General Surgery Board Review Case Studies & Practical Application 4

Question 1

A 30-year-old male presents with a painless right testicular mass. Serum AFP is markedly elevated. CT shows retroperitoneal lymphadenopathy. Orchiectomy is planned. What is the most likely diagnosis?

Accepted Answer

Yolk sac tumor (non-seminomatous GCT)

Answer

Markedly elevated AFP is diagnostic of non-seminomatous germ cell tumor (NSGCT), as pure seminoma does not produce AFP.

Question 2

A 62-year-old male undergoes emergent sigmoid colectomy with Hartmann's procedure for perforated diverticulitis. Six months later, he is healthy with a colostomy. What is the next appropriate step?

Accepted Answer

Colostomy reversal (Hartmann's reversal) with colorectal anastomosis

Answer

After recovery from Hartmann's procedure for diverticulitis, restoration of bowel continuity via Hartmann's reversal is appropriate in a fit patient.

Question 3

A 48-year-old woman has a 2 cm solid pancreatic tail mass found incidentally on CT. EUS-FNA shows cells consistent with a pancreatic neuroendocrine tumor. Octreotide scan shows no distant metastases. What is the recommended treatment?

Accepted Answer

Distal pancreatectomy and splenectomy

Answer

Resectable non-functional pancreatic NETs ≥2 cm should be surgically resected; distal pancreatectomy with splenectomy is standard for tail lesions.

Question 4

A 55-year-old male with alcoholic cirrhosis (Child-Pugh B) presents with a 3 cm HCC on imaging. AFP is 450. CT shows no portal vein invasion or distant metastases. He is not a transplant candidate. What is the best local treatment option?

Accepted Answer

Radiofrequency ablation (RFA)

Answer

In cirrhotic patients who are not surgical candidates, RFA is preferred for HCC ≤3 cm with excellent local control rates comparable to resection.

Question 5

A 38-year-old woman presents with a palpable 2.5 cm right breast mass. Core biopsy shows invasive ductal carcinoma, ER+/PR+/HER2-. Sentinel lymph node biopsy shows 1/3 nodes positive (micrometastasis 0.4 mm). What is the next best step for axillary management?

Accepted Answer

No further axillary surgery — observe with radiation

Answer

Per Z0011 trial criteria, patients with 1-2 positive sentinel nodes undergoing breast-conserving surgery and whole-breast radiation do not benefit from completion ALND.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Case Studies & Practical Application 4