Colorectal Flashcards
Which of the following watershed areas are prone to ischemic attacks due to incomplete formation of the marginal artery arcades at the splenic flexure
a. Arc of Riolan
b. Griffith’s point
c. Right colon
d. Sudek’s point
b. Griffith’s point
Which of the following segments of the colon is the Marginal Artery of Drummond poorly developed in 50% of the population
a. Ascending colon
b. Hepatic flexure
c. Splenic flexure
d. Rectosigmoid junction
a. Ascending colon
Which of the following venous tributaries contribute to the portal vein outflow?
a. SMV & IMV
b. IVC & Middle colic vein
c. IMV & Splenic vein
d. SMV & splenic vein
d. SMV & splenic vein
pon exploration for obstruction for a descending colon mass, enlarged lymph nodes were noted alongside Left Colic vessels. What is the classification of the lymph node?
a. Epicolic
b. Paracolic
c. Intermediate
d. Main
c. Intermediate
A common complication of diverting Ileostomy is diversion colitis. There is increased mucus production abdominal pain with intermittent low-grade fever. There is a decreased population of anaerobic bacteria, increased NO production and reduced SCFA absorption. Which of the following fatty acids are not being absorbed
a. Propionic and palmitic acid
b. Acetic and Lauritic acid
c. Butyric and Tricosic acid
d. Propionic, Acetic and Butyric acid
d. Propionic, Acetic and Butyric acid
A 43 yo male will undergo total colectomy for familial adenomatous polyposis. If the inferior mesenteric vein IMV requires ligation, where would be the safest area to look for it?
a. Locate for the inferior mesenteric artery as the IMV runs parallel to it
b. The IMV can be ligated at the inferior edge of the pancreas, just below where it joins with the
splenic vein
c. The portal vein is dissected behind the pancreas and the IMV is ligated before it becomes the splenic vein
d. The Arc of Riolan identifies the bifurcation of the IMV and portal vein
b. The IMV can be ligated at the inferior edge of the pancreas, just below where it joins with the
splenic vein
A 65 yo, female complained of sudden onset abdominal pain followed by abdominal distention and vomiting. On examination, vital signs were BP 140/90 mmHg, HR 82, RR 20; abdomen was soft with no guarding Xray of the abdomen revealed segmental ileus CT Scan showed a whirl (whirlpool) sign at the left lower quadrant with vascularity of the involved segment. What would be the appropriate INITIAL management for the patient?
a. Bowel rest, insert NGT and antibiotics
b. Do a hydrostatic or barium pressure reduction
c. Endoscopic detorsion and
observe patient
d. Explore and perform a manual detorsion
c. Endoscopic detorsion and
observe patient
A 68 yo male was admitted for diffuse abdominal tenderness Vital signs were stable and patient underwent exploratory laparotomy with findings of abscess formation at the right & left colic gutters, interloop and pelvic areas. A gangrenous and necrotic diverticulum at the sigmoid area was similarly noted with uninflamed diverticula at the transverse and sigmoid colon. What would be the appropriate surgical management?
a. Apply multiple drains and perform a diverting ileostomy
b. Sigmoid colectomy with end-to-end anastomosis
c. Hartmann’s procedure with
resection of sigmoid
d. Resection of transverse and sigmoid
c. Hartmann’s procedure with
resection of sigmoid
Which of the following has the most common cause of massive lower gastrointestinal bleeding?
a. Diverticulosis
b. Hemorrhoids
c. Bleeding colonic mass
d. Angiodysplasia
a. Diverticulosis
. A 67 year old male was admitted for hematochezia. Vital signs were stable and colonoscopy revealed bleeding throughout the colon but with no identifiable source. What would be the next appropriate step?
a. RBC tagging
b. Mesenteric angiography
c. Endoscopic clippings
d. Total colectomy
b. Mesenteric angiography
Which of the following is the most important prognostic determinant of survival after treatment for colorectal cancer?
a. Serosal extension
b. Tumor size
c. Histologic differentiation
d. Lymph node involvement
d. Lymph node involvement
Which of the following is an acute complication of colostomy creation?
a. Parastomal hernia
b. Mucosal prolapse
c. Colostomy retraction
d. Colostomy necrosis
d. Colostomy necrosis
Which of the following histopathologic result following excision biopsy of a colorectal polyp is a colonic resection NOT indicated?
a. Poor differentiation
b. Margin < 2mm
c. Presence of multiple
hamartomatous polyps
d. Incomplete excision of a villous
adenoma
d. Incomplete excision of a villous
adenoma
In which of the following scenarios should a low anterior resection LAR be performed?
a. A 56yo male with a circumferential villous adenoma
starting at the dentate line and
extending 8cm cephalad
b. 60 yo male with obstructing mass at the dentate line with multiple liver nodules x
c. A 75 yo male with urinary incontinence and a rectal adenocarcinoma 5 cm above the dentate line
d. 80 yo male complaining of tenesmus with a rectal mass involving anal sphincter x
c. A 75 yo male with urinary incontinence and a rectal adenocarcinoma 5 cm above the dentate line
A screening colonoscopy revealed a polyp 5 cm above the dentate line. Biopsy revealed a villous adenoma with mild dysplasia. Endorectal UTZ showed no underlying lymph nodes and muscularis propriaa is not involved. What would be the appropriate subsequent management for this patient?
a. Repeat biopsy
b. Transmural excision
c. Mile’s procedure
d. Radiotherapy
b. Transmural excision
A 56 year old male underwent aortic reconstruction for an abdominal aortic aneurysm. On post operative Day 1, he complained of pain in left lower quadrant with tenderness. What would be the appropriate management for the patient?
a. Patient requires bowel rest and IV antibiotics
b. Perform abdominal xray and look for thumb printing
c. Perform a CT scan to rule out
iatrogenic bowel injury
d. Patient requires laparotomy and probably a Hartmann’s procedure
c. Perform a CT scan to rule out
iatrogenic bowel injury
Familial Adenomatous Polyposis
Mandibular osteomas
HNPCC Syndrome
Synchronous colorectal cancer
Peutz Jeghers Syndrome’s
Oral melanin spots
Cronkhite-Canada syndrome
Alopecia
