General Surgery Board Review General Surgery Board Review MCQ 3 — Questions and Answers
Question 1: A 40-year-old woman has a thyroid nodule measuring 1.8 cm with microcalcifications and irregular margins on ultrasound. FNA shows papillary thyroid carcinoma. What is the most appropriate surgical treatment?
- Lobectomy only
- Total thyroidectomy (Correct answer)
- Total thyroidectomy with prophylactic central neck dissection
- Observation with repeat ultrasound
Correct answer: Total thyroidectomy
Total thyroidectomy is recommended for papillary thyroid carcinoma greater than 1 cm, allowing RAI therapy and simplifying surveillance with thyroglobulin monitoring.
Question 2: During a Whipple procedure, which of the following anastomoses is NOT performed?
- Pancreaticojejunostomy
- Hepaticojejunostomy
- Gastrojejunostomy
- Choledochoduodenostomy (Correct answer)
Correct answer: Choledochoduodenostomy
The Whipple (pancreaticoduodenectomy) includes pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy; the common bile duct is anastomosed to the jejunum, not the duodenum, which is resected.
Question 3: Which nutritional marker best reflects acute changes in a surgical patient's nutritional status over a 2- to 3-day period?
- Albumin
- Prealbumin (transthyretin) (Correct answer)
- Transferrin
- Total lymphocyte count
Correct answer: Prealbumin (transthyretin)
Prealbumin has a half-life of 2-3 days, making it the best short-term marker for acute nutritional changes, unlike albumin which has a 20-day half-life.
Question 4: A patient with a suspected sigmoid volvulus is hemodynamically stable without signs of peritonitis. What is the first-line treatment?
- Emergency sigmoid colectomy
- Flexible sigmoidoscopy with rectal tube decompression (Correct answer)
- CT-guided drainage
- Colonoscopy and surgical resection at the same sitting
Correct answer: Flexible sigmoidoscopy with rectal tube decompression
Flexible sigmoidoscopy with rectal tube placement achieves decompression in 70-90% of sigmoid volvulus cases and is the first-line treatment in stable patients without peritonitis.
Question 5: Which of the following is an absolute contraindication to laparoscopic appendectomy?
- Morbid obesity
- Prior lower abdominal surgery
- Uncorrected coagulopathy (Correct answer)
- Pregnancy in the third trimester
Correct answer: Uncorrected coagulopathy
Uncorrected coagulopathy is an absolute contraindication to any laparoscopic surgery due to uncontrollable bleeding risk; the other options are relative contraindications.
Question 6: A 65-year-old man has a 3 cm solitary liver lesion discovered incidentally. He has known cirrhosis and elevated AFP of 450 ng/mL. What is the most likely diagnosis?
- Hepatic hemangioma
- Hepatocellular carcinoma (Correct answer)
- Metastatic colorectal cancer
- Focal nodular hyperplasia
Correct answer: Hepatocellular carcinoma
A > 2 cm liver lesion with classic arterial enhancement on imaging in a cirrhotic patient plus elevated AFP is diagnostic of hepatocellular carcinoma by AASLD criteria.
Question 7: Which of the following findings on colonoscopy in a patient with ulcerative colitis is an indication for prophylactic proctocolectomy?
- Pseudopolyps
- Loss of haustra
- High-grade dysplasia confirmed on repeat biopsy (Correct answer)
- Backwash ileitis
Correct answer: High-grade dysplasia confirmed on repeat biopsy
High-grade dysplasia confirmed by expert pathology on repeat colonoscopy in ulcerative colitis warrants proctocolectomy due to the high risk of synchronous or future colorectal cancer.
General Surgery Board Review General Surgery Board Review MCQ 3
A 40-year-old woman has a thyroid nodule measuring 1.8 cm with microcalcifications and irregular margins on ultrasound.
FNA shows papillary thyroid carcinoma.
What is the most appropriate surgical treatment?