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

Gastrinoma (Zollinger-Ellison syndrome) presents with refractory peptic ulcers and markedly elevated fasting gastrin; confirmed by a secretin stimulation test showing a paradoxical rise in gastrin levels.

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

Insulinoma is the most common functioning pancreatic NET; it satisfies Whipple's triad (symptoms with hypoglycemia, glucose <50 mg/dL, relief with glucose), with elevated endogenous C-peptide distinguishing it from exogenous insulin use.

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

Glucagonoma produces the 4 Ds (Dermatitis/migratory necrolytic erythema, Diabetes, DVT, Depression); the skin rash is pathognomonic, and tumors are usually large (>5 cm) in the pancreatic body/tail at diagnosis.

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

VIPoma causes WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria), also called Verner-Morrison syndrome; VIP inhibits gastric acid secretion (achlorhydria distinguishes it from gastrinoma, which causes acid hypersecretion).

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

RET proto-oncogene mutations cause hereditary MTC in MEN2A and MEN2B; first-degree relatives are offered genetic testing, and RET mutation carriers undergo prophylactic thyroidectomy at an age determined by the specific codon involved.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Endocrine Surgery 3