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

Minimally invasive parathyroidectomy with intraoperative PTH monitoring is preferred when imaging is concordant; a >50% drop in PTH from baseline at 10 minutes post-excision confirms cure (Miami criterion).

Question 2

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

Accepted Answer

MEN type 2B

Answer

MEN2B is caused by a RET codon 918 mutation and includes MTC, pheochromocytoma, mucosal neuromas of the lips and tongue, and marfanoid habitus; it lacks the hyperparathyroidism seen in MEN2A.

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

Pheochromocytoma must be ruled out with plasma/urine metanephrines before any adrenal surgery, as unrecognized pheochromocytoma can cause a fatal hypertensive crisis during anesthesia induction.

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

Primary aldosteronism (Conn's syndrome) presents with hypertension, hypokalemia, metabolic alkalosis, elevated aldosterone, and suppressed renin; a unilateral adenoma is confirmed by adrenal vein sampling.

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

Alpha-blockade (phenoxybenzamine) must precede beta-blockade; initiating beta-blockade first leaves alpha receptors unopposed, potentially causing paradoxical severe hypertension.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Endocrine Surgery 2