1
, 2
Sabiston Textbook of Surgery
The Biological Basis of Modern Surgical
Practice — 22nd Edition
Original ABSITE TEST BANK
CHAPTER LIST
Chapter 1. Surgical Education: Past, Present, and Chapter 17. Global Surgery and Surgical
Future Disparities
Chapter 2. Surgical Simulation and New Ways to Chapter 18. Perioperative Management of the
Optimize Performance Geriatric Surgical Patient
Chapter 3. Certification of Surgeon Competence Chapter 19. Principles of Preoperative Preparation
Chapter 4. Preoperative Risk Assessment and Chapter 20. Anesthesia Principles and Pain
Alterations in the COVID-19 Era Management
Chapter 5. Social Determinants of Health and Chapter 21. Surgical Infections and Antimicrobial
Their Impact on Surgical Outcomes Therapy
Chapter 6. Critical Assessment of Surgical Chapter 22. Hemostasis and Transfusion Therapy
Outcomes and Health Services Research Chapter 23. Shock, Electrolytes, and Fluid
Chapter 7. Surgical Quality Improvement Management
Programs Chapter 24. Metabolic Response to Injury and
Chapter 8. Patient-Reported Outcomes in Surgery Nutritional Support
Chapter 9. Safety in the Surgical Environment Chapter 25. Burns
Chapter 10. Advances and Training Chapter 26. Principles of Wound Healing and
Considerations in Robotic Surgery Wound Care
Chapter 11. Advances and Training Chapter 27. Surgical Complications
Considerations in Laparoscopic Surgery Chapter 28. Venous Thromboembolism:
Chapter 12. Advances and Training Prophylaxis and Management
Considerations in Endoscopy Chapter 29. Surgical Considerations in the Obese
Chapter 13. Enhanced Recovery After Surgery Patient
(ERAS) Protocols Chapter 30. Acute Kidney Injury in Surgical
Chapter 14. Surgical Palliative Care Patients
Chapter 15. Informed Consent and Surgical Ethics Chapter 31. Surgical Considerations in the
Chapter 16. Surgical Innovation and New Immunocompromised Patient
Technology Assessment
, 2
Chapter 32. Surgical Considerations in the Chapter 57. Adrenal Glands
Pregnant Patient Chapter 58. Multiple Endocrine Neoplasia
Chapter 33. Pediatric Perioperative Management Syndromes
Chapter 34. Surgical Considerations in the Chapter 59. Abdominal Wall, Umbilicus,
Diabetic Patient Peritoneum, Mesenteries, Omentum, and
Chapter 35. Cardiac Evaluation and Management Retroperitoneum
of the Non-Cardiac Surgical Patient Chapter 60. Hernias
Chapter 36. Injury Epidemiology and Prevention Chapter 61. Esophagus
Chapter 37. Initial Assessment and Management Chapter 62. Stomach
of Trauma Chapter 63. Small Intestine
Chapter 38. Head and Central Nervous System Chapter 64. Colon and Rectum
Trauma Chapter 65. The Appendix
Chapter 39. Thoracic Trauma Chapter 66. Liver
Chapter 40. Abdominal Trauma Chapter 67. Biliary Tract
Chapter 41. Vascular Trauma Chapter 68. Exocrine Pancreas
Chapter 42. Extremity Trauma Chapter 69. Spleen
Chapter 43. Genitourinary Trauma Chapter 70. Anorectal Disorders
Chapter 44. Surgical Critical Care Chapter 71. Breast Anatomy, Physiology, and the
Chapter 45. The Inflammatory Response Augmented Breast
Chapter 46. Transplant Immunobiology and Chapter 72. Benign Breast Disorders
Immunosuppression Chapter 73. Malignant Breast Tumors
Chapter 47. Kidney and Pancreas Transplantation Chapter 74. Thyroid
Chapter 48. Liver Transplantation Chapter 75. Parathyroid Glands
Chapter 49. Heart and Lung Transplantation Chapter 76. Adrenal Glands
Chapter 50. Small Bowel Transplantation Chapter 77. Endocrine Pancreas and Carcinoid
Chapter 51. Tumor Biology, Biomarkers, and Tumors
Targeted Therapy Chapter 78. Multiple Endocrine Neoplasia
Chapter 52. Melanoma and Cutaneous Syndromes
Malignancies Chapter 79. Morbid Obesity and Metabolic
Chapter 53. Soft Tissue Sarcomas Surgery
Chapter 54. Breast Disease Chapter 80. Vascular Biology, Hemostasis, and
Chapter 55. Diseases of the Thyroid Peripheral Arterial Disease
Chapter 56. Parathyroid Glands Chapter 81. Abdominal Aortic Aneurysm
, 2
SECTION I — SURGICAL TRAINING AND QUALITY CONTROL
Chapter 1. Surgical Education: Past, Present, and Future
Question 1. Which 1910 report fundamentally reformed North American
medical education by advocating science-based university-affiliated training?
A. The Osler Report
B. The Flexner Report
C. The Halsted Report
D. The Carnegie Commission Report
✅ Correct Answer: B. The Flexner Report
Rationale: The Flexner Report, commissioned by the Carnegie Foundation in 1910,
surveyed 155 North American medical schools and recommended closing
substandard institutions and affiliating training with universities. It laid the
foundation for modern evidence-based medical education. Halsted developed the
apprenticeship residency model but authored no such report.
DIF: Easy | TOP: History of Medical Education | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 2. The Halstedian model of surgical education is best described as
which of the following?
A. Competency-based progression with standardized assessments
B. Time-limited rotations with didactic curriculum
C. Graduated responsibility apprenticeship under direct mentorship
D. Simulation-based training with objective metrics
✅ Correct Answer: C. Graduated responsibility apprenticeship under direct
mentorship
Rationale: William Halsted established the residency model at Johns Hopkins in
the 1880s based on graduated responsibility under direct mentorship, where
residents assumed increasing operative autonomy as they demonstrated
, 3
competence. This apprenticeship model dominated surgical education for over a
century.
DIF: Easy | TOP: Halstedian Model | MSC: ABSITE Category: Surgical Education & Professional
Development
Question 3. The six ACGME core competencies for residency training include
all of the following EXCEPT:
A. Patient care and medical knowledge
B. Interpersonal and communication skills
C. Operative volume and case diversity
D. Systems-based practice and professionalism
✅ Correct Answer: C. Operative volume and case diversity
Rationale: The six ACGME core competencies are: patient care, medical
knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism, and systems-based practice. Operative
volume is tracked separately as a milestone but is not itself a core competency.
DIF: Moderate | TOP: ACGME Competencies | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 4. Under the 2011 ACGME duty hour restrictions, what is the
maximum number of continuous hours an intern may work?
A. 24 hours
B. 16 hours
C. 28 hours
D. 30 hours
✅ Correct Answer: B. 16 hours
Rationale: The 2011 ACGME update limited first-year residents (interns) to 16
consecutive hours of clinical work, compared to the 24 hours permitted for more
senior residents. All residents remain subject to the 80-hour weekly work limit
established in 2003.
, 4
DIF: Moderate | TOP: Duty Hour Regulations | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 5. The maximum number of work hours per week permitted under
ACGME regulations for all surgical residents is:
A. 60 hours
B. 72 hours
C. 80 hours
D. 88 hours
✅ Correct Answer: C. 80 hours
Rationale: The ACGME implemented an 80-hour weekly work limit averaged over
4 weeks in 2003 following concerns about resident fatigue and patient safety. This
limit applies to all residency programs with allowance for moonlighting counted
toward the total.
DIF: Easy | TOP: Duty Hour Regulations | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 6. Competency-based medical education (CBME) differs from
traditional time-based training in that it:
A. Requires a fixed 5-year residency before independent practice
B. Allows advancement based on demonstrated mastery rather than time spent
C. Emphasizes operative volume over assessed outcomes
D. Eliminates the need for formal assessment tools
✅ Correct Answer: B. Allows advancement based on demonstrated mastery
rather than time spent
Rationale: CBME advances residents based on demonstrated achievement of
defined competencies rather than completion of a fixed time period. This approach,
supported by the ACGME Milestones project, allows individualized progression
and ensures competence before independent practice.
DIF: Moderate | TOP: Competency-Based Education | MSC: ABSITE Category: Surgical Education &
Professional Development
, 5
Question 7. Entrustable Professional Activities (EPAs) in surgical education
are best defined as:
A. Standardized operative cases required for board eligibility
B. Units of professional practice that can be entrusted to trainees once competence
is demonstrated
C. Written examinations assessing surgical knowledge
D. Simulation tasks used to evaluate technical skills
✅ Correct Answer: B. Units of professional practice that can be entrusted to
trainees once competence is demonstrated
Rationale: EPAs are discrete units of work that can be entrusted to a trainee once
they have demonstrated sufficient competence. They bridge the gap between
competency frameworks and day-to-day clinical practice, allowing supervisors to
make trust-based decisions about trainee autonomy.
DIF: Moderate | TOP: Entrustable Professional Activities | MSC: ABSITE Category: Surgical
Education & Professional Development
Question 8. Which principle of deliberate practice, as described by Ericsson,
is most critical to skill acquisition in surgical training?
A. Repetition of procedures already mastered
B. Focused practice just beyond current ability with immediate feedback
C. Self-directed study without instructor supervision
D. High-volume case exposure without structured assessment
✅ Correct Answer: B. Focused practice just beyond current ability with
immediate feedback
Rationale: Ericsson's theory of deliberate practice requires practicing tasks at the
edge of current ability with immediate, specific feedback and conscious effort to
improve. Mere repetition of mastered skills does not drive further improvement;
the challenge must exceed current performance.
DIF: Hard | TOP: Deliberate Practice | MSC: ABSITE Category: Surgical Education & Professional
Development
, 6
Question 9. The ACGME Milestones project assesses surgical residents on a
scale of 1 to 5. A milestone rating of 4 best indicates:
A. The resident performs independently as expected of a graduating senior
B. The resident is ready for unsupervised practice in that domain
C. The resident demonstrates aspirational behaviors of a faculty member
D. The resident meets expectations for early post-residency practice
✅ Correct Answer: D. The resident meets expectations for early post-
residency practice
Rationale: Milestone level 4 indicates performance expected of a graduating senior
resident ready for independent practice. Level 5 represents aspirational expert
faculty-level behaviors. Milestones are assessed semi-annually and reported to the
ACGME.
DIF: Hard | TOP: Milestones Assessment | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 10. Which concept explains why learners perform worse after being
taught multiple skills simultaneously compared to learning each skill in
isolation?
A. Transfer-appropriate processing
B. Cognitive load theory
C. Spaced repetition
D. Interleaved practice
✅ Correct Answer: B. Cognitive load theory
Rationale: Cognitive load theory holds that working memory has limited capacity.
When multiple new skills are taught simultaneously, extraneous cognitive load
overwhelms working memory and impairs learning. Surgical educators should
manage intrinsic and extraneous load to optimize skill acquisition.
DIF: Hard | TOP: Cognitive Load Theory | MSC: ABSITE Category: Surgical Education &
Professional Development
, 2
Sabiston Textbook of Surgery
The Biological Basis of Modern Surgical
Practice — 22nd Edition
Original ABSITE TEST BANK
CHAPTER LIST
Chapter 1. Surgical Education: Past, Present, and Chapter 17. Global Surgery and Surgical
Future Disparities
Chapter 2. Surgical Simulation and New Ways to Chapter 18. Perioperative Management of the
Optimize Performance Geriatric Surgical Patient
Chapter 3. Certification of Surgeon Competence Chapter 19. Principles of Preoperative Preparation
Chapter 4. Preoperative Risk Assessment and Chapter 20. Anesthesia Principles and Pain
Alterations in the COVID-19 Era Management
Chapter 5. Social Determinants of Health and Chapter 21. Surgical Infections and Antimicrobial
Their Impact on Surgical Outcomes Therapy
Chapter 6. Critical Assessment of Surgical Chapter 22. Hemostasis and Transfusion Therapy
Outcomes and Health Services Research Chapter 23. Shock, Electrolytes, and Fluid
Chapter 7. Surgical Quality Improvement Management
Programs Chapter 24. Metabolic Response to Injury and
Chapter 8. Patient-Reported Outcomes in Surgery Nutritional Support
Chapter 9. Safety in the Surgical Environment Chapter 25. Burns
Chapter 10. Advances and Training Chapter 26. Principles of Wound Healing and
Considerations in Robotic Surgery Wound Care
Chapter 11. Advances and Training Chapter 27. Surgical Complications
Considerations in Laparoscopic Surgery Chapter 28. Venous Thromboembolism:
Chapter 12. Advances and Training Prophylaxis and Management
Considerations in Endoscopy Chapter 29. Surgical Considerations in the Obese
Chapter 13. Enhanced Recovery After Surgery Patient
(ERAS) Protocols Chapter 30. Acute Kidney Injury in Surgical
Chapter 14. Surgical Palliative Care Patients
Chapter 15. Informed Consent and Surgical Ethics Chapter 31. Surgical Considerations in the
Chapter 16. Surgical Innovation and New Immunocompromised Patient
Technology Assessment
, 2
Chapter 32. Surgical Considerations in the Chapter 57. Adrenal Glands
Pregnant Patient Chapter 58. Multiple Endocrine Neoplasia
Chapter 33. Pediatric Perioperative Management Syndromes
Chapter 34. Surgical Considerations in the Chapter 59. Abdominal Wall, Umbilicus,
Diabetic Patient Peritoneum, Mesenteries, Omentum, and
Chapter 35. Cardiac Evaluation and Management Retroperitoneum
of the Non-Cardiac Surgical Patient Chapter 60. Hernias
Chapter 36. Injury Epidemiology and Prevention Chapter 61. Esophagus
Chapter 37. Initial Assessment and Management Chapter 62. Stomach
of Trauma Chapter 63. Small Intestine
Chapter 38. Head and Central Nervous System Chapter 64. Colon and Rectum
Trauma Chapter 65. The Appendix
Chapter 39. Thoracic Trauma Chapter 66. Liver
Chapter 40. Abdominal Trauma Chapter 67. Biliary Tract
Chapter 41. Vascular Trauma Chapter 68. Exocrine Pancreas
Chapter 42. Extremity Trauma Chapter 69. Spleen
Chapter 43. Genitourinary Trauma Chapter 70. Anorectal Disorders
Chapter 44. Surgical Critical Care Chapter 71. Breast Anatomy, Physiology, and the
Chapter 45. The Inflammatory Response Augmented Breast
Chapter 46. Transplant Immunobiology and Chapter 72. Benign Breast Disorders
Immunosuppression Chapter 73. Malignant Breast Tumors
Chapter 47. Kidney and Pancreas Transplantation Chapter 74. Thyroid
Chapter 48. Liver Transplantation Chapter 75. Parathyroid Glands
Chapter 49. Heart and Lung Transplantation Chapter 76. Adrenal Glands
Chapter 50. Small Bowel Transplantation Chapter 77. Endocrine Pancreas and Carcinoid
Chapter 51. Tumor Biology, Biomarkers, and Tumors
Targeted Therapy Chapter 78. Multiple Endocrine Neoplasia
Chapter 52. Melanoma and Cutaneous Syndromes
Malignancies Chapter 79. Morbid Obesity and Metabolic
Chapter 53. Soft Tissue Sarcomas Surgery
Chapter 54. Breast Disease Chapter 80. Vascular Biology, Hemostasis, and
Chapter 55. Diseases of the Thyroid Peripheral Arterial Disease
Chapter 56. Parathyroid Glands Chapter 81. Abdominal Aortic Aneurysm
, 2
SECTION I — SURGICAL TRAINING AND QUALITY CONTROL
Chapter 1. Surgical Education: Past, Present, and Future
Question 1. Which 1910 report fundamentally reformed North American
medical education by advocating science-based university-affiliated training?
A. The Osler Report
B. The Flexner Report
C. The Halsted Report
D. The Carnegie Commission Report
✅ Correct Answer: B. The Flexner Report
Rationale: The Flexner Report, commissioned by the Carnegie Foundation in 1910,
surveyed 155 North American medical schools and recommended closing
substandard institutions and affiliating training with universities. It laid the
foundation for modern evidence-based medical education. Halsted developed the
apprenticeship residency model but authored no such report.
DIF: Easy | TOP: History of Medical Education | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 2. The Halstedian model of surgical education is best described as
which of the following?
A. Competency-based progression with standardized assessments
B. Time-limited rotations with didactic curriculum
C. Graduated responsibility apprenticeship under direct mentorship
D. Simulation-based training with objective metrics
✅ Correct Answer: C. Graduated responsibility apprenticeship under direct
mentorship
Rationale: William Halsted established the residency model at Johns Hopkins in
the 1880s based on graduated responsibility under direct mentorship, where
residents assumed increasing operative autonomy as they demonstrated
, 3
competence. This apprenticeship model dominated surgical education for over a
century.
DIF: Easy | TOP: Halstedian Model | MSC: ABSITE Category: Surgical Education & Professional
Development
Question 3. The six ACGME core competencies for residency training include
all of the following EXCEPT:
A. Patient care and medical knowledge
B. Interpersonal and communication skills
C. Operative volume and case diversity
D. Systems-based practice and professionalism
✅ Correct Answer: C. Operative volume and case diversity
Rationale: The six ACGME core competencies are: patient care, medical
knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism, and systems-based practice. Operative
volume is tracked separately as a milestone but is not itself a core competency.
DIF: Moderate | TOP: ACGME Competencies | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 4. Under the 2011 ACGME duty hour restrictions, what is the
maximum number of continuous hours an intern may work?
A. 24 hours
B. 16 hours
C. 28 hours
D. 30 hours
✅ Correct Answer: B. 16 hours
Rationale: The 2011 ACGME update limited first-year residents (interns) to 16
consecutive hours of clinical work, compared to the 24 hours permitted for more
senior residents. All residents remain subject to the 80-hour weekly work limit
established in 2003.
, 4
DIF: Moderate | TOP: Duty Hour Regulations | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 5. The maximum number of work hours per week permitted under
ACGME regulations for all surgical residents is:
A. 60 hours
B. 72 hours
C. 80 hours
D. 88 hours
✅ Correct Answer: C. 80 hours
Rationale: The ACGME implemented an 80-hour weekly work limit averaged over
4 weeks in 2003 following concerns about resident fatigue and patient safety. This
limit applies to all residency programs with allowance for moonlighting counted
toward the total.
DIF: Easy | TOP: Duty Hour Regulations | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 6. Competency-based medical education (CBME) differs from
traditional time-based training in that it:
A. Requires a fixed 5-year residency before independent practice
B. Allows advancement based on demonstrated mastery rather than time spent
C. Emphasizes operative volume over assessed outcomes
D. Eliminates the need for formal assessment tools
✅ Correct Answer: B. Allows advancement based on demonstrated mastery
rather than time spent
Rationale: CBME advances residents based on demonstrated achievement of
defined competencies rather than completion of a fixed time period. This approach,
supported by the ACGME Milestones project, allows individualized progression
and ensures competence before independent practice.
DIF: Moderate | TOP: Competency-Based Education | MSC: ABSITE Category: Surgical Education &
Professional Development
, 5
Question 7. Entrustable Professional Activities (EPAs) in surgical education
are best defined as:
A. Standardized operative cases required for board eligibility
B. Units of professional practice that can be entrusted to trainees once competence
is demonstrated
C. Written examinations assessing surgical knowledge
D. Simulation tasks used to evaluate technical skills
✅ Correct Answer: B. Units of professional practice that can be entrusted to
trainees once competence is demonstrated
Rationale: EPAs are discrete units of work that can be entrusted to a trainee once
they have demonstrated sufficient competence. They bridge the gap between
competency frameworks and day-to-day clinical practice, allowing supervisors to
make trust-based decisions about trainee autonomy.
DIF: Moderate | TOP: Entrustable Professional Activities | MSC: ABSITE Category: Surgical
Education & Professional Development
Question 8. Which principle of deliberate practice, as described by Ericsson,
is most critical to skill acquisition in surgical training?
A. Repetition of procedures already mastered
B. Focused practice just beyond current ability with immediate feedback
C. Self-directed study without instructor supervision
D. High-volume case exposure without structured assessment
✅ Correct Answer: B. Focused practice just beyond current ability with
immediate feedback
Rationale: Ericsson's theory of deliberate practice requires practicing tasks at the
edge of current ability with immediate, specific feedback and conscious effort to
improve. Mere repetition of mastered skills does not drive further improvement;
the challenge must exceed current performance.
DIF: Hard | TOP: Deliberate Practice | MSC: ABSITE Category: Surgical Education & Professional
Development
, 6
Question 9. The ACGME Milestones project assesses surgical residents on a
scale of 1 to 5. A milestone rating of 4 best indicates:
A. The resident performs independently as expected of a graduating senior
B. The resident is ready for unsupervised practice in that domain
C. The resident demonstrates aspirational behaviors of a faculty member
D. The resident meets expectations for early post-residency practice
✅ Correct Answer: D. The resident meets expectations for early post-
residency practice
Rationale: Milestone level 4 indicates performance expected of a graduating senior
resident ready for independent practice. Level 5 represents aspirational expert
faculty-level behaviors. Milestones are assessed semi-annually and reported to the
ACGME.
DIF: Hard | TOP: Milestones Assessment | MSC: ABSITE Category: Surgical Education &
Professional Development
Question 10. Which concept explains why learners perform worse after being
taught multiple skills simultaneously compared to learning each skill in
isolation?
A. Transfer-appropriate processing
B. Cognitive load theory
C. Spaced repetition
D. Interleaved practice
✅ Correct Answer: B. Cognitive load theory
Rationale: Cognitive load theory holds that working memory has limited capacity.
When multiple new skills are taught simultaneously, extraneous cognitive load
overwhelms working memory and impairs learning. Surgical educators should
manage intrinsic and extraneous load to optimize skill acquisition.
DIF: Hard | TOP: Cognitive Load Theory | MSC: ABSITE Category: Surgical Education &
Professional Development
