LARGE INTESTINE

Question 1

Colon CA: stage I

Answer 1

T1-2, N0, MX

Question 2

Colon CA: Stage IIA

Answer 2

T3, N0, Mx

Question 3

Colon CA: Stage IIB

Answer 3

T4, N0, Mx

Question 4

Colon CA: Stage IIIA

Answer 4

any T, N1, Mx

Question 5

Colon CA: Stage IIIB

Answer 5

any T, N2, Mx

Question 6

Colon CA: N1a

Answer 6

Mets in 1 LN

Question 7

Colon CA: N1b

Answer 7

Mets in 2-3 regional LN

Question 8

UC vs CD: Distribution of disease is continuous

Answer 8

UC

Question 9

Pseudopolyps: more common in UC or CD?

Answer 9

UC

Question 10

Deep longitudinal ulcers: UC or CD?

Answer 10

CD

Question 11

Apthous ulcers: UC or CD?

Answer 11

CD

Question 12

Increased friability of mucosa: UC or CD?

Answer 12

CD

Question 13

Rectal involvement: UC or CD?

Answer 13

UC

Question 14

Loss of normal vascular pattern: UC or CD?

Answer 14

UC

Question 15

Superficial fissures: UC or CD?

Answer 15

UC

Question 16

Main blood supply to transverse colon after extended right hemi?

Answer 16

Marginal a of drummond

Question 17

Colon CA: N1c

Answer 17

tumor deposits in subserosa, mesentery, pericolic or perirectal

Question 18

Colon CA: N2a

Answer 18

4-6 regional LN positive

Question 19

Colon CA: N2b

Answer 19

7+ regional LN positive

Question 20

Colon CA: T1

Answer 20

invadse submucosa (through muscularis mucosa)

Question 21

Colon CA: T2

Answer 21

invades muscular is propria

Question 22

Colon CA: T3

Answer 22

tumor invades muscularis oropria into pericolorectal tissues

Question 23

Colon CA: T4a

Answer 23

tumor invades visceral peritoneum

Question 24

Colon CA: T4b

Answer 24

tumor invades or adheres to adjacent organs or structures

Question 25

Colon CA: Stage IIIC

Answer 25

T3-4b, N1-2b

Question 26

Most sensitive test for GI bleed

Answer 26

Tagged RBC scan - can detect as slow as 0.1 mL/min and requires pt to be actively bleeding

Question 27

Peutz Jeuger syndrome mutation

Answer 27

STK11 gene

Question 28

High risk features of stage II colon CA to consider adjuvant chemo

Answer 28

<12 LN resected Poorly differentiated (except MSI-H) Lymphovascular or perineural invasion Positive margins Localized perforation Bowel obstruction

Question 29

Haggitt Level 1 polyp

Answer 29

Submucosal invasion limited to the head of the pedunculated polyp

Question 30

Haggitt Level 2 polyp

Answer 30

Submucosal invasion of the neck of the pedunculated polyp

Question 31

Haggitt Level 3 polyp

Answer 31

Submucosal invasion anywhere in the stalk of the pedunculated polyp

Question 32

Haggitt level 4 polyp

Answer 32

Submucosal invasion beyond stalk but superficial to muscularis mucosa

Question 33

What haggitt level polyp is a sessile polyp?

Answer 33

Level 4

Question 34

MC anaerobe isolated in perf appendicitis

Answer 34

Bacteroides

Question 35

MC aerobe isolated in perf appendicitis

Answer 35

E coli

Question 36

Describe enterococcus bacteria - anaerobic or aerobic? gram + or -?

Answer 36

gram - anaerobe (facultative)

Question 37

RF for recurrence/poor prognostic indicators in anal SCC

Answer 37

Tumor size >5 cm >2/3 anal circumference ALso: male sex, nodal dz, Hgb<13

Question 38

CT angio can detect bleeding rates of

Answer 38

0.3 mL/min

Question 39

Selective mesenteric angiography

Answer 39

>0.5 mL/min Diagnostic and therapeutic

Question 40

Tagged RBC scan can detect bleeding rates of

Answer 40

0.1 mL/min

Question 41

Best predictor of local recurrence of rectal cancer

Answer 41

Initial T stage

Question 42

Amsterdam Criteria

Answer 42

1. At least one colon or HNPCC-related cancer diagnosis prior to age 50 2+ generations affected 3+ relatives have colorectal or HNPCC related cancers. Of them one relative is a first degree relative of other two FAP has to be excluded

Question 43

Risk of colorectal CA by 75 yo in Lynch syndrome

Answer 43

As high as 75%

Question 44

Lifetime risk of uterine cancers in Lynch syndrome

Answer 44

40%

Question 45

Gene mutation in Peutz Jeghers

Answer 45

STK11

Question 46

MUTYH-associated polyposis

Answer 46

at least 10+ synchronous colonic adenomas primarily right sided, AR pattern of inheritance, no genetic mutation in APC gene. Increased risk of CA in duodenum, ovaries, bladder, thyroid, skin.

Question 47

Muir-Torre syndrome

Answer 47

Presence of sebaceous gland tumors (adenoma, CA, and keratoacanthoma) and a visceral CA, most commonly colorectal CA. It is autosomal dominant. The sebaceous gland tumors present as yellow papules usually on face or neck

Question 48

Turcot syndrome

Answer 48

Malignant CNS tumors, GI polyposis, colorectal cancer

Question 49

Gardner syndrome

Answer 49

subctagory of FAP, colonic polyposis, desmoid tumors ,osteomas of mandible or skull, and cutaneous lesions (epidermal cysts and lipomas)

Question 50

Juvenile polyposis

Answer 50

juvenile polyps with other congenital abnormalities like cerebral and pulmonary, cardiac and cranial malformations. Lifetime risk for CRC between 10-50%

Question 51

Cowden syndrome

Answer 51

macrocephaly, trichelemmomas, and/or tumors of thyroid, breast, uterus and skin. Colonic polyps vary and include hamartomas, lipomas, fibromas, neurofibromas, and adenomas.

Question 52

PRognostic factors in GISTS

Answer 52

High mitotic index (>5 per 50 HPF) Other: tumor >5 cm, presence of necrosis, presnce of atypia, location in small bowel

Question 53

Transanal excision criteria for rectal tumors

Answer 53

<3 cm in size <30% circumference of bowel Within 8 cm of anal verge T1 only Mobile, nonficed tumors Well to moderately differentiated No lymphovascular or neural invasion No evidence of lymphadenopathy on imaging Margin clear >3 mm

Question 54

Which symptoms often resolve with medical or surgical tx of Crohns

Answer 54

Peripheral arthritis Aphthous ulcers Episcleritis Erythema nodosum

Question 55

Which prognostic variable predicts metastasis in carcinoid tumors

Answer 55

Tumor size <1 cm in diameter mets in <5% If >2 cm most will have mets at time of dx

Question 56

Suture where in THD

Answer 56

proximal to dentate line to avoid v sensitive anoderm