Management of various Hereditary Syndromes

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Q) Total Proctocolectomy is required for which of the following ? ( MCH GI Surgery Question- Click here for all) 

a) Cowden

b) HNPCC

c) Gardner

d) PJS  

Snippet -- HNPCC- Lynch syndrome patients develop colorectal and extracolonic cancers at a young age. It accounts for approximately 3% of all CRCs, and 10% to 19% of CRCs diagnosed before age 50. Read on..........

Cowden

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Q) Not seen in cowden syndrome
A. NET
B. Hamartoma
C. CA breast
D. Bowel malignancy

Malignancy risk in CS is significant outside the GI tract. Women have a 50% lifetime risk of developing breast cancer ...............

Read on ..............

Colon Lymphoma

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Q) A 55-year-old male patient presents with chronic abdominal pain, weight loss, and intermittent diarrhea. Colonoscopy reveals a mass in the cecum, and biopsy confirms colonic lymphoma. Which of the following statements is most likely true regarding this condition?

A) Colonic lymphoma is predominantly of T-cell origin
B) It is more common in females
C) The cecum is the most common site of involvement
D) It typically presents in the 3rd and 4th decades of life

C) The cecum is the most common site of involvement

Explanation:

Colonic lymphoma is a rare form of lymphoma that primarily affects the gastrointestinal tract. Among the options provided:

  • A) Colonic lymphoma is predominantly of T-cell origin: This is incorrect. Colonic lymphoma is most commonly of B-cell origin, particularly extranodal marginal zone lymphoma (MALT lymphoma), rather than T-cell lymphoma.
  • B) It is more common in females: This is also incorrect. Colonic lymphoma does not have a strong gender predilection. The incidence is more balanced between males and females.
  • C) The cecum is the most common site of involvement: This is correct. The cecum is the most frequent site of involvement in colonic lymphoma, especially for extranodal B-cell lymphoma, such as MALT lymphoma. It tends to present as a mass-like lesion, often causing symptoms such as abdominal pain and weight loss.
  • D) It typically presents in the 3rd and 4th decades of life: This is incorrect. Colonic lymphoma is more commonly diagnosed in older adults, typically over the age of 50. It is relatively rare in younger individuals.

Crohn Disease of Duodenum

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Q) In Crohns  disease of duodenum , patient has a duodenal abscess which is  drained. He develops a fistula with  ileal communication. Surgery with the least chance of success would be

a. Ileal reaction and duodenal bypass

b. Ileal resection an dudodenal HMplasty
c. Ileal freshen and closure
d. Duodenum vertical closure

Pressure Sores

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Q) Frequency of order of pressure sores (Click for more general Surgery MCQs) 

A. Heel>occiput>malleolus>greater trochanter

B. Ischium>sacrum>greater trochanter>heel

C. Malleolus>ischium>greater trochanter>occipital

D. Ischium>greater trochanter>sacrum>heel

ANS:  D

This is a very simple question which is often answered incorrectly.

Pressure sore frequency in descending order

1. Ischium
2. Greater trochanter
3. Sacrum
4. Heel
5. Malleolus (lateral>medial)
6. Occiput

Bailey summary box 3.5 page 29