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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.
Adrian Ben Cresswell MD(Res) FRCS (Gen) Consultant HPB & General Surgeon, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK; Professor of Clinical Surgery, St George’s University International Medical School; Specialty Editor, SURGERY
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
B
Colonic resections carry a higher lifetime risk of adhesive small-bowel obstruction than cholecystectomy
C
Up to 20 litres of fluid per day can be secreted into obstructed bowel
D
In 20e30% of large bowel obstructions, the ileocaecal valve will be incompetent, resulting in small bowel dilatation
E
The ColoRectal Stenting Trial (CReST) reported a lower incidence of stomas when stenting was employed as a bridge to surgery for obstructed colorectal cancers
1 Bowel cancer screening Regarding bowel cancer screening A
In the development of colon cancer, loss of the tumour suppressor gene represents the final stage of transformation on the adenomaecarcinoma sequence
B
Transformation between ‘early’ and ‘late’ adenomata generally takes 2e3 years
C
Two or more first-degree relatives affected at an age of less than 50 years equates to a high-to-moderate risk of familial bowel cancer
D
Single sample faecal occult blood (FOB) testing provides a 92e94% sensitivity for the prediction of colorectal cancer in a screened population
E
The National Bowel Scope Programme offers a oneoff invitation for flexible sigmoidoscopy at 55 years of age and has been found to reduce the risk of dying of bowel cancer by 43%
4 Intestinal stomas Regarding intestinal stomas
2 Surgery for colorectal cancer Regarding surgery for colorectal cancer A
A synchronous colorectal cancer may be present in up to 9% of diagnoses
B
An involved circumferential resection margin, identified on MRI scanning, is usually an indication for neo-adjuvant therapy
C
D
E
Loop colostomies are usually easier to manage than loop ileostomies
B
Around 40% of end stomas, formed at a Hartmann’s procedure, are never reversed
C
A high-output stoma produces in excess of 2.5 litres per day and places the patient at risk of dehydration and electrolyte disturbance
D
Terminal ileal resection is associated with the formation of gallstones
E
Intestinal stomas carry a low risk of complications of around 5%
5 Anatomy of the rectum and anal canal Theme: pathology
Longitudinal intramural lymphatic spread in the colon rarely exceeds 4 cm, hence the rationale for 5 cm proximal and distal margins Colonic resections should include a minimum of 12 lymph nodes in the specimen to be considered as oncologically radical Follow-up colonoscopy is usually recommended at 3 years following excision of a colorectal cancer
A
Taeniae coli
B
Seminal vesicles
C
Middle rectal artery
D
Rectal shelves
E
Superior rectal artery
F
The levator hiatus
G
Middle third of rectum
H
Upper third of rectum
When considering the anatomy of the rectum and the anal canal, from the descriptions listed below, select the single most likely structure from the list above. Each option may be used only once, more than once or not at all.
3 Intestinal obstruction Regarding intestinal obstruction A
A
Colorectal cancer is the most common cause of intestinal obstruction
see next page
SURGERY 35:3
171
MCQs
Questions cont. 1
A defect in the pelvic floor, through which allows passage of the pelvic viscera to the perineum
2
Three smooth laterally facing curves, also known as the ‘valves of Houston’
3
External features which characterize the colon, but are absent on the rectal wall
4
The level at which the rectum becomes continuous with the anal canal
5
Covered by peritoneum only on its anterior surface
6
The principal arterial blood supply to the rectum
7
Arises from the external iliac artery and runs just above the pelvic floor
8
This structure is often found within the lateral ligament of the rectum
B The phase between an early and late adenoma is estimated to be 5e10 years D A single FOB test offers only 25e38% sensitivity for the detection of colorectal cancer. Combination of three samples increases this rate to 92e94% Question 2
C Longitudinal intramural lymphatic spread rarely exceeds 2 cm in the colon Question 3
A Eighty percent of cases of intestinal obstruction are small bowel obstruction, usually due to adhesions. Colorectal cancer is the commonest cause of large bowel obstruction C Up to 10 litres of fluid per day may be secreted into obstructed bowel
Answers 1 2 3 4 5
Question 4
C, E A, B, D, E B, D, E B, D 1F, 2D, 3A, 4F, 5G, 6E, 7C, 8C
A Loop ileostomies are associated with less odour, fewer appliance changes and lower complications than loop colostomies C The definition of a high-output stoma is an output in excess of 1.5 litres per day E Complications of intestinal stomas occur in around 34% of patients
Answers to incorrect statements Question 1
A Loss of the tumour suppressor gene is the initial phase of transformation of normal colonic mucosa to adenoma and is therefore an early, not a late, change
SURGERY 35:3
172
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.
Adrian Ben Cresswell MD(Res) FRCS (Gen) Consultant HPB & General Surgeon, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK; Professor of Clinical Surgery, St George’s University International Medical School; Specialty Editor, SURGERY
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
B
Colonic resections carry a higher lifetime risk of adhesive small-bowel obstruction than cholecystectomy
C
Up to 20 litres of fluid per day can be secreted into obstructed bowel
D
In 20e30% of large bowel obstructions, the ileocaecal valve will be incompetent, resulting in small bowel dilatation
E
The ColoRectal Stenting Trial (CReST) reported a lower incidence of stomas when stenting was employed as a bridge to surgery for obstructed colorectal cancers
1 Bowel cancer screening Regarding bowel cancer screening A
In the development of colon cancer, loss of the tumour suppressor gene represents the final stage of transformation on the adenomaecarcinoma sequence
B
Transformation between ‘early’ and ‘late’ adenomata generally takes 2e3 years
C
Two or more first-degree relatives affected at an age of less than 50 years equates to a high-to-moderate risk of familial bowel cancer
D
Single sample faecal occult blood (FOB) testing provides a 92e94% sensitivity for the prediction of colorectal cancer in a screened population
E
The National Bowel Scope Programme offers a oneoff invitation for flexible sigmoidoscopy at 55 years of age and has been found to reduce the risk of dying of bowel cancer by 43%
4 Intestinal stomas Regarding intestinal stomas
2 Surgery for colorectal cancer Regarding surgery for colorectal cancer A
A synchronous colorectal cancer may be present in up to 9% of diagnoses
B
An involved circumferential resection margin, identified on MRI scanning, is usually an indication for neo-adjuvant therapy
C
D
E
Loop colostomies are usually easier to manage than loop ileostomies
B
Around 40% of end stomas, formed at a Hartmann’s procedure, are never reversed
C
A high-output stoma produces in excess of 2.5 litres per day and places the patient at risk of dehydration and electrolyte disturbance
D
Terminal ileal resection is associated with the formation of gallstones
E
Intestinal stomas carry a low risk of complications of around 5%
5 Anatomy of the rectum and anal canal Theme: pathology
Longitudinal intramural lymphatic spread in the colon rarely exceeds 4 cm, hence the rationale for 5 cm proximal and distal margins Colonic resections should include a minimum of 12 lymph nodes in the specimen to be considered as oncologically radical Follow-up colonoscopy is usually recommended at 3 years following excision of a colorectal cancer
A
Taeniae coli
B
Seminal vesicles
C
Middle rectal artery
D
Rectal shelves
E
Superior rectal artery
F
The levator hiatus
G
Middle third of rectum
H
Upper third of rectum
When considering the anatomy of the rectum and the anal canal, from the descriptions listed below, select the single most likely structure from the list above. Each option may be used only once, more than once or not at all.
3 Intestinal obstruction Regarding intestinal obstruction A
A
Colorectal cancer is the most common cause of intestinal obstruction
see next page
SURGERY 35:3
171
MCQs
Questions cont. 1
A defect in the pelvic floor, through which allows passage of the pelvic viscera to the perineum
2
Three smooth laterally facing curves, also known as the ‘valves of Houston’
3
External features which characterize the colon, but are absent on the rectal wall
4
The level at which the rectum becomes continuous with the anal canal
5
Covered by peritoneum only on its anterior surface
6
The principal arterial blood supply to the rectum
7
Arises from the external iliac artery and runs just above the pelvic floor
8
This structure is often found within the lateral ligament of the rectum
B The phase between an early and late adenoma is estimated to be 5e10 years D A single FOB test offers only 25e38% sensitivity for the detection of colorectal cancer. Combination of three samples increases this rate to 92e94% Question 2
C Longitudinal intramural lymphatic spread rarely exceeds 2 cm in the colon Question 3
A Eighty percent of cases of intestinal obstruction are small bowel obstruction, usually due to adhesions. Colorectal cancer is the commonest cause of large bowel obstruction C Up to 10 litres of fluid per day may be secreted into obstructed bowel
Answers 1 2 3 4 5
Question 4
C, E A, B, D, E B, D, E B, D 1F, 2D, 3A, 4F, 5G, 6E, 7C, 8C
A Loop ileostomies are associated with less odour, fewer appliance changes and lower complications than loop colostomies C The definition of a high-output stoma is an output in excess of 1.5 litres per day E Complications of intestinal stomas occur in around 34% of patients
Answers to incorrect statements Question 1
A Loss of the tumour suppressor gene is the initial phase of transformation of normal colonic mucosa to adenoma and is therefore an early, not a late, change
SURGERY 35:3
172