Colorectal Surgery Practice Questions

Q: Rectal prolapse occurs due to all EXCEPT:

Fistula-in-Ano. The image displays a prominent **rectal prolapse**, characterized by the eversion of the rectal wall through the anus. This condition can be caused by various factors that increase intra-abdominal pressure or weaken the pelvic floor. ***Fistula-in-Ano*** - A **fistula-in-ano** is an abnormal connection between the anal canal and the perianal skin, typically resulting from an anal abscess. - While it can be associated with inflammatory bowel disease or local infection, it is a **separate pathological entity** that does not cause rectal prolapse. - Fistula-in-ano does not directly increase intra-abdominal pressure or weaken the pelvic floor muscles, and thus is **not a cause of rectal prolapse**. *Whooping cough* - **Whooping cough (pertussis)** leads to severe, paroxysmal coughing fits, which significantly increase **intra-abdominal pressure**. - This sustained increase in pressure, especially in children, can contribute to the development or worsening of **rectal prolapse**. *Obstetric trauma* - **Obstetric trauma**, particularly during childbirth, can cause significant damage to the **pelvic floor muscles** and ligaments. - Weakening of these supporting structures is a major predisposing factor for **rectal prolapse**, especially in multiparous women. *Marasmus* - **Marasmus** is a severe form of protein-energy malnutrition seen in children, characterized by significant weight loss and muscle wasting. - While less direct than other causes, it can contribute to rectal prolapse through chronic malnutrition, diarrhea, and weakened pelvic tissues in pediatric populations.

Q: Which of the following is shown in the image?

Pilonidal sinus. ***Pilonidal sinus*** - The image shows a **pilonidal sinus**, characterized by a small opening (pit) in the **natal cleft**, often with surrounding inflammation, redness, and discharge. - This condition is typically found at the top of the buttocks or near the coccyx, consistent with the image's appearance. - **Pilonidal disease** results from hair follicle obstruction in the natal cleft region, leading to cyst and sinus tract formation. *Fistula-in-Ano* - A fistula-in-ano is an **abnormal tract** connecting the anal canal or rectum to the perianal skin, often presenting as a perianal opening with discharge. - While it involves openings near the anus, its anatomical location is typically **closer to the anal margin**, not in the natal cleft as seen in the image. *Bowen disease* - Bowen disease (squamous cell carcinoma in situ) presents as a **red, scaly patch or plaque** on the skin, often in sun-exposed areas but can occur anywhere. - It is a **precancerous condition**, not typically presenting as a sinus or tract with discharge in the natal cleft region. *Hidradenitis suppurativa* - This chronic inflammatory skin condition primarily affects areas with **apocrine sweat glands** (e.g., axillae, groin, gluteal folds) and presents with painful nodules, abscesses, and sinus tracts. - While it can occur in the gluteal fold, it presents with **multiple recurring lesions and scarring**, unlike the typical single pit appearance of pilonidal sinus in the natal cleft.

Q: A 35-year-old patient with history of significant weight loss and medically refractory constipation underwent a barium enema shown below. In how many % of cases Metastatic liver disease is found?

33 %. ***33 %*** - Approximately **20-25% of colorectal cancer patients present with synchronous liver metastases** at initial diagnosis, and another **15-25% develop metachronous metastases** during follow-up. - The figure of **33% represents a reasonable approximation** of the overall incidence, considering both presentation and subsequent development of liver metastases. - The liver is the **most common site of distant metastasis** in colorectal cancer due to portal venous drainage from the colon directly to the liver. - This makes **33% the most accurate answer** among the given options for the cumulative incidence of metastatic liver disease. *75 %* - This is a **significant overestimation** of the true incidence of liver metastases in colorectal cancer patients. - While the liver is the most common metastatic site, **only 20-25% have liver metastases at presentation**, and the cumulative lifetime incidence reaches approximately 40-50%, not 75%. - This exaggerated figure does not align with current epidemiological data. *10 %* - This is **too low** and underestimates the true burden of liver metastatic disease in colorectal cancer. - Given that approximately one-quarter of patients present with liver metastases at diagnosis alone, 10% significantly underrepresents the actual incidence. *15 %* - This also **underestimates** the true incidence of liver metastases in colorectal cancer patients. - While 15% might represent a specific subset or early-stage disease, it does not reflect the overall cumulative incidence of metastatic liver disease.

Q: An 80-year-old male patient complains of bleeding per rectum with alteration in bowel habits. On physical examination of the abdomen there is mass on the left side. Patient's history is positive for smoking, alcohol and regular nonvegetarian food. Barium enema of the patient is given in the below picture. All of the following statements regarding the diagnosis are true except: (Recent NEET Pattern 2016-17)

High fiber and low animal fat diet is the major risk factor. ***High fiber and low animal fat diet is the major risk factor*** - A **high-fiber diet** is actually **protective** against colorectal cancer. It promotes healthy bowel movements and dilutes carcinogens. - A **low animal fat diet** is also generally considered protective, while a **high intake of red and processed meats** (animal fat) is a known risk factor for colorectal cancer. *Most common age is 8th decade of life* - The incidence of **colorectal cancer** significantly **increases with age**, with the majority of cases diagnosed in individuals **over 50 years old**. - The 8th decade of life (70s) is indeed a common age for diagnosis, fitting the patient's age of 80. *Liver is the most commonly affected organ due to this condition* - **Colorectal cancer** frequently metastasizes via the **portal venous system** to the liver, making the **liver the most common site for distant metastasis**. - This is a well-established pattern of spread for colorectal malignancies. *5-FU is used as chemotherapy in this condition* - **5-fluorouracil (5-FU)** is a foundational chemotherapeutic agent, often used in combination with other drugs, for the treatment of **colorectal cancer**. - It works by interfering with DNA and RNA synthesis, inhibiting cancer cell growth.

Q: All of the following statements regarding this image are true except:

High fiber diet will reduce the incidence of this defect. **_High fiber diet will reduce the incidence of this defect_** - This statement is **false**. High fiber intake is generally recommended for preventing diverticular disease and not for their treatment in this case. - While fiber can reduce the incidence of diverticulosis, it does not apply to the *defect itself*, which refers to existing diverticula. *Defect occurs usually between tenia coli and the blood vessel entering colonic wall* - This statement is **true**. Diverticula commonly arise at points where **colonic blood vessels** penetrate the muscular layers, creating weak spots. - These areas are anatomically predisposed to herniation due to the passage of **vasa recta** through the muscularis propria. *They are a result of tractional force* - This statement is **true**. Diverticula are generally classified as **false diverticula** (pseudodiverticula) because they are formed by the herniation of mucosa and submucosa through defects in the muscularis. - This herniation is primarily caused by **increased intraluminal pressure** working against the weakened colonic wall, rather than external traction. *Most common site for this defect is sigmoid colon* - This statement is **true**. The **sigmoid colon** is the most common site for diverticular disease due to its narrow lumen and higher intraluminal pressure. - This region experiences the greatest stress during fecal transit, predisposing it to the formation of these outpouchings.

Q: A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :

Colovesical fistula. ***Colovesical fistula*** - The presence of **pneumaturia (gas/bubbles in urine)** and **frothy urine** is pathognomonic of colovesical fistula, indicating abnormal communication between the colon and bladder with gas passage from bowel to bladder. - **Recurrent UTIs** occur in >50% of cases due to constant contamination of the bladder with fecal bacteria. - Other features include **fecaluria** (fecal matter in urine) - though less common than pneumaturia. - Most commonly caused by diverticular disease (65%), followed by colorectal cancer and Crohn's disease. *Tubercular cystitis* - While it can cause recurrent UTIs and bladder irritation, it does not typically present with **pneumaturia** or frothy urine. - Presents with sterile pyuria, dysuria, hematuria, and frequency. - Diagnosis requires identification of *Mycobacterium tuberculosis* in urine culture or bladder biopsy. *Urethrocutaneous fistula* - This involves an abnormal communication between the urethra and the skin, leading to urine leakage onto the skin surface. - Does not cause gas to enter the bladder or result in **pneumaturia**. - May cause recurrent UTIs if fistula leads to inadequate bladder emptying, but not the presenting features. *Anaerobic bacterial infection* - Although anaerobic bacteria can cause UTIs, they do not produce sufficient gas to cause **pneumaturia** without an underlying anatomical defect. - **Pneumaturia** is a mechanical sign indicating an abnormal connection with a gas-containing organ (colon), not merely infection.

Q: Which of the following statements with regard to Colorectal Carcinoma are correct ? 1. Left-sided Colorectal Carcinoma presents with bleeding per rectum. 2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia. 3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma. 4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 4*** - **Left-sided colorectal carcinoma** often presents with **bleeding per rectum** due to its proximity to the anus [1]. - **Right-sided colorectal carcinoma** is more likely to cause insidious blood loss, leading to **iron deficiency anemia** [1]. - **Colonoscopy** is considered the **gold standard** for diagnosing colorectal carcinoma due to its ability to visualize the entire colon and allow for biopsy [1]. *2, 3 and 4* - While statements 2 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more common** than right-sided colorectal carcinoma [1]. - Right-sided lesions more generally cause anemia, and colonoscopy is the appropriate investigation of choice [1]. *1, 2 and 3* - Statements 1 and 2 are correct. However, statement 3 is incorrect; **left-sided colorectal carcinoma has a higher incidence** compared to right-sided colorectal carcinoma [1]. - Bleeding per rectum is characteristic of left-sided lesions while iron deficiency anemia for right-sided lesions [1]. *1, 3 and 4* - While statements 1 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more prevalent** than right-sided colorectal carcinoma [1]. - Clinical presentation with bleeding per rectum is typical for left-sided cancers, and colonoscopy is the definitive diagnostic tool [1].

Question 1

Rectal prolapse occurs due to all EXCEPT:

Accepted Answer

Fistula-in-Ano

Answer

Whooping cough

Answer

Marasmus

Answer

Obstetric trauma

Question 2

Which of the following is shown in the image?

Accepted Answer

Pilonidal sinus

Answer

Fistula-in-Ano

Answer

Bowen disease

Answer

Hidradenitis suppurativa

Question 3

A 35-year-old patient with history of significant weight loss and medically refractory constipation underwent a barium enema shown below. In how many % of cases Metastatic liver disease is found?

Accepted Answer

33 %

Answer

10 %

Answer

15 %

Answer

75 %

Question 4

An 80-year-old male patient complains of bleeding per rectum with alteration in bowel habits. On physical examination of the abdomen there is mass on the left side. Patient's history is positive for smoking, alcohol and regular nonvegetarian food. Barium enema of the patient is given in the below picture. All of the following statements regarding the diagnosis are true except: (Recent NEET Pattern 2016-17)

Accepted Answer

High fiber and low animal fat diet is the major risk factor

Answer

Most common age is 8th decade of life

Answer

Liver is the most commonly affected organ due to this condition

Answer

5-FU is used as chemotherapy in this condition

Question 5

A patient presents with abdominal distension, obstipation and vomiting. The patient reports a long history of intermittent obstructive symptoms and distension. On radiological examination this is the presentation of the patient. Which of the following statement regarding his condition would be false?

Accepted Answer

Urgent sigmoid colectomy and anastomosis if fecal peritonitis present

Answer

Coffee bean appearance is seen on X-ray

Answer

Risk of reoccurrence is up to $40 \%$

Answer

Endoscopic detorsion is used as initial treatment

Question 6

All of the following statements regarding this image are true except:

Accepted Answer

High fiber diet will reduce the incidence of this defect

Answer

Defect occurs usually between tenia coli and the blood vessel entering colonic wall

Answer

They are a result of tractional force

Answer

Most common site for this defect is sigmoid colon

Question 7

A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is :

Accepted Answer

Colovesical fistula

Answer

Tubercular cystitis

Answer

Urethrocutaneous fistula

Answer

Anaerobic bacterial infection

Question 8

Which of the following statements with regard to Colorectal Carcinoma are correct ?

1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.
2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.
3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.
4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 9

Which one of the following statements is true regarding "injection sclerotherapy" for haemorrhoids ?

Accepted Answer

Injection of sclerosant is made above the dentate line (pectinate line)

Answer

Sclerotherapy is the treatment of choice for the prolapsed haemorrhoids

Answer

In patients with haemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock positions, the injection is made in the sitting position

Answer

Sclerotherapy is the ideal treatment for acute external haemorrhoids

Question 10

In a 65 year old, double contrast barium enema shows cancer of colon with an apple core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next step of management?

Accepted Answer

CECT to stage disease

Answer

Surgery

Answer

Radiotherapy

Answer

Chemotherapy

Colorectal Surgery — MCQs

Colorectal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?