Six weeks after a kidney transplant, a 45-year-old woman makes less urine and her kidney function worsens. Acute rejection is suspected. Which test can confirm that the organ is being rejected?MedlinePlus Medical Encyclopedia, "Transplant rejection", Causes; Exams and Tests. Outline: NBME Surgery Subject Exam content outline, Immune System.
Blood and lymphoreticular system 4
A 24-year-old woman with von Willebrand disease is scheduled to have her gallbladder removed. Which medicine may her surgeon give before surgery to see whether her von Willebrand factor level rises?MedlinePlus Medical Encyclopedia, "Von Willebrand disease", Summary; Treatment. Outline: NBME Surgery Subject Exam content outline, Blood & Lymphoreticular System.
A 30-year-old man had his spleen removed after a car crash. For which kind of severe infection is he now at increased risk?MedlinePlus Medical Encyclopedia, "Post-splenectomy complications", Summary. Outline: NBME Surgery Subject Exam content outline, Blood & Lymphoreticular System.
A 66-year-old man with an infection in the blood after bowel surgery starts bleeding from several sites at once, and his clotting tests are abnormal. Disseminated intravascular coagulation is diagnosed. What is the goal of treatment?MedlinePlus Medical Encyclopedia, "Disseminated intravascular coagulation (DIC)", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Blood & Lymphoreticular System.
During a blood transfusion after surgery, a 58-year-old man has chills, a fever, back pain and bloody urine, and the transfusion is stopped. What happens in a hemolytic transfusion reaction?MedlinePlus Medical Encyclopedia, "Hemolytic transfusion reaction", Summary; Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Blood & Lymphoreticular System.
Show all 48 questions (43 more)
Nervous system and special senses 4
A 9-year-old boy fell from a tree and hit his head. An hour later he has bruising behind one ear and clear fluid draining from his nose. Which injury do these signs suggest?MedlinePlus Medical Encyclopedia, "Skull fracture", Symptoms. Outline: NBME Surgery Subject Exam content outline, Nervous System & Special Senses.
A 62-year-old man suddenly sees bright flashes of light at the edge of his vision and many new floaters in one eye. A detached retina is found. What do most people with this problem need?MedlinePlus Medical Encyclopedia, "Retinal detachment", Symptoms; Treatment; When to Contact a Medical Professional. Outline: NBME Surgery Subject Exam content outline, Nervous System & Special Senses.
After a severe head injury, a 27-year-old man loses consciousness, and one pupil is wide and does not react to light. Brain herniation is suspected. Which medicine may be given to reduce the swelling?MedlinePlus Medical Encyclopedia, "Brain herniation", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Nervous System & Special Senses.
An 80-year-old woman who takes warfarin had a minor fall 4 weeks ago. She is now confused and weak on one side, and a CT scan shows a chronic subdural hematoma. Which treatment relieves the pressure?MedlinePlus Medical Encyclopedia, "Chronic subdural hematoma", Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Nervous System & Special Senses.
Skin 2
A 22-year-old man has a warm, tender, swollen area near his tailbone, and pus drains from a small pit in the crease between the buttocks. Which condition is this?MedlinePlus Medical Encyclopedia, "Pilonidal sinus disease", Summary; Considerations. Outline: NBME Surgery Subject Exam content outline, Skin & Subcutaneous Tissue.
A 51-year-old woman has a melanoma on her calf, confirmed by biopsy. In the surgery to remove it, what decides how much skin is taken?MedlinePlus Medical Encyclopedia, "Melanoma", Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Skin & Subcutaneous Tissue.
Musculoskeletal system 3
A 7-year-old girl has a fever and pain in her lower leg, and tests show a bone infection in the tibia. For how long are antibiotics taken for osteomyelitis?MedlinePlus Medical Encyclopedia, "Osteomyelitis", Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Musculoskeletal System.
After lifting a heavy box, a 41-year-old warehouse worker has sharp pain in one buttock and leg, with numbness in the foot. A herniated disk is suspected. Which area of the spine is most commonly affected?MedlinePlus Medical Encyclopedia, "Herniated disk", Causes; Symptoms. Outline: NBME Surgery Subject Exam content outline, Musculoskeletal System.
An 84-year-old woman has surgery to repair a broken hip. Which risk, more common after hip surgery, is the reason she is encouraged to walk as soon as the first day?MedlinePlus Medical Encyclopedia, "Hip fracture surgery", Risks; After the Procedure. Outline: NBME Surgery Subject Exam content outline, Musculoskeletal System.
Cardiovascular system 6
A 49-year-old woman who stands all day at work has swollen, twisted veins in both legs that ache by evening. What goes wrong in the veins?MedlinePlus Medical Encyclopedia, "Varicose veins", Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
A 66-year-old man with long-term high blood pressure has hoarseness and trouble swallowing. A CT scan shows an aneurysm of the aortic arch pressing on nearby structures. What is the most common cause of a thoracic aortic aneurysm?MedlinePlus Medical Encyclopedia, "Thoracic aortic aneurysm", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
A 67-year-old smoker has pain in both calves when he walks two blocks, and it goes away when he rests. Which test compares the blood pressure in the arms and the legs?MedlinePlus Medical Encyclopedia, "Peripheral artery disease - legs", Causes; Symptoms; Exams and Tests. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
A 68-year-old man who smoked for 40 years has an abdominal aortic aneurysm found on ultrasound and no symptoms. Most of the time, surgery is done when the aneurysm is growing quickly or is bigger than what size?MedlinePlus Medical Encyclopedia, "Abdominal aortic aneurysm", Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
A 70-year-old man is found to have a bruit over the left side of his neck, and a duplex ultrasound shows a severely narrowed carotid artery. Which surgery removes the plaque buildup?MedlinePlus Medical Encyclopedia, "Carotid artery disease", Causes; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
A 72-year-old woman with atrial fibrillation has sudden pain in her right leg. The leg is cold and pale, and no pulse can be felt at the ankle. What is the likely cause?MedlinePlus Medical Encyclopedia, "Arterial embolism", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Cardiovascular System.
Respiratory system 5
A 57-year-old man treated for bacterial pneumonia still has a fever and chest pain. Fluid taken from the pleural space is pus. Along with antibiotics, how is an empyema treated?MedlinePlus Medical Encyclopedia, "Empyema", Summary; Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Respiratory System.
A 64-year-old former smoker has an adenocarcinoma in an outer area of the right lung. Staging tests show that it has not spread beyond nearby lymph nodes. What is the common treatment?MedlinePlus Medical Encyclopedia, "Non-small cell lung cancer", Summary; Treatment. Outline: NBME Surgery Subject Exam content outline, Respiratory System.
A chest x-ray before knee surgery shows a single round nodule in the lung of a 45-year-old woman who has never smoked. X-rays from 2 years ago show the same nodule at the same size. What does this mean?MedlinePlus Medical Encyclopedia, "Solitary pulmonary nodule", Causes; Exams and Tests. Outline: NBME Surgery Subject Exam content outline, Respiratory System.
On the day after abdominal surgery under general anesthesia, a 60-year-old woman takes shallow breaths, and a chest x-ray shows atelectasis at both lung bases. Which treatment helps re-expand the lung tissue?MedlinePlus Medical Encyclopedia, "Atelectasis", Causes; Treatment; Prevention. Outline: NBME Surgery Subject Exam content outline, Respiratory System.
Two days after emergency surgery under general anesthesia, a 79-year-old man who was drowsy from opioid pain medicine has a fever, a cough and shortness of breath. Aspiration pneumonia is diagnosed. What causes it?MedlinePlus Medical Encyclopedia, "Aspiration pneumonia", Summary; Causes. Outline: NBME Surgery Subject Exam content outline, Respiratory System.
Gastrointestinal system 11
A 12-year-old girl has nausea, a low fever and pain that has settled in the right lower abdomen, at McBurney point. Where does the pain of appendicitis often begin?MedlinePlus Medical Encyclopedia, "Appendicitis", Symptoms. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 40-year-old man with diabetes has constant throbbing pain and a tender, swollen lump beside the anus, with a fever. An anorectal abscess is diagnosed. What does treatment involve?MedlinePlus Medical Encyclopedia, "Anorectal abscess", Symptoms; Treatment; Possible Complications. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 44-year-old woman has sharp, steady pain in the upper right abdomen with nausea and a fever. An ultrasound shows a gallstone blocking the cystic duct. What will she probably need?MedlinePlus Medical Encyclopedia, "Acute cholecystitis", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 47-year-old man has trouble swallowing both liquids and solids, and food comes back up. Achalasia is suspected. Which test measures whether the esophagus is working properly?MedlinePlus Medical Encyclopedia, "Achalasia", Causes; Symptoms; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 55-year-old man has had a bulge in his groin for a year. Today it is painful and swollen, he is vomiting, and he cannot pass gas. What does he need?MedlinePlus Medical Encyclopedia, "Hernia", Summary; Symptoms. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 58-year-old woman has upper abdominal pain and yellowing of the skin and eyes. A stone in the common bile duct is suspected. Which is the most accurate non-invasive test to look for it?MedlinePlus Medical Encyclopedia, "Choledocholithiasis", Summary; Symptoms; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 61-year-old man has blood in the stool and narrow stools. Colonoscopy and scans show a colon cancer that has spread through the muscle wall of the colon but not to lymph nodes. Which stage is this?MedlinePlus Medical Encyclopedia, "Colorectal cancer", Symptoms; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 63-year-old man has had several attacks of fever and pain in the left lower abdomen from diverticulitis. A CT scan now shows an abnormal connection between his colon and his bladder. What is this complication called?MedlinePlus Medical Encyclopedia, "Diverticulitis", Symptoms; Possible Complications. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
A 68-year-old man has jaundice, itching, dark urine, clay-colored stools and weight loss. A CT scan shows a pancreatic tumor that has spread and is blocking the bile duct. Which procedure can relieve the jaundice and itching?MedlinePlus Medical Encyclopedia, "Pancreatic cancer", Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
After a week of constipation with hard stools, a 34-year-old woman has pain during bowel movements and bright red blood on the toilet paper. A small tear is seen in the lining of the anus. What does care include?MedlinePlus Medical Encyclopedia, "Anal fissure", Summary; Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
Three weeks after an attack of severe acute pancreatitis, a CT scan shows a small pseudocyst in a 50-year-old man who feels well. What is true of many pancreatic pseudocysts?MedlinePlus Medical Encyclopedia, "Pancreatic pseudocyst", Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Gastrointestinal System.
Renal and urinary system 2
A 30-year-old man has broken his pelvis in a motorcycle crash and cannot pass urine. What must be ruled out before a urinary catheter is inserted?MedlinePlus Medical Encyclopedia, "Traumatic injury of the bladder and urethra", Causes; Exams and Tests. Outline: NBME Surgery Subject Exam content outline, Renal & Urinary System.
A 69-year-old man who has smoked for 45 years has blood in his urine. Which test examines the inside of the bladder with a camera and allows a biopsy?MedlinePlus Medical Encyclopedia, "Bladder cancer", Causes; Symptoms; Exams and Tests. Outline: NBME Surgery Subject Exam content outline, Renal & Urinary System.
Female reproductive system and breast 2
A 36-year-old woman finds a new lump in one breast. Her surgeon wants to know whether it is a fluid-filled cyst. Which imaging test can determine that?MedlinePlus Medical Encyclopedia, "Breast lump", Causes. Outline: NBME Surgery Subject Exam content outline, Female Reproductive System & Breast.
A 54-year-old woman has a breast cancer found on a mammogram and confirmed by needle biopsy. Which test checks whether the cancer has spread to the lymph nodes?MedlinePlus Medical Encyclopedia, "Breast cancer", Causes; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Female Reproductive System & Breast.
Male reproductive system 1
A 27-year-old man has a painless lump in one testicle, and an ultrasound of the scrotum shows a mass. Which blood tests are tumor markers for testicular cancer?MedlinePlus Medical Encyclopedia, "Testicular cancer", Causes; Symptoms; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Male Reproductive System.
Endocrine system 2
A 43-year-old woman has a single thyroid nodule and no symptoms. Her TSH level is normal, and an ultrasound has been done. Which test takes a sample of the nodule?MedlinePlus Medical Encyclopedia, "Thyroid nodule", Causes; Symptoms; Exams and Tests; Treatment. Outline: NBME Surgery Subject Exam content outline, Endocrine System.
A 58-year-old woman has kidney stones and fragile bones. Her blood calcium and parathyroid hormone levels are both high. What is the cause of primary hyperparathyroidism about 80% of the time?MedlinePlus Medical Encyclopedia, "Hyperparathyroidism", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Endocrine System.
Multisystem disorders 4
A 4-year-old boy has blistered, partial-thickness burns over his chest and arm from hot water. Why do children under age 5 have a higher chance of complications from severe burns?MedlinePlus Medical Encyclopedia, "Burns", Considerations. Outline: NBME Surgery Subject Exam content outline, Multisystem Processes & Disorders.
During an operation under general anesthesia with sevoflurane, a 23-year-old man has a fast rise in body temperature and severe muscle contractions. Which medicine is often given?MedlinePlus Medical Encyclopedia, "Malignant hyperthermia", Summary; Causes; Treatment. Outline: NBME Surgery Subject Exam content outline, Multisystem Processes & Disorders.
Seven days after a bowel operation, a 62-year-old man has an incision that is red, hot and painful, with pus draining from it. Besides antibiotics, what may the surgeon do to the wound?MedlinePlus Medical Encyclopedia, "Surgical wound infection - treatment", Summary; Treatment. Outline: NBME Surgery Subject Exam content outline, Multisystem Processes & Disorders.
Two days after a deep, dirty wound of the thigh, a 35-year-old man has severe pain and swelling around it, and air is felt under the skin. Which bacteria most often cause gas gangrene?MedlinePlus Medical Encyclopedia, "Gas gangrene", Causes; Symptoms; Treatment. Outline: NBME Surgery Subject Exam content outline, Multisystem Processes & Disorders.
Social sciences 1
A 74-year-old woman on a ventilator after surgery for cancer that cannot be cured has decision-making capacity. She asks that the ventilator be stopped, knowing she is expected to die. By the AMA Code of Medical Ethics, what is her right?AMA Code of Medical Ethics, Opinion 5.3, Withholding or Withdrawing Life-Sustaining Treatment. Outline: NBME Surgery Subject Exam content outline, Social Sciences.
How this list was compiled: Our own questions, written to the content outline of the Surgery Subject Exam that NBME publishes (https://www.nbme.org/institutions/assess-learn/subject-exams/clinical-science/surgery/, read 2026-10-15). Its fourteen systems and their ranges: Immune System 1-5%, Blood & Lymphoreticular System 5-10%, Nervous System & Special Senses 5-10%, Skin & Subcutaneous Tissue 1-5%, Musculoskeletal System 3-7%, Cardiovascular System 10-15%, Respiratory System 8-12%, Gastrointestinal System 20-25%, Renal & Urinary System 3-7%, Female Reproductive System & Breast 3-7%, Male Reproductive System 1-5%, Endocrine System 3-7%, Multisystem Processes & Disorders 5-10%, Social Sciences 1-5%. The bank holds 1, 4, 4, 2, 3, 6, 5, 11, 2, 2, 1, 2, 4 and 1 questions in that order, 48 in all; four patients are children, as the outline gives ages from birth to 17 a share of 8 to 12%. Every clinical fact was read on 2026-10-15 in the MedlinePlus Medical Encyclopedia (National Library of Medicine) article the question names; the ethics question rests on the AMA Code of Medical Ethics. Licence: Questions, choices and explanations are original work of this site.
How it works
This free NBME surgery shelf practice exam has 48 short cases of our own for the Surgery Subject Exam. It is unofficial: the National Board of Medical Examiners (NBME) is not affiliated with this site and has not endorsed it.
Read the full guide
What the surgery shelf covers
NBME's Surgery Subject Exam content outline, read October 15, 2026, lists 14 systems. The gastrointestinal system is the largest, so 11 of the 48 cases are on the digestive tract: esophagus, appendix, gallbladder, bile duct, bowel, hernia, pancreas and anus.
How the cases are built
Most cases ask what is decided before or after the operation: which test, when to operate, what a complication means. Four patients are children. Every answer names the article and section it was read in, from MedlinePlus in all but one.
Timed practice
At the real exam's pace of a minute and a half an item, 40 cases take an hour; that is the timed round here.
A size that decides answers: an abdominal aortic aneurysm is most often repaired when bigger than 2 inches (5 centimeters) across or growing quickly.
Questions and answers
How many questions are on the NBME surgery shelf exam?
The Surgery exam has 110 items and lasts 2 hours 45 minutes, by NBME's Subject Examination Timing Chart (July 2021). On a web exam a tutorial comes first and adds 15 minutes.
Are these real NBME surgery shelf questions?
No. The 48 cases are our own, written from the public content outline and public health pages. No NBME sample item or self-assessment was opened, and no question bank or review book was used or reworded.
What should a surgery shelf study guide cover first?
By NBME's outline: gastrointestinal 20 to 25% of items, cardiovascular 10 to 15%, respiratory 8 to 12%. Blood, the nervous system and multisystem disorders carry 5 to 10% each, and four more systems 3 to 7% each.
Does NBME sell its own surgery shelf practice exams?
Yes. Its Clinical Science Mastery Series has Surgery forms at $21 each, with 50 multiple-choice questions a form, by NBME's site on October 15, 2026. Those are NBME's product; this page is free and is not one of them.