MCQ ASSESSMENT M62 Course 2005 Answers

1. MCQ ASSESSMENT M62 Course 2005Answers Association of Coloproctology of Great Britain and Ireland

2. M62 - MCQ 1 A healthy adult presents acutely with prolapsed gangrenous haemorrhoids. Which of the following statements is true (choose the best answer) A) One week of non-operative treatment is necessary before attempting surgery B) Urgent operation has an unacceptable rate of postoperative anal stricture C) Urgent operation has an unacceptable rate of postoperative spetic pylephlebitis D) Urgent operation has a five fold greater risk of postoperative bleeding than elective haemorrhoidectomy E) Duration of pain and disability is minimised by urgent haemorrhoidectomy

3. M62 - MCQ 1 A healthy adult presents acutely with prolapsed gangrenous haemorrhoids. Which of the following statements is true (choose the best answer) E) Duration of pain and disability is minimised by urgent haemorrhoidectomy

4. M62 - MCQ 2 In patients with Bowen’s disease or Paget’s disease of the perianal skin:- A) Only Bowen’s begins as a localised intra-epidermal malignancy B) The two conditions are easily distinguished on clinical grounds C) Invasive Bowen’s disease is best managed by abdoperineal excision of the rectum. D) Wide local excision can be definitive treatment in both conditions E) Occupation is an important aetiological factor

5. M62 - MCQ 2 In patients with Bowen’s disease or Paget’s disease of the perianal skin:- D) Wide local excision can be definitive treatment in both conditions

6. M62 - MCQ 3 Regarding perineal procedures for rectal prolapse the following are all true EXCEPT; A) Delorme’s procedure decreases rectal compliance B) Delorme’s procedure produces virtually no change in sphincter pressure C) Recurrence after Delorme’s procedure reaches a plateau at 8 years follow up D) Altemeier’s operation includes a sutured coloanal anastomosis E) Perineal procedures are most suited to the elderly and frail

7. M62 - MCQ 3 Regarding perineal procedures for rectal prolapse the following are all true EXCEPT; C. Recurrence after Delorme’s procedure reaches a plateau at 8 years follow up

8. M62 - MCQ 4 In the management of anal fissures, all of the following are true EXCEPT; A) Placebo treatments are associated with 35% healing rate B) Botulinum toxin injection into the internal sphincter cannot be repeated C) Surgery is more effective than medical therapy in curing fissure D) GTN therapy is significantly more likely to be associated with headache than placebo E) Calcium channel blockers achieve healing rates similar to GTN

9. M62 - MCQ 4 In the management of anal fissures, all of the following are true EXCEPT; B. Botulinum toxin injection into the internal sphincter cannot be repeated

10. M62 - MCQ 5 In the management of polyp cancer the following are true EXCEPT: A) Lymphatics in the colon wall do not penetrate the muscularis mucosae B) Sessile polyps with a focus of invasive cancer can be managed by snare excision C) Carcinoma limited to the head of a pedunculated polyp can be managed by snare excision D) Carcinoma limited to the head of a pedunculated polyp does not mandate colonic resection if poorly differentiated E) Carcinoma limited to the head of a pedunculated polyp does not mandate colonic resection if associated with vascular or lymphatic invasion

11. M62 - MCQ 5 In the management of polyp cancer the following are true EXCEPT: A) Lymphatics in the colon wall do not penetrate the muscularis mucosae

12. M62 - MCQ 6 With regard to Solitary Rectal Ulcer Syndrome (SRUS) all of the following are true EXCEPT A) Ulceration is due to trauma to the leading edge of an internal intussusception B) Biofeedback can be initially helpful in up to 30% of patients C) Defaecating proctography is useful in patient assessment. D) Colitis cystica profunda is a recognised variant. E) Rectopexy is associated with symptom resolution in more than 90% of patients

13. M62 - MCQ 6 With regard to Solitary Rectal Ulcer Syndrome (SRUS) all of the following are true EXCEPT E) Rectopexy is associated with symptom resolution in more than 90% of patients

14. M62 - MCQ 7 All of the following statements regarding “colitis” are true EXCEPT:- A) CMV infection is a recognised complication of IBD that does not alter patient prognosis B) Clostridium associated diarrhoea may present as an acute abdomen C) Pseudomembranous colitis may require colectomy D) Entamoeba histolytica is responsible for amoebic colitis E) In the UK and other developed countries most cases of bacillary dysentery (>90%) are due to S. sonnei

15. M62 - MCQ 7 All of the following statements regarding “colitis” are true EXCEPT:- A) CMV infection is a recognised complication of IBD that does not alter patient prognosis

16. M62 - MCQ 8 In patients with anal carcinoma the following are true EXCEPT:- A) Nearly all cases are of the epidermoid type B) Combined modality therapy (radiotherapy, fluorouracil and mitomycin) has no advantage over radiotherapy alone. C) Randomised trials of best therapy demonstrate 3 to 5 year survival rates of 56-76% D) 90% of local treatment failures occur within 36 months E) Salvage anorectal excision can produce cure in about 50% of patients

17. M62 - MCQ 8 In patients with anal carcinoma the following are true EXCEPT:- B) Combined modality therapy (radiotherapy, fluorouracil and mitomycin) has no advantage over radiotherapy alone.

18. M62 - MCQ 9 The management of a high transphincteric fistula might include any of the following EXCEPT (Choose the best answer) A) Draining seton B) Immediate division of the external sphincter C) Cutting seton D) Advancement flap

19. M62 - MCQ 9 The management of a high transphincteric fistula might include any of the following EXCEPT (Choose the best answer) B) Immediate division of the external sphincter

20. M62 - MCQ 10 Complications of radiation injury to the rectum include all of the following EXCEPT (Choose the best answer) A) Diarrhoea B) Fistulation C) Rectal stricture D) Colitis cystica profunda

21. M62 - MCQ 10 Complications of radiation injury to the rectum include all of the following EXCEPT (Choose the best answer) D) Colitis cystica profunda

22. M62 - MCQ 11 Regarding abdominal operations for full thickness rectal prolapse, all of the following are true EXCEPT:- A) The rectum is mobilised completely to the coccyx B) Most patients are female C) Mesh rectopexy may be associated with severe constipation D) Anterior resection for prolapse predictably improves anal continence. E) In anterior resection for prolapse approximately 20cm of rectum and sigmoid is resected.

23. M62 - MCQ 11 Regarding abdominal operations for full thickness rectal prolapse, all of the following are true EXCEPT:- D) Anterior resection for prolapse predictably improves anal continence.

24. M62 - MCQ 12 Regarding chemotherapy for colorectal cancer the following statements are true, EXCEPT: A) 5 FU/FA has been the mainstay of therapy for metastatic CRC for 40 years B) All Dukes B patients benefit from adjuvant chemotherapy C) 5 FU/FA adjuvant chemotherapy is standard practice after curative resection of lymph node positive CRC D) NICE guidelines allow capecitabine use as first line therapy for metastatic CRC E) NICE guidelines allow irinotecan use as second line therapy for metastatic CRC

25. M62 - MCQ 12 Regarding chemotherapy for colorectal cancer the following statements are true, EXCEPT: B) All Dukes B patients benefit from adjuvant chemotherapy

26. M62 - MCQ 13 In the management of HIV infection and the anus, the following are true EXCEPT: A) 5% of all HIV/AIDS patients will see a proctologist B) Perianal pain and/or mass are common presenting symptoms in HIV/AIDS C) The incidence and progression of anal intra-epithelial neoplasia is unrelated to HIV status D) HPV serotypes 6 and 11 are associated with genital/anal warts E) HPV serotypes 16 and 18 are onocogenic

27. M62 - MCQ 13 In the management of HIV infection and the anus, the following are true EXCEPT: C) The incidence and progression of anal intra-epithelial neoplasia is unrelated to HIV status

28. M62 - MCQ 14 In the prevention of DVT after colorectal surgery A) Heparins reduce the incidence of DVT and PE when compared to no treatment B) Unfractionated heparin and low molecular weight heparins are equally effective C) Enoxaparin can be given 2 hours before surgery if an epidural is planned. D) Graded compression stockings with low dose heparin are more effective than low dose heparin alone E) There is insufficient evidence for the role of intermittent pneumatic compression in colorectal DVT prevention

29. M62 - MCQ 14 In the prevention of DVT after colorectal surgery C) Enoxaparin can be given 2 hours before surgery if an epidural is planned.

30. M62 - MCQ 15 In the management of pruritus ani following are true EXCEPT: A) Intradermal injection of methylene blue can be effective in relieving symptoms B) Topical capsaicin [a natural alkaloid extracted from red chili peppers] produces significant relief of pruritus ani symptoms C) Attention to personal hygiene is important D) Patch testing for contact dermatitis is not helpful E) Topical corticosteroids can be useful

31. M62 - MCQ 15 In the management of pruritus ani following are true EXCEPT: D) Patch testing for contact dermatitis is not helpful

32. M62 – Course Feedback

33. FEEDBACK Facilities

34. FEEDBACK Relevance

35. FEEDBACK Change Practice

36. FEEDBACK Further M62 Course ?

37. M62 - MCQ Hotshots THE WINNERS 15 / 24 / 42 (NW) 45 (GW)/ 50 / 141 / 18 (KC)

38. M62 COLOPROCTOLOGY COURSEhttp://www.m62course.org March 30-31st 2006