Original EMREE questions on surgery, with explanations.
Short answer: 10 original multiple-choice practice questions on surgery for EMREE, the Emirates Medical Residency Entrance Examination, each with the correct answer and a full explanation. The blueprint gives this subject 15 percent of the exam. They are original and are not real exam items.
About these questions
Every question here is original. Meddex wrote it for exam preparation. None is a real, recalled or leaked exam item, and none comes from DHA, Prometric, UAE University or the NIHS.
Meddex is independent and is not affiliated with DHA, Prometric, UAE University or the NIHS.
Clinical review of the question bank is not complete yet. Treat the explanations as study aids and check official guidance before you rely on a fact.
This is a sample, not the whole bank, and doing well on it does not predict an exam result.
What surgery covers
Acute abdomen, trauma, peri-operative care, orthopaedics, urology and surgical emergencies.
Resuscitate and recognise the surgical emergency first, then choose the investigation. Many items ask what to do before an operation, not the operation itself.
Where it fits in the exam
The organiser's EMREE blueprint (November 2025 edition) gives Surgery 15 percent of the exam, which is about 18 of 120 questions. It says the distribution may differ by up to 5 percent in each category. These weights are official, and the question counts are our arithmetic.
The organiser does not state how many answer options its questions have or whether each has one best answer. Meddex practice items use four options with one best answer, as a practice format.
How to use these questions
Decide your answer before you press Show answer. Then read the reason for every option, including the ones you rejected. Note the idea you missed and come back to it in a few days.
Practice questions
Question 1
SurgeryEasy
A 38-year-old man has had 3 months of painless bright red blood on the paper and in the pan, with a prolapse on straining that reduces by itself. He has no change in bowel habit, no weight loss and no family history of bowel cancer. Proctoscopy shows second-degree internal haemorrhoids, and 8 weeks of extra fibre and fluid has not helped. Which is the most appropriate next treatment?
AOption A: Lateral internal sphincterotomy
BOption B: Excisional haemorrhoidectomy under general anaesthesia
COption C: Long-term topical corticosteroid cream
DOption D: Rubber band ligation as an outpatient procedure
Show answer for question 1
Correct answer: D. Rubber band ligation as an outpatient procedure
First-line care for haemorrhoids is dietary fibre, fluid and avoiding straining. When symptoms persist in first- to third-degree disease, an office procedure is the next step, and rubber band ligation is the most widely used and effective. Surgical haemorrhoidectomy is kept for large, high-grade, complicated or recurrent disease. Topical steroids give short-term relief only, and lateral internal sphincterotomy treats chronic anal fissure, not haemorrhoids.
Why A is wrong. Sphincterotomy is for chronic anal fissure and would not treat prolapsing haemorrhoids.
Why B is wrong. Surgery carries more pain and complications and is kept for high-grade or failed office treatment.
Why C is wrong. Steroid cream gives short-term relief at best and risks skin thinning with prolonged use.
Topic: Anorectal: second-degree haemorrhoids. Reference: Davis BR et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum 2018; NICE Clinical Knowledge Summaries: Haemorrhoids
Question 2
SurgeryEasy
A 62-year-old man with type 2 diabetes takes gliclazide 80 mg twice daily. His HbA1c is 56 mmol/mol. He is first on the morning list for an elective laparoscopic cholecystectomy and is fasting from midnight, missing only breakfast. Which is the most appropriate advice about his gliclazide?
AOption A: Omit the morning dose and check glucose on arrival
BOption B: Start a variable-rate insulin infusion on admission
COption C: Take the usual dose with a sip of water
DOption D: Take half the usual dose with a sip of water
Show answer for question 2
Correct answer: A. Omit the morning dose and check glucose on arrival
A sulfonylurea stimulates insulin release regardless of glucose, so taking it while fasting risks hypoglycaemia. For a patient who misses only one meal, the morning dose is omitted, the usual dose is resumed when eating, and capillary glucose is checked on arrival and during the day. A variable-rate insulin infusion is used when more than one meal will be missed or glucose control is poor. Taking a full or half dose while fasting still carries a hypoglycaemia risk.
Why B is wrong. An infusion is for longer fasts or poor control and is unnecessary after one missed meal.
Why C is wrong. A full dose of a sulfonylurea while fasting carries a real risk of hypoglycaemia.
Why D is wrong. A reduced dose still stimulates insulin release without food, so the risk remains.
Topic: Peri-operative care: sulfonylurea before a morning operation. Reference: Centre for Perioperative Care: Guideline for perioperative care for people with diabetes mellitus undergoing elective and emergency surgery
Question 3
SurgeryMedium
A 70-year-old man with diabetes who smokes has had 3 weeks of foot pain at night, relieved by hanging the leg over the side of the bed. He has a 1 cm heel ulcer that has not healed in 5 weeks. Pedal pulses are absent and the ankle-brachial pressure index is 0.3. Which is the most appropriate management?
AOption A: Supervised exercise programme with review in 3 months
BOption B: Compression bandaging for a presumed venous ulcer
COption C: Urgent vascular referral for revascularisation
DOption D: Naftidrofuryl with reassessment in 6 weeks
Show answer for question 3
Correct answer: C. Urgent vascular referral for revascularisation
Rest pain, tissue loss and a very low ankle-brachial pressure index mean chronic limb-threatening ischaemia, which carries a high risk of amputation and death. He needs urgent vascular assessment with imaging to plan revascularisation, alongside risk factor control, analgesia and wound care. Exercise therapy and vasoactive drugs are for intermittent claudication. Compression is contraindicated in significant arterial disease because it can cause tissue necrosis.
Why A is wrong. Exercise is a claudication treatment and does not rescue a limb with rest pain and ulceration.
Why B is wrong. Compression on an ischaemic leg reduces perfusion further and can cause necrosis.
Why D is wrong. Vasoactive drugs are for claudication and delay definitive treatment in critical ischaemia.
Topic: Chronic limb ischaemia: rest pain and tissue loss. Reference: NICE CG147 Peripheral arterial disease: diagnosis and management; ESVS 2024 Clinical Practice Guidelines on the Management of Chronic Limb-Threatening Ischaemia
Question 4
SurgeryMedium
A 63-year-old postmenopausal woman has had wide local excision and sentinel node biopsy for an 18 mm grade 2 invasive ductal carcinoma. It is strongly oestrogen receptor positive and HER2 negative, with clear sentinel nodes. She has completed radiotherapy. Which is the most appropriate adjuvant systemic treatment?
AOption A: Trastuzumab for 12 months
BOption B: An aromatase inhibitor such as anastrozole or letrozole
COption C: No endocrine therapy, because her nodes are clear
DOption D: Tamoxifen alone, as aromatase inhibitors act only before menopause
Show answer for question 4
Correct answer: B. An aromatase inhibitor such as anastrozole or letrozole
Adjuvant endocrine therapy substantially reduces recurrence and breast cancer death in hormone receptor positive disease, even when nodes are negative. In postmenopausal women an aromatase inhibitor is the preferred agent, because it reduces oestrogen production in peripheral tissue and is slightly more effective than tamoxifen. Tamoxifen is used in premenopausal women or when an aromatase inhibitor is not tolerated. Trastuzumab targets HER2-positive disease. Bone density monitoring is advised on an aromatase inhibitor.
Why A is wrong. Trastuzumab is for HER2-positive tumours, and hers is HER2 negative.
Why C is wrong. Receptor-positive disease benefits from endocrine therapy whatever the nodal status.
Why D is wrong. Aromatase inhibitors act on peripheral oestrogen production after menopause and tamoxifen is the second choice.
Topic: Breast cancer: adjuvant endocrine therapy after surgery. Reference: NICE NG101 Early and locally advanced breast cancer: diagnosis and management; ESMO Clinical Practice Guideline for early breast cancer
Question 5
SurgeryMedium
A 66-year-old man attends his first screening scan for abdominal aortic aneurysm in the NHS programme. Ultrasound shows a maximum anteroposterior aortic diameter of 4.8 cm. He is asymptomatic and fit. Which is the most appropriate management?
AOption A: Elective endovascular repair now
BOption B: Discharge from surveillance
COption C: Repeat ultrasound every 12 months
DOption D: Repeat ultrasound every 3 months
Show answer for question 5
Correct answer: D. Repeat ultrasound every 3 months
The NHS Abdominal Aortic Aneurysm Screening Programme classifies a diameter of 3.0 to 4.4 cm as small, with annual surveillance, and 4.5 to 5.4 cm as medium, with surveillance every 3 months. A diameter of 5.5 cm or more is large, and the patient is referred for vascular assessment for repair. At 4.8 cm the correct interval is every 3 months, since growth is faster at larger diameters. Early repair of small and medium aneurysms did not improve survival in trials.
Why A is wrong. Elective repair is offered from 5.5 cm, so repair at 4.8 cm exposes him to risk without benefit.
Why B is wrong. Discharge would leave an enlarging aneurysm unmonitored.
Why C is wrong. An annual scan applies to aneurysms below 4.5 cm.
Topic: Aneurysm: surveillance interval in a screening programme. Reference: NHS Abdominal Aortic Aneurysm Screening Programme: surveillance protocol; ESVS 2024 Clinical Practice Guidelines on abdominal aorto-iliac artery aneurysms
Question 6
SurgeryEasy
A 71-year-old woman has a 4 cm shallow ulcer above the medial malleolus with haemosiderin staining and varicose veins. Pedal pulses are palpable and the ankle brachial pressure index is 0.95. The wound is clean with no cellulitis. What is the most appropriate treatment?
AOption A: Referral for arterial bypass surgery
BOption B: Prophylactic oral flucloxacillin
COption C: A hydrocolloid dressing with leg elevation only
DOption D: Compression bandaging
Show answer for question 6
Correct answer: D. Compression bandaging
The site, skin changes and varicosities indicate a venous ulcer, and an ankle brachial pressure index of 0.8 or above excludes significant arterial disease, which makes compression safe. Graduated multi-layer compression is the treatment that heals venous ulcers fastest and reduces recurrence. Antibiotics are for clinical infection, and a dressing without compression does not treat the underlying venous hypertension.
Why A is wrong. Her arterial supply is adequate, so bypass is not indicated.
Why B is wrong. Antibiotics do not heal a clean ulcer and are given only for clinical infection.
Why C is wrong. Dressings and elevation alone do not correct venous hypertension.
Topic: Vascular: venous leg ulcer after excluding limb ischaemia. Reference: Compression for venous leg ulcers (Cochrane review, O'Meara et al., 2012)
Question 7
SurgeryEasy
A 40-year-old man has had his second calcium oxalate kidney stone in 3 years. Serum calcium and urate are normal. Which advice is most appropriate to reduce recurrence?
AOption A: Eat more animal protein to increase satiety
BOption B: Restrict dietary calcium to under 400 mg a day and avoid dairy products
COption C: Drink enough fluid to pass 2 to 2.5 litres of urine a day
DOption D: Take a daily vitamin C supplement to acidify the urine
Show answer for question 7
Correct answer: C. Drink enough fluid to pass 2 to 2.5 litres of urine a day
High fluid intake that produces a urine volume of at least 2 to 2.5 litres a day is the cornerstone of stone prevention. Dietary calcium should be normal because restriction increases intestinal oxalate absorption and urinary oxalate. Reducing salt and animal protein and avoiding vitamin C supplements, which are metabolised to oxalate, also help.
Why A is wrong. Higher animal protein intake increases urinary calcium and urate and lowers citrate.
Why B is wrong. Calcium restriction raises urinary oxalate and can increase stone formation.
Why D is wrong. Vitamin C is metabolised to oxalate and can increase stone risk.
A 58-year-old man has had a large haematemesis. After resuscitation his pulse is 96 per minute and systolic blood pressure is 112 mmHg. He has no history of liver disease, takes no QT-prolonging drugs, and endoscopy is planned within the next 2 hours. According to the European Society of Gastrointestinal Endoscopy, which pre-endoscopy measure is recommended to improve gastric visualisation?
AOption A: Intravenous erythromycin 250 mg given 30 to 120 minutes before endoscopy
BOption B: Intravenous tranexamic acid
COption C: Intravenous terlipressin in every patient
DOption D: Nasogastric tube lavage with iced saline
Show answer for question 8
Correct answer: A. Intravenous erythromycin 250 mg given 30 to 120 minutes before endoscopy
Blood and clots in the stomach reduce mucosal visualisation and increase the need for repeat endoscopy. ESGE recommends intravenous erythromycin 250 mg, given 30 to 120 minutes before endoscopy, to empty the stomach, provided there is no QT prolongation or interacting drug. Nasogastric lavage is not recommended because it does not improve outcomes and is uncomfortable. Tranexamic acid did not reduce mortality in the HALT-IT trial and increased venous thromboembolism, and terlipressin is for suspected variceal bleeding only.
Why B is wrong. Tranexamic acid did not reduce death from gastrointestinal bleeding and increased thrombosis in a large trial.
Why C is wrong. Terlipressin treats variceal bleeding, and there is no suggestion of varices here.
Why D is wrong. Nasogastric lavage does not improve visualisation reliably or change outcomes, so it is not recommended.
Topic: Upper GI bleeding: pre-endoscopy prokinetic. Reference: European Society of Gastrointestinal Endoscopy guideline on non-variceal upper gastrointestinal haemorrhage; HALT-IT trial collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding. Lancet 2020
Question 9
SurgeryMedium
A 66-year-old man has taken prednisolone 10 mg daily for polymyalgia rheumatica for 2 years. He is to undergo an elective total knee replacement under general anaesthesia. He is well, with no adrenal insufficiency symptoms. Which is the most appropriate peri-operative steroid plan?
AOption A: Give no extra steroid because the dose is below 20 mg daily
BOption B: Stop prednisolone 2 weeks before the operation date
COption C: Omit prednisolone on the day of surgery to improve wound healing
DOption D: Usual dose plus intravenous hydrocortisone at induction
Show answer for question 9
Correct answer: D. Usual dose plus intravenous hydrocortisone at induction
Patients on prednisolone 5 mg or more daily for 4 weeks or longer are assumed to have a suppressed hypothalamic-pituitary-adrenal axis. They take their usual dose on the day of surgery and receive supplementary intravenous hydrocortisone at induction (for example 100 mg for major surgery), then resume the oral dose or continue hydrocortisone while unwell. Any unexplained hypotension peri-operatively should prompt treatment of adrenal crisis.
Why A is wrong. Incorrect: Patients taking 5 mg or more of prednisolone for more than 4 weeks should be considered suppressed, regardless of the dose being below 20 mg.
Why B is wrong. Incorrect: Abrupt withdrawal causes relapse and adrenal insufficiency.
Why C is wrong. Incorrect: Omission risks hypotension and adrenal crisis under surgical stress.
Topic: Peri-operative steroid cover for long-term prednisolone. Reference: Woodcock T et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. Anaesthesia 2020
Question 10
SurgeryEasy
A 28-year-old woman at 24 weeks of gestation has right loin pain and microscopic haematuria. She is afebrile with normal observations. Which is the most appropriate first imaging investigation?
AOption A: Non-contrast CT of the kidneys, ureters and bladder
BOption B: Intravenous urography with contrast
COption C: Plain abdominal radiograph
DOption D: Renal tract ultrasound
Show answer for question 10
Correct answer: D. Renal tract ultrasound
Ultrasound is the first-line investigation for suspected stone disease in pregnancy because it involves no ionising radiation, and it can show hydronephrosis. MRI is the second option, and low-dose CT is a last resort when other tests are inconclusive. Intravenous urography and plain films expose the fetus to radiation and add little.
Why A is wrong. CT involves fetal radiation exposure and is a third-line option.
Why B is wrong. Urography needs radiation and contrast and is not used in pregnancy.
Why C is wrong. A plain film has low sensitivity in pregnancy and exposes the fetus to radiation.
Topic: Urology: ureteric stone in pregnancy. Reference: EAU Guidelines on Urolithiasis
Practise more surgery questions
A free account lets you practise this subject in the app, review your mistakes and track progress. Nothing to pay.
Meddex is an independent preparation platform and is not affiliated with, endorsed by, or sponsored by the Dubai Health Authority (DHA), Prometric, UAE University or the National Institute of Health Specialties (NIHS). Always confirm exam details on the official websites. Last reviewed .
Frequently asked questions
The blueprint gives Surgery 15 percent of the exam, about 18 of 120 questions, and says it may differ by up to 5 percent. It is the organiser's own figure from the November 2025 blueprint.
No. They are original practice questions written by Meddex for exam preparation. The organiser publishes a blueprint, not sample questions, and a confidentiality agreement covers the real exam, so we do not use or claim real or recalled items.
The Meddex app has the full bank, which you can practise by topic with a free account. These pages are a short sample, and the questions on them do not change.
No. Each question has a Show answer button. The answer, the explanation and the reason each wrong option is wrong are part of the page text, so they are there when you press it.