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Test yourself: MCQ and extended matching
MCQS
Test yourself
MCQ and extended matching
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne, UK, Honorary Reader, Newcastle University, Clinical Editor, SURGERY, Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below. B
1 Clinical, radiological and physiological assessment of anorectal function
C
When considering clinical, radiological and physiological assessment of anorectal function
D E
A The prevalence of faecal incontinence in the community estimated at 1.4% and rising to 7% in the elderly. B The external anal sphincter demonstrates sinusoidal ‘slow-wave’ activity with a frequency of 20e40 cycles/ minute and is the main contributor to resting anal pressure in a healthy individual. C Rectal compliance is often altered in patients with faecal urgency, constipation and incontinence. D Defaecating proctography is only able to detect a rectal prolapse, but has limited other diagnostic capabilities. E Rectal balloon insufflation tests provide an indication of rectal motor function.
based continence and defaecation mechanisms is unknown. In refractory chronic anal fissures, there is no role for YeV simple cutaneous advancement flap anoplasty. The key tenants of perianal abscess management involve bed rest, antibiotics and regular hot baths. The mainstay of treatment for fissure in ano is surgical. The overall cure rate of the primary first presentation incision and drainage for acute pilonidal abscess disease is 80 percent.
4 Sigmoid volvulus, acquired megacolon and pseudo-obstruction For patients with sigmoid volvulus, acquired megacolon and pseudo-obstruction A Colonic pseudo-obstruction is a term used to characterize a clinical syndrome with symptoms, signs, and a radiographic appearance of large bowel obstruction without a mechanical cause. B Acute colonic pseudo-obstruction occurs in 1% of hospitalised orthopaedic patients undergoing hip, knee and spinal surgery. C In Russia, sigmoid volvulus accounts for 50% of emergency admissions with a large bowel obstruction. D Patients with sigmoid volvulus always present with acute intestinal obstruction. E The majority of patients with Idiopathic Megabowel require surgery to control symptoms.
2 Diverticular disease For patients with diverticular disease A Right sided diverticular are seen in the context of pancolonic disease and is more common in Asians than Caucasians. B The term diverticulitis should be reserved for clinical, radiological or endoscopic proven inflammation to avoid over-treatment with resection. C The management of diverticular bleeding is usually conservative and most will cease with close observation. D Elective resection should be offered to those with recurrent and proven symptomatology attributable to diverticular disease with complications from the disease. E Complicated diverticular disease can be resected laparoscopically, but with a conversion rate of approximately 60%.
5 Secretory functions of the gastrointestinal tract Theme: secretory functions of the gastrointestinal tract A High molecular weight proteins rich in glycosylated amino acid residues which add visco-elasticity to the saliva facilitating bolus formation and safe swallowing. B Modify the primary saliva through absorption of Naþ via the ENaC channel, and Cl reabsorption and HCO3 secretion. C Secrete the intrinsic factor, a 55 kDa glycoprotein complexing with vitamin B12 facilitating ileal B12 absorption. D Theses are all mucous.
3 Benign anal conditions For patients with benign anal conditions A Haemorrhoids are varicosities of the walls of the anal canal, but their relevance to the anal sphincter
see next page
SURGERY 32:8
439
MCQS
Questions cont. E Secreted by both parotid and submandibular/sublingual glands, important for dental health as it lubricates and protects the integrity of the enamel. F Secrete isotonic fluid with Naþ, Cl and Kþ, along with proteins in secretory granules from the basal membrane of the cells. G Mainly serous and also the largest responder to elevated salivary secretion requirements. H The most abundantly secreted protein and is secreted by the parotid gland upon food intake.
Answers to incorrect statements Question 1
B The internal anal sphincter demonstrates sinusoidal ‘slow-wave’ activity with a frequency of 20e40 cycles/ minute and is the main contributor to resting anal pressure in a healthy individual. D Defaecating proctography may detect a rectocele, an enterocoele or a rectal prolapse. E Rectal balloon insufflation tests provide an indication of rectal sensory function.
When considering the secretory functions of the gastrointestinal tract listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all 1. 2. 3. 4. 5. 6. 7. 8.
Question 3
A Haemorrhoids are varicosities of the walls of the anal canal, which are physiological important for the fine-tuning of anal sphincter based continence and defaecation mechanisms. B In refractory chronic anal fissures YeV, simple cutaneous advancement flap anoplasty provides an alternative to a lateral sphinctorotomy. C Deloculation, curettage, irrigation and deroofing are key tenants of perianal abscess management. D The mainstay of treatment for fissure in ano is surgical, with the exception of Crohn’s disease. E The overall cure rate of the primary first presentation incision and drainage for acute pilonidal abscess disease can be as low as fifty percent.
Parotid gland secretions Submucosal gland secretions Mucins Amylase Statherines Aciner cells Epithelial duct cells Patietal cells
Answers 1. 2. 3. 4. 5.
A, C All None A, B, C 1G, 2D, 3A, 4H, 5E, 6F, 7B, 8C
SURGERY 32:8
Question 4
D Patients with sigmoid volvulus present as acute or subacute intestinal obstruction. E The majority of patients with Idiopathic Megabowel are managed conservatively to control symptoms.
440
Test yourself
MCQ and extended matching
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne, UK, Honorary Reader, Newcastle University, Clinical Editor, SURGERY, Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
For questions 1e4, select the statements which are true and which are false. The correct answers are given below. B
1 Clinical, radiological and physiological assessment of anorectal function
C
When considering clinical, radiological and physiological assessment of anorectal function
D E
A The prevalence of faecal incontinence in the community estimated at 1.4% and rising to 7% in the elderly. B The external anal sphincter demonstrates sinusoidal ‘slow-wave’ activity with a frequency of 20e40 cycles/ minute and is the main contributor to resting anal pressure in a healthy individual. C Rectal compliance is often altered in patients with faecal urgency, constipation and incontinence. D Defaecating proctography is only able to detect a rectal prolapse, but has limited other diagnostic capabilities. E Rectal balloon insufflation tests provide an indication of rectal motor function.
based continence and defaecation mechanisms is unknown. In refractory chronic anal fissures, there is no role for YeV simple cutaneous advancement flap anoplasty. The key tenants of perianal abscess management involve bed rest, antibiotics and regular hot baths. The mainstay of treatment for fissure in ano is surgical. The overall cure rate of the primary first presentation incision and drainage for acute pilonidal abscess disease is 80 percent.
4 Sigmoid volvulus, acquired megacolon and pseudo-obstruction For patients with sigmoid volvulus, acquired megacolon and pseudo-obstruction A Colonic pseudo-obstruction is a term used to characterize a clinical syndrome with symptoms, signs, and a radiographic appearance of large bowel obstruction without a mechanical cause. B Acute colonic pseudo-obstruction occurs in 1% of hospitalised orthopaedic patients undergoing hip, knee and spinal surgery. C In Russia, sigmoid volvulus accounts for 50% of emergency admissions with a large bowel obstruction. D Patients with sigmoid volvulus always present with acute intestinal obstruction. E The majority of patients with Idiopathic Megabowel require surgery to control symptoms.
2 Diverticular disease For patients with diverticular disease A Right sided diverticular are seen in the context of pancolonic disease and is more common in Asians than Caucasians. B The term diverticulitis should be reserved for clinical, radiological or endoscopic proven inflammation to avoid over-treatment with resection. C The management of diverticular bleeding is usually conservative and most will cease with close observation. D Elective resection should be offered to those with recurrent and proven symptomatology attributable to diverticular disease with complications from the disease. E Complicated diverticular disease can be resected laparoscopically, but with a conversion rate of approximately 60%.
5 Secretory functions of the gastrointestinal tract Theme: secretory functions of the gastrointestinal tract A High molecular weight proteins rich in glycosylated amino acid residues which add visco-elasticity to the saliva facilitating bolus formation and safe swallowing. B Modify the primary saliva through absorption of Naþ via the ENaC channel, and Cl reabsorption and HCO3 secretion. C Secrete the intrinsic factor, a 55 kDa glycoprotein complexing with vitamin B12 facilitating ileal B12 absorption. D Theses are all mucous.
3 Benign anal conditions For patients with benign anal conditions A Haemorrhoids are varicosities of the walls of the anal canal, but their relevance to the anal sphincter
see next page
SURGERY 32:8
439
MCQS
Questions cont. E Secreted by both parotid and submandibular/sublingual glands, important for dental health as it lubricates and protects the integrity of the enamel. F Secrete isotonic fluid with Naþ, Cl and Kþ, along with proteins in secretory granules from the basal membrane of the cells. G Mainly serous and also the largest responder to elevated salivary secretion requirements. H The most abundantly secreted protein and is secreted by the parotid gland upon food intake.
Answers to incorrect statements Question 1
B The internal anal sphincter demonstrates sinusoidal ‘slow-wave’ activity with a frequency of 20e40 cycles/ minute and is the main contributor to resting anal pressure in a healthy individual. D Defaecating proctography may detect a rectocele, an enterocoele or a rectal prolapse. E Rectal balloon insufflation tests provide an indication of rectal sensory function.
When considering the secretory functions of the gastrointestinal tract listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all 1. 2. 3. 4. 5. 6. 7. 8.
Question 3
A Haemorrhoids are varicosities of the walls of the anal canal, which are physiological important for the fine-tuning of anal sphincter based continence and defaecation mechanisms. B In refractory chronic anal fissures YeV, simple cutaneous advancement flap anoplasty provides an alternative to a lateral sphinctorotomy. C Deloculation, curettage, irrigation and deroofing are key tenants of perianal abscess management. D The mainstay of treatment for fissure in ano is surgical, with the exception of Crohn’s disease. E The overall cure rate of the primary first presentation incision and drainage for acute pilonidal abscess disease can be as low as fifty percent.
Parotid gland secretions Submucosal gland secretions Mucins Amylase Statherines Aciner cells Epithelial duct cells Patietal cells
Answers 1. 2. 3. 4. 5.
A, C All None A, B, C 1G, 2D, 3A, 4H, 5E, 6F, 7B, 8C
SURGERY 32:8
Question 4
D Patients with sigmoid volvulus present as acute or subacute intestinal obstruction. E The majority of patients with Idiopathic Megabowel are managed conservatively to control symptoms.
440