General Surgery Board Review General Surgery Board Review Gastrointestinal Surgery 2

Question 1

Which factor best defines resectability of colorectal liver metastases (CRLM)?

Accepted Answer

Ability to achieve R0 resection with adequate future liver remnant volume

Answer

Modern criteria define CRLM resectability as the ability to achieve negative margins (R0) while leaving adequate functional liver remnant (≥25–30% of total liver volume) — number and size are no longer absolute contraindications.

Question 2

A T3N1M0 colon cancer corresponds to which AJCC stage?

Accepted Answer

Stage IIIB

Answer

T3N1M0 colon cancer is Stage IIIB: T3 indicates invasion through the muscularis propria into pericolorectal tissues, N1 indicates 1–3 positive regional nodes, and M0 indicates no distant metastasis.

Question 3

A patient with Crohn's disease has an ileosigmoid fistula. What is the standard surgical approach?

Accepted Answer

Resection of the diseased terminal ileum with simple closure or repair of the sigmoid defect

Answer

The diseased bowel (terminal ileum in Crohn's) is the source of the fistula; resection of the affected ileum with closure of the 'innocent bystander' sigmoid defect is the standard surgical approach.

Question 4

Which operation is preferred for a patient with toxic megacolon from ulcerative colitis who fails 48–72 hours of maximal medical therapy?

Accepted Answer

Subtotal colectomy with end ileostomy

Answer

Subtotal colectomy with end ileostomy is the preferred emergency operation — it removes the diseased colon quickly, preserves the rectum for future IPAA, and avoids pelvic dissection in a sick patient.

Question 5

The most common cause of significant lower GI bleeding in patients over 60 years of age is:

Accepted Answer

Diverticulosis

Answer

Diverticulosis accounts for approximately 40–55% of significant lower GI bleeding episodes in elderly patients; most bleeds stop spontaneously but can be massive.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review General Surgery Board Review Gastrointestinal Surgery 2