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Question 1
A 52-year-old man from Goiás, Brazil, presents with progressive dysphagia to both solids and liquids for 8 years, nocturnal regurgitation, and a 12 kg weight loss. Serology for Trypanosoma cruzi (Chagas disease) is positive. A timed barium esophagogram reveals an esophageal diameter of 5.5 cm, marked retention of contrast with a distal 'bird's beak' taper, and uncoordinated non-propulsive tertiary contractions (Rezende Classification Group II / Grau II). Upper endoscopy rules out mucosal malignancy. According to the Brazilian consensus and CBCD guidelines for Chagasic megaesophagus (Megaesôfago Chagásico), what is the most appropriate surgical treatment?
Correct Answer:
Laparoscopic Heller cardiomyotomy extended 6 cm on the esophagus and 2 cm onto the stomach, combined with a partial anterior fundoplication (Heller-Pinotti procedure)
Question 2
A 38-year-old woman presents with severe retrosternal chest pain and dysphagia. High-resolution manometry (HRM) evaluated under the Chicago Classification v4.0 demonstrates an elevated median Integrated Relaxation Pressure (IRP > 15 mmHg), 100% failed peristalsis, and premature spastic contractions with a Distal Latency (DL) < 4.5 seconds in > 20% of swallows, confirming Type III (Spastic) Achalasia. Which of the following therapeutic modalities provides superior clinical success and symptom relief for this specific manometric subtype?
Correct Answer:
Peroral Endoscopic Myotomy (POEM) with tailored long proximal esophageal myotomy
Question 3
A 46-year-old man with refractory gastroesophageal reflux disease (GERD) unresponsive to double-dose proton pump inhibitors undergoes preoperative evaluation for antireflux surgery. 24-hour pH-impedance monitoring confirms pathological acid exposure with a DeMeester score of 42. High-resolution manometry demonstrates Ineffective Esophageal Motility (IEM) with > 70% failed or weak peristaltic sequences and low distal contractile integral (DCI < 450 mmHg·s·cm). Which surgical antireflux procedure is most appropriate to prevent postoperative severe dysphagia while controlling reflux?
Correct Answer:
Posterior partial fundoplication (Toupet 270-degree) with hiatoplasty
Question 4
A 64-year-old man with long-standing Barrett's esophagus undergoes surveillance high-definition chromoendoscopy. A flat 12 mm slightly elevated lesion (Paris 0-IIa) is identified at the 5 o'clock position, 3 cm above the gastroesophageal junction. Endoscopic Submucosal Dissection (ESD) is performed. Histopathology confirms a well-differentiated intramucosal adenocarcinoma (pT1a-m3) with clear lateral and deep resection margins (R0), no lymphovascular invasion, and no submucosal infiltration. What is the standard oncological management following this resection?
Correct Answer:
Endoscopic eradication therapy (e.g., Radiofrequency Ablation - RFA) of the remaining Barrett's mucosa combined with endoscopic surveillance
Question 5
A 58-year-old male smoker is diagnosed with a moderately differentiated squamous cell carcinoma (SCC) of the middle third of the thoracic esophagus, located 28 cm from the incisors. Endoscopic ultrasound (EUS) and PET-CT stage the tumor as cT3 N1 M0 (resectable locally advanced, with two positive periesophageal lymph nodes and no distant metastases). Bronchoscopy shows no tracheobronchial invasion. Based on the CROSS trial and CBCD oncological consensus, what is the best treatment strategy?
Correct Answer:
Neoadjuvant chemoradiation (weekly carboplatin and paclitaxel with 41.4 Gy radiation) followed by restaging and transthoracic esophagectomy with two-field lymphadenectomy
Question 1
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Prepare with the TECAD Cirurgia Digestiva Practice Questions - TECAD - Título de Especialista em Cirurgia do Aparelho Digestivo (CBCD AMB) Exam practice quiz. This question bank includes 100 questions covering year-old, gastric, presents, upper, and reveals. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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TECAD Cirurgia Digestiva Practice Questions - TECAD - Título de Especialista em Cirurgia do Aparelho Digestivo (CBCD AMB) Exam

This practice set contains 100 questions from the matching question bank and focuses on year-old, gastric, presents, upper, and reveals. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

This is an independent study resource intended for practice and review; it is not an official examination or an endorsement by any organization named in the title.

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