Free Colon Surgery MCQs
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Q1. Risk of Colon Cancer in Adenomatous Polyp is related to all except?
Answer: b) Number of polyps
The risk of cancer is related to the type of polyp, size (>2 cm), and degree of dysplasia.
Teaching Points:
- Size >2 cm increases malignancy risk.
- Villous histology carries higher risk than tubular polyps.
- Dysplasia is the key histological marker for cancer potential.
Take-Home Message: Focus on polyp type, size, and dysplasia rather than number for cancer risk assessment.
Q2. Colon polyps are generally managed endoscopically. Which of the following is not an indication for colon resection surgery?
Answer: d) Lesion in upper 1/3rd of submucosa
Only invasion into the lower 1/3rd of submucosa warrants colectomy.
Teaching Points:
- Endoscopic resection is preferred for most polyps.
- Deep submucosal invasion is the key indication for surgery.
- Lymphovascular invasion and poor differentiation increase risk of residual cancer.
Take-Home Message: Surgical resection is needed only when high-risk histological features or deep invasion are present.
Q3. Which of the following organs are not involved in Familial Adenomatous Polyposis?
Answer: c) Astrocytomas in brain
FAP is associated with medulloblastomas and gliomas, not astrocytomas.
Teaching Points:
- FAP has extracolonic manifestations: thyroid, hepatoblastoma, desmoid tumors.
- CNS tumors linked to FAP are medulloblastomas and gliomas.
Take-Home Message: Not all brain tumors are part of FAP; astrocytomas are usually unrelated.
Q4. What is not true for HNPCC?
Answer: c) It is associated with APC mutation
APC mutation occurs in FAP, not HNPCC.
Teaching Points:
- HNPCC (Lynch syndrome) is due to mismatch repair (MMR) gene mutations.
- It is associated with colon and extraintestinal cancers like endometrial cancer.
Take-Home Message: Lynch syndrome ≠ APC mutation; APC is classic for FAP.
Q5. Which of the following is not fermented by colonic bacteria?
Answer: a) Lignin
Lignin is non-fermentable; pectin is fully fermented, cellulose partially.
Teaching Points:
- Colonic fermentation contributes to short-chain fatty acid production.
- Fiber type affects fermentation and colon health.
Take-Home Message: Not all dietary fibers are fermentable; lignin is resistant.
Q6. True about Ulcerative Colitis with colon cancer?
Answer: c) Is related to duration of ulcerative colitis
Risk increases with duration and extent of colitis.
Teaching Points:
- Long-standing UC increases colorectal cancer risk.
- Extent of colitis correlates with risk.
Take-Home Message: Duration and extent are key risk factors; regular surveillance is important.
Q7. In ulcerative colitis with toxic megacolon, lowest recurrence rate is seen in which surgery?
Answer: a) Complete proctocolectomy and Brooke's ileostomy
Removes almost all diseased mucosa, hence lowest recurrence.
Teaching Points:
- Total proctocolectomy eliminates diseased mucosa.
- Other procedures preserve rectum → higher recurrence risk.
Take-Home Message: Complete resection is definitive in toxic megacolon for UC.
Q8. All are precancerous for colon cancer except:
Answer: d) Carotene
Carotene, Vit C, and Calcium reduce colon cancer risk.
Teaching Points:
- Dietary antioxidants reduce colon cancer risk.
- Bile acids and high-fat diet increase risk.
Take-Home Message: Protective nutrients include carotene, Vit C, and calcium; not all compounds are carcinogenic.
Q9. Regarding colorectal anastomoses, which of the following is true?
Answer: d) None of the above
Leak rates are similar across techniques (Cochrane Review 2012).
Teaching Points:
- No single technique guarantees lower leak rates.
- Proper tissue handling and patient optimization matter more.
Take-Home Message: Technique choice should be based on surgeon preference and patient factors, not assumed superiority.
Q10. In a recently diagnosed case of sigmoid diverticulitis with alternating diarrhea and constipation, management includes?
Answer: d) Fiber supplement and increased fluid intake
Uncomplicated diverticular disease is managed with fiber and fluids.
Teaching Points:
- High-fiber diet reduces recurrence risk.
- Antibiotics reserved for complicated or acute diverticulitis.
Take-Home Message: Lifestyle and dietary management are first-line for uncomplicated diverticular disease.