
A 24-year-old male presents after a fall onto an outstretched hand (FOOSH) during sports. He complains of wrist pain and has point tenderness over the anatomical snuffbox.
Which carpal bone fracture is primarily suspected and carries a high risk of avascular necrosis?
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Answer: A. Scaphoid fracture
Why: Scaphoid fractures account for the vast majority of carpal fractures following a FOOSH injury. Classic physical findings include focal tenderness in the anatomical snuffbox, scaphoid tubercle tenderness, and pain on axial thumb compression. Due to the retrograde arterial supply to the proximal pole, unrecognized or undisplaced scaphoid fractures carry a high risk of non-union and avascular necrosis (AVN). Initial plain radiographs can be negative, requiring scaphoid-cast immobilization and re-imaging or MRI.
- B. Incorrect. A Colles fracture involves the extra-articular distal radius with dorsal displacement, causing a 'dinner fork' deformity rather than isolated snuffbox tenderness.
- C. Incorrect. Lunate dislocation presents with volar wrist pain, swelling, and potential median nerve compression symptoms.
- D. Incorrect. A Boxer's fracture is a fracture of the 5th metacarpal neck resulting from a direct axial punch impact.
Sources: Australian Orthopaedic Association (AOA) Clinical Guidelines; Therapeutic Guidelines: Emergency
3 / 10
A 68-year-old woman presents with a 2-day history of abdominal distension, colicky abdominal pain, and obstipation. She has a history of a midline laparotomy for a hysterectomy 10 years ago. On examination, her abdomen is distended and tympanic, with high-pitched tinkling bowel sounds.
What is the most likely cause of her bowel obstruction?
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Answer: C. Adhesive small bowel obstruction.
Why: Intestinal adhesions resulting from prior abdominal or pelvic surgeries are the single most common cause of small bowel obstruction, accounting for approximately 60-70% of cases. The high-pitched bowel sounds and distension are classic features.
- A. Sigmoid volvulus is less common and typically presents with a classic coffee-bean sign.
- B. Femoral hernia would present with a palpable groin mass, which is not described here.
- D. Colonic malignancy causes large bowel obstruction and is less likely to present acutely.
Sources: RACS Surgical Guidelines
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4 / 10
A 25-year-old man has a complete cervical spinal cord injury after a rugby scrum collapsed. He is hypotensive at 84/50 mmHg with a heart rate of 52 beats per minute, warm peripheries and good urine output.
Which diagnosis best explains these findings?
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Answer: B. Neurogenic shock from the cervical cord injury
Why: Neurogenic shock follows cervical or high thoracic spinal cord injury and results from loss of sympathetic vasomotor tone. The RACS guideline contrasts it with hypovolaemic shock: neurogenic shock shows hypotension with bradycardia, warm extremities and preserved urinary output, whereas hypovolaemic shock gives tachycardia. Treatment comprises the Trendelenburg position, cautious fluid replacement and inotropes if needed to maintain a systolic blood pressure above 90 mmHg. Distinguishing the two is essential, because the response to fluid and vasoactive therapy differs.
- A. Bleeding causes tachycardia and cool peripheries, whereas this man is bradycardic with warm extremities and preserved urine output.
- C. A simple faint causes a transient collapse that recovers quickly and does not persist with a warm, well-perfused periphery after major trauma.
- D. A severe allergic reaction produces urticaria, wheeze and often tachycardia, none of which are present in this man.
Sources: Royal Australasian College of Surgeons. The Management of Acute Neurotrauma in Rural and Remote Locations. RACS, version 2, 2009.
5 / 10
A 34-year-old man presents with sudden, severe, colicky left flank pain radiating to his groin, accompanied by macroscopic haematuria and vomiting. On examination, he is pacing the room and cannot find a comfortable position. His vitals are normal.
What is the most appropriate initial imaging modality to confirm the diagnosis?
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Answer: C. Non-contrast CT kidneys, ureters, and bladder (CT KUB).
Why: Non-contrast CT KUB is the gold standard investigation for suspected renal/ureteric colic. It is highly sensitive (95-97%) and specific, and can detect all stone types (including radiolucent uric acid stones) while providing details on stone size and location.
- A. IVP has been replaced by CT due to lower sensitivity and contrast risks.
- B. Ultrasound is less sensitive for small ureteric stones, though useful in pregnancy.
- D. Plain X-rays miss radiolucent stones and small stones, having low sensitivity.
Sources: eTG Complete: Renal Colic
6 / 10
A 34-year-old orthopaedic registrar performs exposure-prone procedures. At her annual review she asks how often she is required to be tested for blood-borne viruses.
What testing frequency does RACS support for healthcare workers who perform exposure-prone procedures?
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Answer: A. At least once every three years
Why: RACS supports the recommendation of the relevant peak regulatory bodies that healthcare workers who perform exposure-prone procedures undergo regular testing at least once every three years. RACS notes that the Australian Health Practitioner Regulation Agency supports the Communicable Diseases Network Australia recommendation for three-yearly testing, and endorses the National Health and Medical Research Council Australian guidelines for the prevention and control of infection in healthcare on the same point. Testing only after a sharps injury, testing every six months, or testing limited to the start of employment do not reflect that recommendation.
- B. Testing limited to after an injury abandons the regular surveillance interval that the national recommendation specifies for exposure-prone work.
- C. Six-monthly testing is more frequent than the recommendation and is not the interval RACS supports.
- D. A single test at commencement does not meet the requirement for ongoing regular testing while she continues to perform exposure-prone procedures.
Sources: Royal Australasian College of Surgeons. Prevention of Blood-Borne Virus Transmission in Surgery. Position Paper POS-3203, July 2026.
7 / 10
A 44-year-old woman has a chronic posterior anal fissure that has persisted for 4 months despite a full trial of topical therapy. She has no history of anal surgery and no Crohn's disease.
Which management option is most appropriate, and what is its main adverse effect?
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Answer: D. Lateral internal sphincterotomy, with transient incontinence of flatus or stool in up to 17% of patients.
Why: The AJGP review states that surgical management of anal fissure is typically recommended at least 6 to 8 weeks after attempting conservative treatment, and that lateral internal sphincterotomy, a partial incision of the internal anal sphincter, is most often used for chronic fissure. Its significant adverse effect is transient incontinence of flatus or stool in up to 17% of patients, with 1% experiencing faecal incontinence five years after the procedure. A calcium channel blocker is a second-line topical option rather than surgery, antibiotics have no role, spontaneous healing is unlikely once a fissure is chronic, and advancement anoplasty is reserved for hypotonic fissures or where incontinence risk with sphincterotomy is high.
- A. A calcium channel blocker is used when prior topical therapy has failed, which is not the situation here, and its adverse effects are usually mild.
- B. Antibiotics have no role in healing a chronic fissure, which is driven by internal sphincter hypertonicity and local ischaemia.
- C. Chronic fissures have raised edges and exposed internal sphincter, and they are unlikely to heal without active treatment.
- E. Anoplasty is considered for patients with hypotonia, diagnostic doubt or a high risk of incontinence with lateral internal sphincterotomy, not as the routine first surgical choice.
Sources: Lyle V, Young CJ. Anal fissures: An update on treatment options. Australian Journal of General Practice 2024;53(1-2).
8 / 10
A 50-year-old woman presents after discovering a discrete, non-tender lump in her right breast during self-examination. A screening mammogram was reported as equivocal.
What three components constitute the gold-standard 'Triple Test' for evaluating breast symptoms in Australia?
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Answer: D. Clinical examination, Imaging (Mammography and/or Ultrasound), and Pathology (Core biopsy or FNA)
Why: Cancer Australia guidelines recommend the Triple Test for investigating any new breast symptom: 1) Clinical breast examination, 2) Imaging (mammography and/or ultrasound), and 3) Non-excisional pathology (core needle biopsy or fine-needle aspiration). When all three components are concordant, the negative predictive value for malignancy exceeds 99%.
- A. Incorrect. MRI and PET-CT are advanced staging or high-risk screening tools, not the initial diagnostic triple test components.
- B. Incorrect. Serum tumor markers lack sensitivity and specificity for primary breast cancer diagnosis and are not part of the Triple Test.
- C. Incorrect. Physical examination alone is insufficient and misses a significant proportion of malignant breast lesions.
Sources: Cancer Australia: National Breast Cancer Centre Guidelines; Therapeutic Guidelines: Surgery
9 / 10
A 74-year-old man has a chronic venous leg ulcer with copious exudate and marked ankle oedema. There are no signs of infection. His general practitioner asks which measures will promote healing.
What are the three first-line management principles for this ulcer?
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Answer: A. Reduce oedema, disrupt biofilm and protect the surrounding skin from exudate
Why: Chronic ulcers that are not pressure related, ischaemic or malignant may be addressed at low expense with three management principles: reduce oedema, manage biofilm and prevent exudative dermatitis. Gravity-related oedema needs antigravity measures such as compression garments, short-stretch inelastic bandaging or bed rest with lower limb elevation to the level of the heart, and reducing oedema also reduces cellulitis. Biofilm is disrupted by debriding the wound bed at each dressing change, and the wound edge skin is protected with barrier cream and superabsorbent dressings changed before they become saturated. Antibiotics, early surgery and dependency of the limb do not follow these principles.
- B. Antibiotics and swabs are indicated only when there are signs of infection, and prolonged bed rest without compression does not address the venous oedema driving the ulcer.
- C. Invasive treatments, including varicose vein surgery, remain controversial as adjuncts to compression and should be avoided in the initial phase of management.
- D. Leaving the leg dependent worsens gravity-related oedema, whereas elevation to the level of the heart and graduated compression are the antigravity measures required.
Sources: Kelly G, Bingley J, Muir J. The non-healing leg ulcer: a logical approach. Australian Journal of General Practice 2024;53(1-2).
10 / 10
A 24-year-old man is admitted to a country hospital three hours by road from the nearest neurosurgical unit after a motorcycle crash. Over 40 minutes his Glasgow Coma Score falls by three points and his right pupil becomes dilated. No CT scanner is available on site.
What is the most appropriate management?
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Answer: C. Give mannitol and proceed to burrhole exploration at the country hospital
Why: When a deteriorating patient is more than two hours from a neurosurgical unit the guideline offers two options: transfer within two hours after stabilising the airway and giving mannitol, or, if transfer will exceed two hours, burrhole exploration on site by the local practitioner supported by neurosurgical advice. This man is three hours away, so mannitol plus on site burrhole evacuation offers the best chance. Simply transferring risks fatal brainstem compression en route. Corticosteroids are not recommended in acute head injury, and lumbar puncture is dangerous when intracranial pressure is rising.
- A. When the estimated transfer time exceeds two hours, waiting for transfer risks fatal brainstem compression before the clot is evacuated.
- B. Corticosteroids are not recommended in acute head injury and do not relieve compression from an extradural clot.
- D. Lumbar puncture is contraindicated when intracranial pressure is rising and would risk herniation.
Sources: Neurosurgical Society of Australasia. The Management of Acute Neurotrauma in Rural and Remote Locations, 3rd ed, 2009 (published by the Royal Australasian College of Surgeons).
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Exam-style questions written by MedHub for practice. They are not official exam questions.