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Test yourself: MCQ and extended matching
MCQS
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University, UK; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
A
Selection of patients suitable for multimodality therapy is guided by the risk of distant metastasis if surgery alone were offered.
1 Anatomy of the caecum, appendix and colon
B
No main European trials have supported the use of preoperative radiotherapy versus surgery alone in the TME era.
C
All patients with cancer limited to the rectal wall (T1 and T2) should be offered curative local excision and radiotherapy.
D
The aim of radiotherapy is to treat all macroscopic tumour with an adequate margin to cover microscopic disease.
E
The role of neoadjuvant treatment in colon cancer is unestablished and is currently being investigated in the FOxTROT trial.
When considering anatomy of the caecum, appendix and colon A
On average, the total length of the large bowel is about 1.5 m (5 feet).
B
The blood supply of the appendix derives from the appendicular artery, which arises from the ileocolic artery.
C
The lymphatic drainage of each segment of bowel corresponds fairly accurately to its blood supply.
D
There is a natural vascular watershed in the transverse colon between the branches of the middle and left colic vessels.
E
4 Laparoscopic colorectal surgery For patients requiring laparoscopic colorectal surgery
The caecum is usually completely peritonealized.
2 Population screening for colorectal cancer When considering population screening for colorectal cancer A
B
Around 30% of bowel cancer cases in men and 20% in women in the UK are linked to lifestyle and environmental factors. Guaiac-based faecal occult blood testing is used as the first line screening tool in all UK screening programmes.
C
The English, Welsh and Scottish screening models all follow a singly funded ‘exclusive designated provider’.
D
MDTs following the introduction of screening programmes are typically seeing an increased in workload of approximately 10%.
E
One-off flexible sigmoidoscopy at 60 has been demonstrated in a randomized trial to reduce both the incidence and mortality from colorectal cancer.
A
Conversion rates of laparoscopic to open varied considerably from 11% to 29%.
B
There is a 5-year survival benefit in favour of patients undergoing no preoperative bowel preparation.
C
Laparoscopic resection of colorectal malignancy is safe and effective in managing appropriate patients.
D
Most units should expect a stay of 1e2 days following a laparoscopic right hemicolectomy.
E
The NICE 2000 guidance states that ‘laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable’.
5 The pathology of colorectal polyps and cancers (including biopsy) Theme: The pathology of colorectal polyps and cancers (including biopsy)
3 Chemotherapy and radiotherapy for colorectal cancers For patients requiring chemotherapy and radiotherapy for colorectal cancer
A
Is associated with an increased risk of several malignancies, including cancers of the colon, pancreas, breast, lung, ovaries, uterus, and testicles.
B
Polyps that are usually between 5 and 10 mm in size and display complex architectural abnormalities with minor cytological atypia. see next page
SURGERY 32:4
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MCQS
Questions cont. C
Answers to incorrect statements
Include neuroendocrine tumours, smooth muscle tumours, gastrointestinal stromal tumours, neural tumours, lipomatous tumours, vascular tumours and lymphomas.
D
Is associated with extraintestinal manifestations such as congenital hypertrophy of the retinal pigment epithelium.
E
Is characterized by young ageeonset colorectal cancer, which is usually proximally located.
F
Tumour-like growths composed of disorganized, mature tissue elements that are normally present at the site in which they develop.
G
Is characterized by macrocephaly, gastrointestinal polyposis and benign skin tumours.
H
A proliferation of glandular epithelium with at least low-grade dysplasia.
Question 2
A Around 57% of bowel cancer cases in men and 52% in women in the UK are linked to lifestyle and environmental factors. C The English, Welsh and Northern Irish screening models all follow a singly funded ‘exclusive designated provider’. E One-off flexible sigmoidoscopy at 55 has been demonstrated in a randomized trial to reduce both the incidence and mortality from colorectal cancer. Question 3
A Selection of patients suitable for multimodality therapy is guided by the risk of local recurrence if surgery alone were offered. B Two main European trials have supported the use of preoperative radiotherapy versus surgery alone in the TME era. C Patients with cancer limited to the rectal wall (T1 and T2) may be offered curative surgery by local excision techniques alone.
When considering the pathologies of colorectal polyps and cancers 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
Adenoma
2
Familial adenomatous polyposis
3
Sessile serrated lesion.
4
Hamartomas
5
PeutzeJeghers syndrome
6
Cowden syndrome
7
Lynch syndrome
8
Polypoid tumours of non-epithelial origin
Question 4
B There is a 5-year survival benefit in favour of patients undergoing preoperative bowel preparation. D Most units should expect a stay of 2e4 days following a laparoscopic right hemicolectomy. E The NICE 2006 guidance states that ‘laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable’.
Answers 1. 2. 3. 4. 5.
All B, D D, E A, C 1A, 2D, 3D, 4F, 5A, 6G, 7E, 8C
SURGERY 32:4
219
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University, UK; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
A
Selection of patients suitable for multimodality therapy is guided by the risk of distant metastasis if surgery alone were offered.
1 Anatomy of the caecum, appendix and colon
B
No main European trials have supported the use of preoperative radiotherapy versus surgery alone in the TME era.
C
All patients with cancer limited to the rectal wall (T1 and T2) should be offered curative local excision and radiotherapy.
D
The aim of radiotherapy is to treat all macroscopic tumour with an adequate margin to cover microscopic disease.
E
The role of neoadjuvant treatment in colon cancer is unestablished and is currently being investigated in the FOxTROT trial.
When considering anatomy of the caecum, appendix and colon A
On average, the total length of the large bowel is about 1.5 m (5 feet).
B
The blood supply of the appendix derives from the appendicular artery, which arises from the ileocolic artery.
C
The lymphatic drainage of each segment of bowel corresponds fairly accurately to its blood supply.
D
There is a natural vascular watershed in the transverse colon between the branches of the middle and left colic vessels.
E
4 Laparoscopic colorectal surgery For patients requiring laparoscopic colorectal surgery
The caecum is usually completely peritonealized.
2 Population screening for colorectal cancer When considering population screening for colorectal cancer A
B
Around 30% of bowel cancer cases in men and 20% in women in the UK are linked to lifestyle and environmental factors. Guaiac-based faecal occult blood testing is used as the first line screening tool in all UK screening programmes.
C
The English, Welsh and Scottish screening models all follow a singly funded ‘exclusive designated provider’.
D
MDTs following the introduction of screening programmes are typically seeing an increased in workload of approximately 10%.
E
One-off flexible sigmoidoscopy at 60 has been demonstrated in a randomized trial to reduce both the incidence and mortality from colorectal cancer.
A
Conversion rates of laparoscopic to open varied considerably from 11% to 29%.
B
There is a 5-year survival benefit in favour of patients undergoing no preoperative bowel preparation.
C
Laparoscopic resection of colorectal malignancy is safe and effective in managing appropriate patients.
D
Most units should expect a stay of 1e2 days following a laparoscopic right hemicolectomy.
E
The NICE 2000 guidance states that ‘laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable’.
5 The pathology of colorectal polyps and cancers (including biopsy) Theme: The pathology of colorectal polyps and cancers (including biopsy)
3 Chemotherapy and radiotherapy for colorectal cancers For patients requiring chemotherapy and radiotherapy for colorectal cancer
A
Is associated with an increased risk of several malignancies, including cancers of the colon, pancreas, breast, lung, ovaries, uterus, and testicles.
B
Polyps that are usually between 5 and 10 mm in size and display complex architectural abnormalities with minor cytological atypia. see next page
SURGERY 32:4
218
MCQS
Questions cont. C
Answers to incorrect statements
Include neuroendocrine tumours, smooth muscle tumours, gastrointestinal stromal tumours, neural tumours, lipomatous tumours, vascular tumours and lymphomas.
D
Is associated with extraintestinal manifestations such as congenital hypertrophy of the retinal pigment epithelium.
E
Is characterized by young ageeonset colorectal cancer, which is usually proximally located.
F
Tumour-like growths composed of disorganized, mature tissue elements that are normally present at the site in which they develop.
G
Is characterized by macrocephaly, gastrointestinal polyposis and benign skin tumours.
H
A proliferation of glandular epithelium with at least low-grade dysplasia.
Question 2
A Around 57% of bowel cancer cases in men and 52% in women in the UK are linked to lifestyle and environmental factors. C The English, Welsh and Northern Irish screening models all follow a singly funded ‘exclusive designated provider’. E One-off flexible sigmoidoscopy at 55 has been demonstrated in a randomized trial to reduce both the incidence and mortality from colorectal cancer. Question 3
A Selection of patients suitable for multimodality therapy is guided by the risk of local recurrence if surgery alone were offered. B Two main European trials have supported the use of preoperative radiotherapy versus surgery alone in the TME era. C Patients with cancer limited to the rectal wall (T1 and T2) may be offered curative surgery by local excision techniques alone.
When considering the pathologies of colorectal polyps and cancers 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
Adenoma
2
Familial adenomatous polyposis
3
Sessile serrated lesion.
4
Hamartomas
5
PeutzeJeghers syndrome
6
Cowden syndrome
7
Lynch syndrome
8
Polypoid tumours of non-epithelial origin
Question 4
B There is a 5-year survival benefit in favour of patients undergoing preoperative bowel preparation. D Most units should expect a stay of 2e4 days following a laparoscopic right hemicolectomy. E The NICE 2006 guidance states that ‘laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable’.
Answers 1. 2. 3. 4. 5.
All B, D D, E A, C 1A, 2D, 3D, 4F, 5A, 6G, 7E, 8C
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