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Self-Assessment Questions

General Surgery

Gastrointestinal Surgery: Review Questions

Sheilendra S. Mehta, MD, Bhupesh Vasisht, MD, and Robert Silich, MD

Dr. Mehta is a Resident in Surgery, Dr. Vasisht is a Chief Resident in Surgery, and Dr. Silich is Director, Surgical Oncology, Staten Island University Hospital, Staten Island, NY.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 68-year-old African American man presents to his primary care physician for a routine physical examination. The patient’s medical history is significant for hypertension. The patient is found to have guaiac-positive stools and is subsequently referred for colonoscopy. Colonoscopy reveals a “golf ball”-size, near-obstructing tumor in the ascending colon. The biopsy is positive for adenocarcinoma of the colon.

1. Which of the following is the next step in the management of this patient?

  1. Metastatic workup, including abdominal computed tomography (CT) scan, chest radiograph, and liver profile, followed by colon resection
  2. A course of radiation therapy prior to any resection
  3. Surgical resection in conjunction with chemotherapy
  4. Exploratory laparotomy with colon resection
  5. Laparoscopic colon resection
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2. After the appropriate evaluation, the patient undergoes surgery. No intraoperative evidence of metastases is identified. Postoperatively, the pathology report reveals that the tumor is an adenocarcinoma invading into the pericolonic fat, with 2 involved lymph nodes. After the patient recovers from surgery, which of the following is the most appropriate next step in his management?

  1. Abdominal CT scan every 6 months
  2. No further therapy is indicated, because the involved nodes were removed
  3. Chemotherapy with 5-fluorouracil (5-FU) and levamisole
  4. Measurement of carcinoembryonic antigen (CEA) levels yearly
  5. Colonoscopy every 6 months
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3. A 59-year-old woman with no significant past medical history presents to the emergency department with a 2-day history of left lower quadrant abdominal pain. The patient denies nausea and vomiting, although she claims decreased oral intake. She also reports a low-grade fever and profuse diarrhea. She describes a milder episode several years ago, which resolved on its own. On physical examination, the patient is found to have left lower quadrant tenderness with some mild guarding, but no rebound. She is hemodynamically stable, and her heart rate is 82 bpm. In the initial management of this patient, which of the following is the most sensitive diagnostic test?
  1. Complete blood count, SMA-7 (sodium, potassium, CO2, chloride, glucose, blood urea nitrogen, and creatinine)
  2. An obstructive series
  3. A barium enema study
  4. Abdominal/pelvic CT with oral contrast
  5. Abdominal ultrasound
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