General Surgery Board Review General Surgery Board Review Gastrointestinal Surgery 1 — Questions and Answers
Question 1: What is the standard surgical treatment for a stable patient with a perforated duodenal ulcer presenting within 6 hours of onset?
- Nonoperative management with IV antibiotics alone
- Omental patch repair (Graham patch) (Correct answer)
- Billroth II gastrojejunostomy
- Total gastrectomy
Correct answer: Omental patch repair (Graham patch)
Graham patch (omental patch) closure is the procedure of choice for perforated duodenal ulcers; definitive anti-ulcer surgery is largely abandoned in the era of H. pylori eradication and PPIs.
Question 2: In the AJCC staging system for gastric cancer, which T stage indicates tumor invasion through the muscularis propria into the subserosa without penetrating the serosa?
- T1b
- T2
- T3 (Correct answer)
- T4a
Correct answer: T3
T3 gastric cancer invades through the muscularis propria into the subserosal connective tissue without penetrating the visceral peritoneum (serosa); T4a penetrates the serosa.
Question 3: A patient with Barrett's esophagus and confirmed high-grade dysplasia should undergo which management?
- Surveillance endoscopy every 6 months indefinitely
- Endoscopic eradication therapy such as radiofrequency ablation (Correct answer)
- Immediate esophagectomy in all cases
- High-dose PPI therapy alone without endoscopic intervention
Correct answer: Endoscopic eradication therapy such as radiofrequency ablation
Endoscopic eradication therapy (EET), including radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR), is the preferred treatment for high-grade dysplasia in Barrett's esophagus.
Question 4: Which operation is the primary surgical treatment for achalasia to relieve lower esophageal sphincter obstruction?
- Nissen fundoplication
- Heller myotomy (Correct answer)
- Esophagectomy
- Esophagogastrectomy
Correct answer: Heller myotomy
Laparoscopic Heller myotomy (LHM), which divides the circular muscle fibers of the lower esophageal sphincter, is the surgical treatment of choice for achalasia.
Question 5: The gold-standard confirmatory test for Zollinger-Ellison syndrome (gastrinoma) is:
- Fasting serum gastrin >1000 pg/mL with positive secretin stimulation test (Correct answer)
- Upper GI series showing giant rugal folds
- CT scan showing pancreatic head mass
- Helicobacter pylori biopsy from antrum
Correct answer: Fasting serum gastrin >1000 pg/mL with positive secretin stimulation test
The secretin stimulation test showing a paradoxical rise in gastrin >120 pg/mL above baseline is confirmatory for ZES; fasting gastrin >1000 pg/mL with acidic gastric pH is highly suggestive.
Question 6: The most common primary site of gastrointestinal stromal tumors (GISTs) is:
- Small intestine
- Colon
- Stomach (Correct answer)
- Esophagus
Correct answer: Stomach
Approximately 60% of GISTs arise in the stomach; they originate from the interstitial cells of Cajal and are driven by KIT (CD117) or PDGFRA mutations.
General Surgery Board Review General Surgery Board Review Gastrointestinal Surgery 1
What is the standard surgical treatment for a stable patient with a perforated duodenal ulcer presenting within 6 hours of onset?