General Surgery Board Review General Surgery Board Review MCQ 5 — Questions and Answers
Question 1: A 48-year-old woman undergoes elective laparoscopic Nissen fundoplication. On POD 2 she develops tachycardia, fever, and left shoulder pain. What is the most concerning diagnosis?
- Pulmonary embolism
- Esophageal perforation (Correct answer)
- Pneumonia
- Splenic injury
Correct answer: Esophageal perforation
Left shoulder pain (Kehr's sign), tachycardia, and fever after fundoplication suggest esophageal or gastric perforation, a serious complication requiring urgent evaluation.
Question 2: A 62-year-old man with a BMI of 32 and type 2 diabetes is considering bariatric surgery. Which procedure provides the most durable long-term diabetes remission?
- Laparoscopic adjustable gastric band
- Sleeve gastrectomy
- Roux-en-Y gastric bypass (Correct answer)
- Intragastric balloon
Correct answer: Roux-en-Y gastric bypass
Roux-en-Y gastric bypass produces the highest rates of durable type 2 diabetes remission (60-80% at 5 years) compared to other bariatric procedures.
Question 3: Which of the following is the most common site of metastasis for colorectal cancer?
- Lung
- Liver (Correct answer)
- Brain
- Bone
Correct answer: Liver
The liver is the most common site of colorectal cancer metastasis, occurring in approximately 50% of patients due to portal venous drainage from the colon.
Question 4: What is the most appropriate management of an incidentally found 2.5 cm adrenal adenoma that is biochemically silent (non-functioning incidentaloma)?
- Immediate adrenalectomy
- Annual imaging for 5 years, no repeat biochemical workup
- Repeat imaging at 6-12 months and annual biochemical testing for 5 years (Correct answer)
- No further workup needed
Correct answer: Repeat imaging at 6-12 months and annual biochemical testing for 5 years
Non-functioning adrenal incidentalomas < 4 cm with benign imaging characteristics require follow-up imaging at 6-12 months and annual hormonal assessment for up to 5 years per guideline recommendations.
Question 5: A patient presents with hypercalcemia, nephrolithiasis, and a serum PTH level of 110 pg/mL (normal 10-65). Sestamibi scan shows a single focus of uptake in the right lower parathyroid. What is the treatment?
- Cinacalcet therapy
- Bilateral neck exploration
- Minimally invasive parathyroidectomy (Correct answer)
- Four-gland parathyroid exploration
Correct answer: Minimally invasive parathyroidectomy
A solitary parathyroid adenoma localized by sestamibi is best treated with minimally invasive (focused) parathyroidectomy, confirmed by intraoperative PTH drop > 50%.
Question 6: Which of the following findings on abdominal CT is most consistent with strangulated small bowel obstruction?
- Transition point with decompressed distal bowel
- Pneumobilia
- Lack of bowel wall enhancement after IV contrast (Correct answer)
- Dilated loops of bowel with air-fluid levels
Correct answer: Lack of bowel wall enhancement after IV contrast
Lack of bowel wall enhancement on contrast CT indicates bowel ischemia/strangulation, which mandates urgent operative intervention.
Question 7: A 25-year-old unrestrained driver sustains blunt chest trauma. CXR shows a widened mediastinum. BP is 90/60 mmHg. What is the next best step?
- CT angiography of the chest (Correct answer)
- Emergent left thoracotomy
- Transesophageal echocardiography
- Aortography
Correct answer: CT angiography of the chest
CT angiography of the chest is the gold standard for rapid evaluation of traumatic aortic injury in a hemodynamically stable or resuscitable patient with a widened mediastinum.
General Surgery Board Review General Surgery Board Review MCQ 5
A 48-year-old woman undergoes elective laparoscopic Nissen fundoplication.
On POD 2 she develops tachycardia, fever, and left shoulder pain.
What is the most concerning diagnosis?