Common ABSITE Question Types You’ll Encounter on the Exam

Types of Questions You’ll Encounter on the ABSITE Exam

At the end of January each year, surgery residents across the nation sit for the American Board of Surgery In-Training Examination (ABSITE). The ABSITE is a comprehensive, multiple-choice examination that tests a trainee’s fund of knowledge in the diagnosis and management of surgical pathology. Topics covered include cases from general surgery and surgical sub-specialties, such as vascular surgery, cardiothoracic surgery, endocrine surgery, and pediatric surgery. One of the key elements of preparing for the ABSITE is understanding the types of questions that can be expected on test day, which we will review below. For the best resources for ABSITE review, see our dedicated post.

ABSITE General Principles

Before we dive into the common question types, let’s take a minute to discuss some important general principles pertaining to the ABSITE. This exam is similar to many others you have previously taken, such as the USMLE and the NBME Subject Examinations. As such, remember to use your effective test-taking strategies: calculate and maintain your per question pace, use the highlight and strike-through tools thoughtfully, and mark questions to be checked at the end of the examination. The critical differences between your experience on the ABSITE and on previous tests are that you take this exam every year for at least five years (advantageous) yet you typically have significant less dedicated time to prepare (disadvantageous). See our related blog post on how best to construct an ABSITE study schedule.

Question Types on the ABSITE

Although the ABSITE is constantly evolving and there are many different types of questions that may be encountered, the following are some of the most common question types. For each question type, take note of the test-taking strategies that can maximize your success and efficiency on these questions.

Case Questions: Diagnosis

One of the most classic question types encountered is a vignette-style question that focuses on arriving at the correct diagnosis. These questions typically conclude with a statement asking the test-taker to identify the most likely diagnosis based on the information provided, similar to question styles from USMLE Step 1 and 2, and the NBME Subject Examinations. To best address case questions, start by reading the final sentence of the question first, revealing the intention of the question and allowing you to focus on the facts of the case that will assist with selecting the correct diagnosis. Next, review the answer options quickly, which will serve a few important functions. First, it will allow you to anticipate the relevant information that must be found within the stem to select the correct diagnosis. Second, you will begin reading the case with a complete differential in mind, increasing your efficiency. After reading the complete case and reviewing the relevant laboratory and imaging results, strike through any diagnoses which immediately can be eliminated. If you are down to two or three options, make one final quick review of the case to help support or rule out the options left. Select the answer which you think fits best. Remember you only have 72 seconds per question on average, so try to avoid spending more than three minutes on any given question initially. You can always mark the question and return to it later if needed.

Case Question: Diagnostic Evaluation

Another common question type is a second-order question that presents a case and then asks you not simply to identify the diagnosis, but rather to select the best diagnostic study. In some scenarios, the diagnosis is not clear and knowing it is not necessary in order to answer the question correctly. Again, begin the case by reading the final sentence and reviewing the answer choices to best direct your focus and increase your efficiency while answering the question. In preparing for these questions, it is important that you devote study time to the typical diagnostic evaluation of surgical pathology. While some clinical scenarios or practice questions you may encounter may deviate from this pathway, the ABSITE will most commonly test your knowledge of standard diagnostic procedure. Examples include understanding when to use abdominal plain imaging versus ultrasound versus cross-sectional imaging. A classic area of ABSITE emphasis is how these decisions may change in particular patient populations, including children, pregnant patients, or older adults. Flashcards reviewing the evaluation of certain pathologies can be an effective and efficient way of mastering these facts.

Case Questions: Management

Questions that ask the test-taker to select the next most appropriate step in management are classic on the ABSITE. These questions may be the least similar to USMLE and shelf questions, which more frequently focus on diagnosis and evaluation. While the ABSITE test creators may be limited in their ability to test your ability to perform safe and effective surgery, they may use case questions to ensure that you understand how to plan for surgery. As with all case questions, begin with the final sentence and review the options available. If you are a junior resident and have not yet completed some of the core surgery rotations, these questions may be the most challenging. Remember that you are only graded against your peers and you can counteract your lack of experience by reviewing surgical videos or intraoperative pictures/drawings to get a feel for the relevant anatomy and key steps of the procedure. If you have narrowed down your answer choices but are struggling to pick your final response, remember that the American Board of Surgery wants to ensure that you are safe first and effective second; if one intervention seems overly aggressive or unsafe, it is quite possible that this answer is incorrect. Similarly, be mindful that some questions will try to “force” you to select an intervention for a patient with a non-surgical issue, so the correct answer may not always involve a surgical intervention, such as for a teenage boy with gynecomastia.  

Case Questions: Complications

The final type of common case question will ask you to identify a complication in a post-surgical patient. Your approach to reading these case questions and reviewing the answer choices is the same above. Although less common that diagnosis or management style questions, complication-focused questions still comprise an important component of the exam. To best prepare for these questions, make sure that you review the top few complications for each surgery you study. Pay particular attention to complications that are unique to a certain surgery, such as a recurrent laryngeal nerve injury following a thyroid/parathyroid operation or a common bile duct injury following cholecystectomy. This can be even more challenging when test-takers are asked to identify complications following surgeries which are no longer routinely performed, such as slipped bands following a gastric banding surgery. 

Fact Questions

Non-case based, fact style questions can be the easiest way to rack up correct answers, while also saving time on the exam. Questions like might sound something like this: “What is the most common cause of small bowel obstruction in the United States?” Frequently, you either know the answer or you don’t. On occasion, using logic or test-taking strategies may allow you to narrow your answer options. Do not fall victim to spending many minutes on these questions hoping the answer will magically appear in your mind. These are easy questions to mark for later review, and any gained time can be used on the longer case-style questions. Be mindful that there are fact-based questions which may be integrated into case-style questions. For example, a question may ask you to identify the most common complication experienced following a surgery, after first describing a typical patient in whom this complication may occur. Using the strategy of reading the final sentence of a question and reviewing the answers may allow you to correctly answer this question without having to review the associated case, which may be of no added benefit. 

Pathophysiology Questions

The final type of question encountered on the ABSITE, and frequently the most feared, asks you to select the answer that best describes the associated pathophysiologic process underlying a surgical pathology or related complication. Note that although the percentages fluctuate from year-to-year, 75% of ABSITE questions are generally patient care questions while only 25% test medical knowledge, of which only a small percentage review pathophysiology. These concepts can be reviewed in review texts such as Fiser or in fundamental surgical textbooks. However, do not devote too much time studying the minutiae of basic-science oriented topics such as microbiology, immunology, and tumor biology, as these tend to be lower yield topics on the exam. Rather, review the clinically relevant microscopic processes within these topics.