General Surgery Board Review Endocrine Surgery 3

Question 1

A patient has recurrent peptic ulcers refractory to maximal PPI therapy and a fasting serum gastrin of 1,200 pg/mL. What is the most likely diagnosis?

Accepted Answer

Gastrinoma (Zollinger-Ellison syndrome)

Answer

Insulinoma

Answer

VIPoma (Verner-Morrison syndrome)

Answer

Glucagonoma

Question 2

A 38-year-old woman has episodic hypoglycemia with diaphoresis relieved by eating. Supervised fasting shows glucose of 42 mg/dL with inappropriately elevated insulin and C-peptide. What is the diagnosis?

Accepted Answer

Insulinoma

Answer

Glucagonoma

Answer

Gastrinoma

Answer

Factitious hypoglycemia from exogenous insulin

Question 3

Which pancreatic neuroendocrine tumor is associated with migratory necrolytic erythema, new-onset diabetes mellitus, deep vein thrombosis, and depression (the '4 Ds')?

Accepted Answer

Glucagonoma

Answer

Insulinoma

Answer

VIPoma

Answer

Somatostatinoma

Question 4

A patient presents with profuse secretory watery diarrhea (>3 L/day), severe hypokalemia, and achlorhydria. CT reveals a 3 cm pancreatic tail mass. What is the diagnosis?

Accepted Answer

VIPoma (WDHA syndrome)

Answer

Insulinoma

Answer

Carcinoid tumor with carcinoid syndrome

Answer

Gastrinoma

Question 5

Which genetic mutation underlies hereditary medullary thyroid carcinoma in both MEN2A and MEN2B, and guides prophylactic thyroidectomy decisions in family members?

Accepted Answer

RET proto-oncogene mutation

Answer

VHL tumor suppressor gene mutation

Answer

PTEN tumor suppressor mutation

Answer

MEN1 (menin) gene mutation

Question 6

After resection of a small bowel carcinoid tumor, a patient develops episodic flushing, secretory diarrhea, and bronchospasm. Which laboratory test confirms carcinoid syndrome?

Accepted Answer

24-hour urine 5-hydroxyindoleacetic acid (5-HIAA)

Answer

Fasting serum gastrin level

Answer

Serum insulin and C-peptide

Answer

Plasma free metanephrines

Question 7

In a patient with MEN2A undergoing surgery for medullary thyroid carcinoma, which condition must be identified and surgically addressed BEFORE thyroid surgery?

Accepted Answer

Pheochromocytoma

Answer

Primary hyperparathyroidism

Answer

Insulinoma

Answer

Adrenocortical adenoma causing Cushing's syndrome