# MCCQE Part I Surgery Questions: 10 Free Practice MCQs > 10 free MCCQE Part I surgery questions with answers and explanations, from a bank of 190 surgery questions. Try them now, no sign up. Canonical: https://medhub.one/practice/mccqe-part-1/surgery Last updated: 2026-10-29 Ten MCCQE Part I-style surgery questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 190 surgery questions and many more across every topic. 1. 1 / 10 A 48-year-old woman with no symptoms, no family history of colorectal cancer and no other risk factors asks her family physician to begin colorectal cancer screening because she read that screening now starts at age 45. According to the BC Guidelines, what is the most appropriate response? Show answer **Answer: C.** Screening average-risk individuals under age 50 is not recommended **Why:** The BC Guidelines state that screening average-risk individuals under age 50 is not recommended, and the American recommendation to start at 45 has not been adopted here. Starting stool testing now, beginning screening colonoscopy, or annual stool testing below age 50 all contradict the Canadian position. * **A.** The American recommendation to start at 45 has not been adopted here, and screening average-risk individuals under 50 is not recommended. * **B.** Colonoscopy is not used as a primary screening test, and there is no indication to start it in this age group. * **D.** An annual stool test schedule is not recommended, and starting any screening below age 50 is not supported. Sources: Government of British Columbia. BC Guidelines: Colorectal Cancer Part 1, Screening (2022). 2. 2 / 10 A 70-year-old woman presents with 4 days of abdominal distension, absolute constipation and no passage of flatus. She is haemodynamically stable and her abdomen is distended but soft. Abdominal radiography shows a dilated colon. Which CT finding most raises concern for impending perforation? Show answer **Answer: C.** A caecal diameter of 12 cm or more **Why:** The CAGS Large Bowel Obstructions chapter gives the CT hallmarks of colonic dilatation as a caecum greater than 9 cm and the rest of the colon greater than 6 cm, and states that a caecal diameter of 12 cm or more is associated with increased risk of ischaemia and perforation. Other high-risk features listed include peritoneal signs, strangulation, signs of ischaemia such as a target sign, mesenteric congestion, pneumatosis and delayed or asymmetric enhancement, and perforation or high risk of perforation with a caecum larger than 12 cm, free fluid or free gas. A transverse colon of 8 cm indicates dilatation only, and diverticula with fat stranding or a single air fluid level do not predict perforation. * **A.** A colonic diameter above 6 cm indicates dilatation, but the threshold cited for perforation risk in this chapter applies to the caecum rather than the transverse colon. * **B.** That pattern suggests diverticulitis and does not by itself indicate imminent perforation from a large bowel obstruction. * **D.** Air fluid levels and their height are used to identify high grade obstruction rather than to predict caecal perforation. Sources: Canadian Association of General Surgeons (Committee on Acute Care Surgery). Dynamic Practice Guidelines for Emergency General Surgery, Large Bowel Obstructions chapter. 3. 3 / 10 A 68-year-old woman is seen in a fracture clinic after a wrist fracture from a fall on ice. Her family physician has used the Canadian FRAX tool without bone mineral density and estimated her 10-year risk of a major osteoporotic fracture. According to the BC osteoporosis guideline, which 10-year fracture risk range is classed as moderate? Show answer **Answer: D.** 10% to 20% in the next 10 years **Why:** The BC osteoporosis guideline estimates a patient's fracture risk as low when the 10-year risk is under 10%, moderate between 10% and 20%, and high when it is over 20%. Options A and B describe values that sit in the low range and option C describes the high range, so only option D matches the moderate category. * **A.** Values below 10% fall into the low risk category, which does not include the moderate range. * **B.** A result in this band is still below the 10% cut point and is therefore low rather than moderate. * **C.** A result above 20% is classed as high risk rather than moderate. Sources: BC Guidelines (BC Ministry of Health) - Osteoporosis: Diagnosis, Treatment and Fracture Prevention 4. Like these? CA.med has 1055 more, plus timed mock exams. Free to start: [App Store](https://apps.apple.com/app/id6794733426?utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=mccqe-part-1) · [Google Play](https://play.google.com/store/apps/details?id=com.medicinahub.camed&utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=mccqe-part-1) 5. 4 / 10 A 64-year-old female is on postoperative day 1 following an open colectomy. She develops a fever of 38.4°C. She is asymptomatic otherwise, and her vitals are stable. Chest exam reveals decreased breath sounds at the lung bases bilaterally. What is the most likely cause of this patient's fever? Show answer **Answer: D.** Atelectasis **Why:** Postoperative fever follows a classic timeline (the '5 Ws'): Wind (atelectasis/pneumonia, days 1-2), Water (UTI, days 3-5), Wound (wound infection, days 5-7), Walking (DVT/PE, days 7-10), and Wonder drugs (drug fever, >10 days). Atelectasis is the most likely cause on postoperative day 1. * **A.** Typically presents as a cause of postoperative fever on days 3-5 ('water'). * **B.** Typically presents as a cause of postoperative fever on days 5-7 ('wound'). * **C.** Typically presents as a cause of postoperative fever on days 7-10 ('walking'). Sources: Oxford Handbook of Clinical Surgery 6. 5 / 10 A 54-year-old male with a history of open appendectomy presents with crampy abdominal pain, obstipation, and vomiting. Abdominal X-ray shows dilated small bowel loops and air-fluid levels, with no colonic gas. He is clinically stable with no signs of peritonitis. Following resuscitation and nasogastric decompression, what is the most appropriate next step? Show answer **Answer: B.** Administer a water-soluble contrast (Gastrografin) challenge **Why:** In patients with stable, non-complicated adhesive small bowel obstruction, initial management consists of resuscitation, NPO, and NG decompression. A water-soluble contrast (Gastrografin) challenge should be administered; if contrast reaches the colon on a follow-up X-ray within 8-24 hours, the obstruction is highly likely to resolve conservatively. * **A.** Immediate surgery is not indicated in stable patients without signs of complicated obstruction (e.g., ischemia, necrosis, or peritonitis). * **C.** TPN is only indicated if conservative management fails and the patient is expected to be NPO for more than 7-10 days. * **D.** Oral laxatives are contraindicated in patients with mechanical bowel obstruction due to the risk of perforation. Sources: Canadian Association of General Surgeons (CAGS) / Guidelines on Bowel Obstruction 7. 6 / 10 A 62-year-old man has a neurogenic bladder with incomplete emptying and needs long term catheterisation rather than a short term indwelling catheter. He and his physician are discussing the best bladder management strategy. According to the Canadian Urological Association, which approach is preferred for long term use? Show answer **Answer: D.** Intermittent catheterisation **Why:** The Canadian Urological Association guideline on catheter use recommends individualizing the choice of bladder management strategy according to anatomic factors, bladder characteristics, motor and cognitive function, patient preference and quality of life. Intermittent catheterisation is the gold standard for the management of failure to empty the bladder, and intermittent catheters are recommended over indwelling catheters for long term use because they carry a lower risk of urinary tract infection. When an indwelling catheter is necessary, a suprapubic catheter is preferable to a long term indwelling urethral catheter in most cases, and a closed drainage system should be used. Routine use of antimicrobial coated catheters is not recommended because long term use increases resistance and silver toxicity. * **A.** Leaving a urethral catheter in place long term is associated with a higher risk of urinary tract infection than a bladder emptying strategy performed intermittently, so it is not the preferred approach for long term use. * **B.** A suprapubic catheter may be considered when an indwelling catheter is necessary, but it is not the preferred first line strategy for long term use. * **C.** Routine use of antimicrobial coated catheters is not recommended, because long term use increases antimicrobial resistance and silver toxicity. Sources: Canadian Urological Association. Guideline: Catheter Use (2020). 8. 7 / 10 A 40-year-old man has had two episodes of calcium oxalate renal stones in three years. He has normal renal function and asks what he can change to reduce the chance of another stone. According to the Canadian Urological Association, what fluid advice should he receive? Show answer **Answer: C.** Aim for a urine output of about 2.5 litres daily **Why:** The Canadian Urological Association guideline on kidney stone evaluation and medical management states that adequate fluid intake to produce a urine output of 2.5 litres daily has been shown to reduce the risk of stone formation by 60 to 80 percent in several meta-analyses. Water is suggested as the first line fluid, and each 200 mL increase in fluid intake reduces the risk of stones by 13 percent. Fluid restriction would concentrate the urine and increase stone formation, so it is the opposite of the advice required. Dietary measures such as adequate calcium and limited sodium are additional steps, but fluid is the first line intervention. * **A.** Reducing fluid intake concentrates the urine and would increase rather than reduce the risk of forming further stones. * **B.** The guideline recommends water as the first line fluid, and there is no basis for making cranberry juice the main drink. * **D.** A one litre daily target is well below the urine output shown to lower stone formation and would be counterproductive. Sources: Canadian Urological Association. Guideline: Kidney Stone Evaluation and Medical Management. 9. 8 / 10 A 63-year-old man attends a wound clinic with a longstanding ulcer on the sole of his right foot. He has reduced sensation in both feet and the ulcer has not healed with dressings alone. Pedal pulses are present. According to the Ontario Health foot ulcer quality standard, which intervention should be part of his individualized care plan? Show answer **Answer: D.** A pressure-redistribution device **Why:** The Ontario Health foot ulcer standard offers pressure-redistribution devices as part of the individualized care plan for people with a foot ulcer or foot complications, within a comprehensive assessment that covers vascular status, infection and pressure redistribution. This man has a plantar ulcer with reduced sensation and palpable pulses, so offloading is the priority, and options A, B and C do not deliver the pressure redistribution the standard asks for. * **A.** Compression is not the intervention this standard recommends for a plantar ulcer, because the standard asks for pressure redistribution to offload the wound. * **B.** Amputation is not the standard's first step, which asks for a comprehensive assessment and pressure redistribution before surgical options are considered. * **C.** Bed rest without a redistribution device is not what the standard describes and would not support his mobility. Sources: Ontario Health - Diabetic Foot Ulcers Quality Standard 10. 9 / 10 A 66-year-old man describes calf discomfort after walking two blocks that resolves after a few minutes of rest. His pedal pulses are reduced. He asks about having the artery opened or bypassed. According to the Canadian Society for Vascular Surgery, what should be recommended first? Show answer **Answer: C.** A walking programme with smoking cessation and medical therapy **Why:** The Canadian Society for Vascular Surgery states that percutaneous interventions or bypass surgery should not be performed as first line therapy in patients with asymptomatic peripheral arterial disease or in most patients with claudication. Initial therapy should instead include smoking cessation, risk factor modification, medical therapy and a walking programme. Peripheral arterial disease is a marker of systemic atherosclerosis, so patients with claudication have a higher five year risk of cardiovascular events than of amputation, and revascularisation is reserved for limb-threatening ischaemia or truly disabling claudication. Analgesia alone does nothing for the underlying occlusive process. * **A.** Percutaneous intervention should not be first line therapy in most patients with claudication, because medical therapy and a walking programme come first. * **B.** Bypass surgery is reserved for limb-threatening ischaemia or truly disabling claudication rather than ordinary claudication. * **D.** Analgesia does not treat the underlying arterial disease, and a structured walking programme with risk factor modification is the recommended approach. Sources: Choosing Wisely Canada. Canadian Society for Vascular Surgery: Five Tests and Treatments to Question (2023). 11. 10 / 10 A 70-year-old woman with a chronic indwelling urethral catheter develops fever, rigors and flank pain with no other identified source. The ward team plans to collect a urine specimen to confirm catheter associated infection. According to the Canadian Urological Association, how should the specimen be obtained? Show answer **Answer: A.** Exchange the catheter and collect a specimen after the new catheter is inserted **Why:** The Canadian Urological Association guideline on catheter use states that if there is clinical suspicion of catheter associated urinary tract infection, specimen collection should occur prior to antimicrobial therapy and proceed according to the method of bladder management. A catheterised urine specimen is preferable to a voided sample because it avoids contamination with periurethral microbes, and patients with indwelling catheters should have the catheter exchanged with immediate collection of a specimen following insertion of the new catheter; this approach enhances clinical improvement, shortens symptoms and reduces relapse. Specimens should not be collected from a catheter drainage bag, because the bag is colonised and culture alone is inadequate for diagnosis. In chronic catheterisation, the level of colonisation is commonly above 105 colony forming units per mL, so symptoms and illness severity must be considered with the culture. * **B.** Specimens should not be collected from a catheter drainage bag, because the bag is heavily colonised and the result is uninterpretable. * **C.** A midstream specimen is not appropriate while an indwelling catheter is in place, and a catheterised specimen is preferable when a catheter is present. * **D.** If there is clinical suspicion of infection, the specimen should be collected before antimicrobial therapy begins, not afterwards. Sources: Canadian Urological Association. Guideline: Catheter Use (2020). ## 1055 more questions like these are waiting in CA.med Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start. 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