General Surgery Board Review Endocrine Surgery 2

Question 1

A parathyroid adenoma is confirmed by concordant sestamibi scan and ultrasound. Which is the preferred surgical approach with intraoperative biochemical confirmation?

Accepted Answer

Minimally invasive parathyroidectomy with intraoperative PTH monitoring

Answer

Bilateral four-gland exploration

Answer

Endoscopic bilateral neck exploration

Answer

Removal of all four glands with autotransplantation

Question 2

Which MEN syndrome includes medullary thyroid carcinoma, pheochromocytoma, AND mucosal/intestinal ganglioneuromas with marfanoid habitus?

Accepted Answer

MEN type 2B

Answer

MEN type 1 (Werner syndrome)

Answer

MEN type 2A (Sipple syndrome)

Answer

Von Hippel-Lindau syndrome

Question 3

Before operating on an adrenal incidentaloma, which condition MUST be excluded first to prevent a life-threatening intraoperative crisis?

Accepted Answer

Pheochromocytoma

Answer

Subclinical hypercortisolism

Answer

Primary aldosteronism

Answer

Non-functioning adrenal adenoma

Question 4

A patient has hypertension, hypokalemia, metabolic alkalosis, and an elevated aldosterone-to-renin ratio with a 1.8 cm right adrenal adenoma on CT. What is the diagnosis?

Accepted Answer

Primary aldosteronism (Conn's syndrome)

Answer

Pheochromocytoma

Answer

Cushing's syndrome

Answer

Adrenocortical carcinoma

Question 5

What is the correct sequence of preoperative pharmacologic preparation for a patient with pheochromocytoma scheduled for adrenalectomy?

Accepted Answer

Alpha-blockade first, then beta-blockade if needed, over 10-14 days

Answer

Beta-blockade alone for 2 weeks

Answer

Calcium channel blockers alone

Answer

No pharmacologic preparation is required

Question 6

Which zone of the adrenal cortex is the exclusive site of aldosterone synthesis?

Accepted Answer

Zona glomerulosa

Answer

Zona fasciculata

Answer

Zona reticularis

Answer

Adrenal medulla

Question 7

Cortisol is elevated and fails to suppress with low-dose (1 mg) dexamethasone, but suppresses >50% with high-dose (8 mg) dexamethasone. What is the most likely etiology of Cushing's syndrome?

Accepted Answer

Pituitary ACTH-secreting adenoma (Cushing's disease)

Answer

Adrenal cortical adenoma

Answer

Ectopic ACTH production (e.g., small cell lung cancer)

Answer

Adrenocortical carcinoma