colon

lynch Syndrome Surveillance

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Advanced MCQ – Lynch Syndrome Surveillance
A 32-year-old woman is diagnosed with Lynch syndrome after genetic testing reveals a pathogenic MSH6 mutation. She has completed childbearing and asks about her cancer risks and recommended surveillance strategy. Which statement is MOST accurate?
  • A. Her lifetime CRC risk exceeds 60%
  • B. Annual colonoscopy beginning at age 40 is appropriate
  • C. Annual transvaginal ultrasound with endometrial biopsy should be considered starting at age 30–35
  • D. Prophylactic hysterectomy is not recommended
  • E. EPCAM mutations do not require colonoscopic surveillance
Correct Answer: C

Explanation:
• Annual colonoscopy begins at age 20–25 in Lynch syndrome.
• Endometrial cancer screening (TVUS + biopsy) starts at age 30–35.
• Prophylactic hysterectomy should be discussed after completion of childbearing.
• EPCAM deletions silence MSH2 and follow MSH2 surveillance guidelines.
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Pelvic floor

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📘 Theme: Mock Test – 1 March 2026

Pelvic Floor Mechanics

During anorectal manometry, a patient demonstrates preservation of resting continence despite severe internal anal sphincter damage. Which structure is most responsible for maintaining continence in this scenario?

A. Pubococcygeus
B. Iliococcygeus
C. Puborectalis
D. External anal sphincter

Answer: C. Puborectalis

Explanation:
The puborectalis muscle forms a U-shaped sling around the anorectal junction and is the most critical muscle for maintaining fecal continence. Its tonic contraction maintains an acute anorectal angle, preventing involuntary stool passage. Even with internal anal sphincter damage, the puborectalis sling can preserve continence.

Teaching Points:

  • Puborectalis forms a sling at the anorectal junction.
  • Maintains anorectal angle (~80–90°) → continence.
  • Relaxes during defecation → angle straightens.
  • Dysfunction → dyssynergic defecation or fecal incontinence.
  • Key compensatory mechanism when sphincters are weak.

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Ulcerative colitis Surgery in Young female

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Ulcerative Colitis Surgery Choice
#AIIMS 2022 April
Q) Which surgery would be preferred to be done in young unmarried female with steroid refractory Ulcerative colitis and 15 bloody bowel movements per day?
a) TPC with IPAA
b) TPC with EI (end ileostomy)
c) TAC with EI (end ileostomy)
d) TAC with IRA (Ileo rectal anastomosis)
Ans b

The risk of infertility following IPAA was estimated to be approximately 50% compared with 15% among medically treated patients.

Given these data, many surgeons advocate for a three-stage procedure in which subtotal colectomy with end ileostomy is performed and IPAA is deferred until childbearing is completed.
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Colon Diverticulitis

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Q) A  65 year old lady presents with colon diverticulitis. ON CT Scan  She has colonic wall thickening and phlegmon .

Which grade of diverticulitis is it??   # NEET SS 23 MOck tests

a) Grade 0

b) grade I a

c) Grade I b

d) Grade ii