Answer: d) Rectum

Rectum is the most common site of malignancy in all colorectal tumors. Other sites: Sigmoid 21%, Caecum 12%, Hepatic flexure 2%, Anal canal 2%.

Teaching Points:

• Rectal cancer is a common lower GI malignancy.
• Rectal pain is usually a late feature.
• Understand site frequency for diagnosis and screening.

Take-Home Message: Rectum is the predominant site in colorectal cancer; screening should focus accordingly.

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Answer: a) Bowel preparation is not required

Bowel prep is required before DCBE. Patient is rolled to coat barium on mucosa. DCBE is inferior to colonoscopy for small adenomas.

Teaching Points:

• Bowel prep is essential.
• DCBE requires positional movement for optimal imaging.
• Colonoscopy remains gold standard for polyp detection.

Take-Home Message: Proper bowel prep and colonoscopy provide superior diagnostic yield.

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Answer: c) Subfascial

Lipoma of retroperitoneum and mediastinum most commonly undergo malignant change.

Teaching Points:

• Subfascial lipomas have higher risk for malignancy.
• Other lipoma sites rarely transform.

Take-Home Message: Malignant degeneration risk depends on location; monitor retroperitoneal lipomas closely.

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Answer: c) Constipation can be a significant side effect

Ripstein repair places mesh anterior to rectum, requires extensive mobilization. Recurrence 2-5%. Side effects: mesh erosion, obstruction, constipation, ureteral fibrosis.

Teaching Points:

• Mesh placement is anterior, not posterior.
• Constipation is a known postoperative complication.
• Recurrence is lower than older estimates.

Take-Home Message: Monitor bowel function post-Ripstein repair.

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Answer: b) Poorly differentiated carcinoma

APR is indicated if carcinoma is poorly differentiated, sphincters cannot be preserved, or no continence.

Teaching Points:

• Poorly differentiated tumors require APR.
• Anterior resection is not suitable in these cases.

Take-Home Message: Tumor differentiation guides choice of rectal surgery.

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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: Regular surveillance is crucial.

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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.

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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.

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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.

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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.

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