MCQ ANSWERS M62 Course 2004

1. MCQ ANSWERSM62 Course 2004 Association of Coloproctology of Great Britain and Ireland

2. M62 - MCQ 1 Regarding the management of faecal incontinence, all of the following are true EXCEPT A) The role of biofeedback is not proven for faecal incontinence B) Enema use can be useful if faecal soiling is a problem C) Loperamide can be of value D) Prolonged PNTML carries a poor prognosis E) Topical phenylephrine gel may have a role in management

3. M62 - MCQ 1 Regarding the management of faecal incontinence, all of the following are true EXCEPT D) Prolonged PNTML carries a poor prognosis

4. M62 - MCQ 2 The successful operative treatment of patients with moderate to severe symptoms due to an anterior rectocoele has been shown to correlate best with:- A) physical examination identifying a >2cm rectocoele B) MRI identifying a >2cm rectocoele C) Defaecographic identification of a >2cm rectocoele D) Anal incontinence as a presenting complaint E) Duration of symptoms

5. M62 - MCQ 2 The successful operative treatment of patients with moderate to severe symptoms due to an anterior rectocoele has been shown to correlate best with:- C) Defaecographic identification of a >2cm rectocoele

6. M62 - MCQ 3 Regarding irritable bowel syndrome: A) The Rome criteria are a useful clinical tool B) No association with chronic fatigue, fibromyalgia, bladder or gynaecological symptoms is seen C) May be explained by peripheral visceral hypersensitivity or central hypervigilance D) Cannot be induced by Campylobacter infection E) May occur without disturbance in defaecation

7. M62 - MCQ 3 Regarding irritable bowel syndrome: C) May be explained by peripheral visceral hypersensitivity or central hypervigilance

8. M62 - MCQ 4 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

9. M62 - MCQ 4 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

10. M62 - MCQ 5 All of the following statements regarding FOBT population screening for colorectal cancer are true EXCEPT:- A) Targeted population is aged 45 to 65 years B) The most widely used kit is a guaiac based test for peroxidase activity C) Population compliance is about 60% D) Less than 2% of returned tests are positive. E) Colonoscopy of the FOB positive population demonstrates a cancer in 10%

11. M62 - MCQ 5 All of the following statements regarding FOBT population screening for colorectal cancer are true EXCEPT:- A) Targeted population is aged 45 to 65 years

12. M62 - MCQ 6 All of the following statements regarding Colonic Volvulus are true EXCEPT:- A) Percutaneous sigmoid colostomy can be useful in selected cases B) Endoscopic decompression is successful as initial therapy in up to 90% of patients C) Sigmoid colectomy for sigmoid volvulus can be associated with a recurrence rate of 30% or more D) The recurrence rate after sigmoid colectomy for volvulus is unaffected by the preoperative presence of megacolon E) Caecal volvulus is less common than sigmoid volvulus

13. M62 - MCQ 6 All of the following statements regarding Colonic Volvulus are true EXCEPT:- D) The recurrence rate after sigmoid colectomy for volvulus is unaffected by the preoperative presence of megacolon

14. M62 - MCQ 7 Lipomas of the colon: A) Are mostly subserosal B) Are most commonly found in the sigmoid C) Cannot be differentiated from cancer on imaging studies D) Are the most common benign intramural colon tumour E) Are best treated by snare excision

15. M62 - MCQ 7 Lipomas of the colon: D) Are the most common benign intramural colon tumour

16. M62 - MCQ 8 Regarding campylobacter enteritis: A) It is a rare cause of infectious diarrhoea in this country B) The organism Campylobacter jejuni are gram positive cocci seen in clusters on a stool smear C) Transmission occurs through a faecal-oral route through contaminated water and fruit D) Treatment of choice is penicillin orally for mild cases or parenterally for severe cases E) Toxin production does not occur

17. M62 - MCQ 8 Regarding campylobacter enteritis: C) Transmission occurs through a faecal-oral route through contaminated water and fruit

18. M62 - MCQ 9 Pneumatosis cystoides intestinalis A) Usually presents with abdominal pain and pneumoperitoneum B) May involve cysts in both the submucosa and the subserosa of the bowel C) Is treated effectively with IV antibiotics and nitrous oxide D) Has a low concentration of hydrogen in the cysts E) Has no known aetiology

19. M62 - MCQ 9 Pneumatosis cystoides intestinalis B) May involve cysts in both the submucosa and the subserosa of the bowel

20. M62 - MCQ 10 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

21. M62 - MCQ 10 Regarding chemotherapy for colorectal cancer the following statements are true, EXCEPT: B) All Dukes B patients benefit from adjuvant chemotherapy

22. M62 - MCQ 11 Regarding the operation of anterior resection for full thickness rectal prolapse, all of the following are true EXCEPT:- A) The rectum is mobilised completely to the coccyx B) The large majority of patients are female C) The cumulative recurrence rate at 10 years is 9.6% D) Anterior resection for prolapse predictably improves anal continence. E) Approximately 20cm of rectum and sigmoid is resected on average.

23. M62 - MCQ 11 Regarding the operation of anterior resection 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 Ileaoanal pouch construction in is associated with all of the following EXCEPT:- A) An overall excision rate of less than 5% B) Metronidazole and Ciprofloaxcin are the most effective agents in managing pouchitis. C) A postulated reduction in female fertility D) Reduced sphincter injury if the double stapled technique is used E) No functional difference between J and W pouches at 12 months follow up

25. M62 - MCQ 12 Ileaoanal pouch construction in is associated with all of the following EXCEPT :- A) An overall excision rate of less than 5%

26. M62 - MCQ 13 In the management of postoperative small bowel obstruction the following are true except:- A) The presence of peritonitis is not an absolute indication for laparotomy B) Water soluble contrast studies require administration of 100mls of contrast solution orally or via the NG tube. C) Small bowel obstruction requiring laparotomy is accurately predicted by failure of contrast to reach the caecum at 4 hours D) Immediate postoperative obstruction would be expected to resolve with conservative measures in 80-90% of patients E) Obstruction after APER often mandates laparotomy

27. M62 - MCQ 13 In the management of postoperative small bowel obstruction the following are true except:- A) The presence of peritonitis is not an absolute indication for laparotomy

28. M62 - MCQ 14 Regarding peri-operative nutrition in Colorectal Surgery all of the following are true EXCEPT :- A) SGA is highly predictive of malnutrition in surgical patients B) Short preoperative course of TPN (5-10 days) may reduce postoperative morbidity in malnourished surgical patients C) TPN should be started after 5 – 10days of postoperative ileus D) Early postoperative oral feeding may be associated with an increased risk of anastomotic breakdown E) Oral intake of clear fluids 2 to 3 hours before anaesthesia is safe in patients with normal gastric emptying

29. M62 - MCQ 14 Regarding peri-operative nutrition in Colorectal Surgery all of the following are true EXCEPT :- D) Early postoperative oral feeding may be associated with an increased risk of anastomotic breakdown

30. M62 - MCQ 15 In patients with Fulminant Colitis the following are true EXCEPT:- A) Can be precipitated by Clostridium difficle infection B) Low division of the rectal stump at colectomy facilitates subsequent reconstructive surgery. C) Optimal management is based on joint care – gastroenterologist, surgeon and specialist nurses D) Primary restorative procedure at the time of urgent colectomy is not advisable E) Fulminant colitis is the first presenation of up to one third of patients

31. M62 - MCQ 15 In patients with Fulminant Colitis the following are true EXCEPT:- B) Low division of the rectal stump at colectomy facilitates subsequent reconstructive surgery.

32. M62 – Course Feedback

34. Caption Competition

37. FEEDBACK Facilities

38. FEEDBACK Relevance

39. FEEDBACK Change Practice

40. FEEDBACK Further M62 Course ?

41. M62 - MCQ Hotshots 136 – Rowena Sheldon 71 ? 148 ?

42. M62 COLOPROCTOLOGY COURSE24th – 25th March 2005http://www.m62course.org