LARGE INTESTINE Multiple Choice Questions and Answers pdf :-
1. Which answers are true? In contrast to ulcerative colitis, Crohn’s disease of the colon:
A. Is not associated with increased risk of colon cancer.
B. Seldom presents with daily hematochezia.
C. Is usually segmental rather than continuous.
D. Has a lower incidence of perianal fistulas.
E. Never develops toxic megacolon.
2. Which answers are true? Options to consider when operating for Crohn’s disease of the large intestine include:
A. Colectomy and ileorectostomy.
B. Colectomy, closure of the rectal stump, and ileostomy.
C. Colectomy and continent ileostomy (Kock pouch).
D. Proctocolectomy and ileostomy.
E. Proctocolectomy and ileal pouch–anal canal anastomosis.
3. Crohn’s disease:
A. Is caused by Mycobacterium paratuberculosis.
B. Is more common in Asians than in Jews.
C. Tends to occur in families.
D. Is less frequent in temperate climates than in tropical ones.
E. Is improved by smoking.
4. Recurrence after operation for Crohn’s disease:
A. Occurs after operations for ileal Crohn’s but not colonic Crohn’s.
B. Is usually found just proximal to an enteric anastomosis.
C. Rarely requires reoperation.
D. Occurs in 1% of patients at risk per year during the first 10 years after the operation.
E. Is prevented by maintenance therapy with corticosteroids.
5. Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn’s because:
A. Excision is safer.
B. Bypass does not relieve symptoms.
C. Excision cures the patient of Crohn’s disease but bypass does not.
D. Fewer early complications appear with excision.
E. The risk of small intestine cancer is reduced.
6. Which statements about anorectal Crohn’s disease are true?
A. It may be the only overt manifestation of Crohn’s disease.
B. It accompanies large intestine Crohn’s more often than small-intestine Crohn’s.
C. It subsides when associated small intestinal Crohn’s is excised.
D. It should not be treated operatively.
E. It may subside in response to metronidazole, 250 mg. q.i.d.
7. The most common indication for operation in Crohn’s disease of the colon is:
B. Chronic debility.
8. Which of the following statements about surgical anatomy of the colon and rectum is/are correct?
A. The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.).
B. The rectosigmoid junction is situated at approximately 15 to 18 cm. from the anus.
C. The rectum is entirely an intraperitoneal organ.
D. The ileocolic, right colic, and middle colic arteries are branches from the inferior mesenteric artery.
E. The arterial arcade created by communicating vessels at 1 to 2 cm. from the mesenteric is called the artery of Drummond.
9. Which of the following statements about surgical procedures on the colon and rectum is/are correct?
A. Successful healing of colonic anastomoses depends on the adequacy of the blood supply.
B. In excising part of the colon containing cancer, the lymphatics should be avoided by dividing the mesentery close to the wall of the colon.
C. Despite complete removal of the colon and rectum, transanal fecal flow can be preserved by means of an ileal pouch–anal anastomosis.
D. When a colostomy is created it cannot be reversed.
E. Colostomy can be life saving in patients with colonic perforation or obstruction.
10. Which of the following statements about colon physiology is/are correct?
A. Colonic recycling of urea is accomplished by the splitting of urea by bacterial ureases.
B. Fermentation by colonic bacteria may rescue malabsorbed carbohydrates.
C. The preferred fuel of the colonic epithelium is glucose.
D. Absorption by the colonic mucosa is a passive process.
E. Insoluble fibers create bulk in the stool.
11. Which of the following statements about colonic motility is/are true?
A. Mass contractions involve only the rectum.
B. “Antiperistaltic” contractions occur in the descending colon.
C. The rectum can accommodate stool by receptive relaxation.
D. Stool in the colon is propelled by tonic contractions.
E. Defecation involves both sensory and motor pathways.
12. Which of the following statements about diagnostic studies for the colon and rectum is/are true?
A. Acetylcholinesterase staining of rectal biopsies is unreliable for the diagnosis of Hirschsprung’s disease.
B. Cinedefecography is useful for detecting “hidden” prolapse or rectal intussusception.
C. A negative osmotic gap in stool is indicative of secretory diarrhea.
D. A colonic transit time study involves serial abdominal x-rays after ingestion of radiopaque markers.
E. Carcinoembryonic antigen (CEA) is useful for monitoring patients after resection for colon cancer.
13. Which of the following statements about anorectal functional testing is/are true?
A. Anorectal manometry is often performed through open-tipped multilumen catheters perfused with fluid.
B. Anorectal manometry can differentiate between segmental and global defects of the anal sphincter in patients with incontinence.
C. Electromyography can demonstrate persistent contraction of the pubis rectalis muscle during defecation, which is diagnostic of paradoxical pelvic floor contraction.
D. Measurement of sensory thresholds may reveal insensitivity in patients with chronic constipation.
14. Which of the following statements about the microbiology of the colon is/are true?
A. The colon contains no more bacteria than the stomach.
B. The predominant bacteria in the colon are aerobic.
C. Nearly one third of the dry weight of feces is bacteria.
D. Common bacteria in the colon are Bacteroides, Bifidobacterium, and Enterobacterium species.
E. The colonic microflora is relatively stable.
15. Which of the following statements about bowel preparation for colon surgery is/are true?
A. Bowel preparation is accomplished by a combination of mechanical cleansing and nonabsorbable antibiotics.
B. Three days of clear liquids provides sufficient mechanical cleansing.
C. Commercial electrolyte-polyethylene glycol solutions provide mechanical cleansing without inducing electrolyte imbalance.
D. Nonabsorbable antibiotics such as neomycin and erythromycin base are administered the day before the operation in three doses.
E. Intravenous antibiotics are also administered the day before surgery.
16. Which of the following patients generally does not require surgical intervention as a consequence of acute diverticulitis?
A. A 35-year-old man with no history of diverticulitis.
B. A 68-year-old man status 2 weeks post–renal transplantation.
C. A 55-year-old woman with hypertension and diabetes mellitus.
D. A 50-year-old man with pneumaturia.
E. A 46-year-old man with right-sided diverticulitis.
17. The test with the highest diagnostic yield for detecting a colovesical fistula is:
A. Barium enema.
C. Computed tomography (CT).
18. Which of the following is not true of diverticular disease:
A. It is more common in the United States and Western Europe than in Asia and Africa.
B. A low-fiber diet may predispose to development of diverticulosis.
C. It involves sigmoid colon in more than 90% of patients.
D. Sixty per cent develop diverticulitis sometime during their lifetime.
E. It is the most common cause of massive lower gastrointestinal hemorrhage.
19. The most common indication for surgery secondary to acute diverticulitis is:
B. Colonic obstruction.
C. Colovesical fistula.
D. Free perforation.
20. Which of the following is/are true about colorectal polyps?
A. Familial juvenile polyposis is associated with an increased incidence of colon cancer.
B. Although the propensity for development of malignancy is related to the size of a neoplastic polyp, those with mixed tubulovillous histologic appearance are most likely to develop malignant changes.
C. The loss of a single tumor suppressor gene such as p53 is sufficient to lead to the development of malignancy in colorectal neoplastic polyps.
D. Endoscopic polypectomy results in a decreased incidence of carcinomas of the colon and rectum.
21. Which of the following statements about familial adenomatous polyposis (FAP) is/are true?
A. Inherited in an autosomal-dominant manner, this genetic defect is of variable penetrance, some patients having only a few polyps whereas others develop thousands.
B. The phenotypic expression of the disease depends mostly on the genotype.
C. Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy.
D. Panproctocolectomy with ileostomy is not appropriate therapy for this disease.
E. Pharmacologic management of this disease may be appropriate in some instances.
22. Which of the following statements about the etiology of chronic ulcerative colitis are true?
A. Ulcerative colitis is 50% less frequent in nonwhite than in white populations.
B. Psychosomatic factors play a major causative role in the development of ulcerative colitis.
C. Cytokines are integrally involved in the pathogenesis of ulcerative colitis.
D. Ulcerative colitis has been identified with a greater frequency in family members of patients with confirmed inflammatory bowel disease.
E. Ulcerative colitis is two to four times more common in Jewish than in non-Jewish populations.
23. Surgical alternatives for the treatment of ulcerative colitis include all of the following except:
A. Colectomy with ileal pouch–anal anastomosis.
B. Left colectomy with colorectal anastomosis.
C. Proctocolectomy with Brooke ileostomy or continent ileostomy.
D. Subtotal colectomy with ileostomy and Hartmann closure of the rectum.
24. The initial management of toxic ulcerative colitis should include:
A. Broad-spectrum antibiotics.
C. Intravenous fluid and electrolyte resuscitation.
D. Opioid antidiarrheals.
E. Colonoscopic decompression.
25. Which finding(s) suggest(s) the diagnosis of chronic ulcerative colitis as opposed to Crohn’s colitis?
A. Endoscopic evidence of backwash ileitis.
B. Granulomas on biopsy.
C. Anal fistula.
D. Rectal sparing.
E. Cobblestone appearance on barium enema.
26. An 80-year-old man who has been bedridden for many years following a stroke presents with acute onset of abdominal distention, obstipation, and colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel and a dilated sigmoid colon resembling a bent inner tube. Examination reveals distention with mild direct tenderness but no rigidity or rebound tenderness. Initial management should consist of:
A. Barium enema examination.
B. Laparotomy with resection of descending colon and descending colostomy.
C. Multiple cleansing enemas to remove impacted feces.
D. Rigid sigmoidoscopy and decompression of the sigmoid colon.
27. Axial twisting of the right colon or cecal volvulus has been shown to be associated with each of the following except:
A. A history of abdominal operation.
B. A mobile cecum.
C. An obstructing lesion in the transverse or left colon.
D. Inflammatory bowel disease.
28. Sigmoid volvulus has been associated with each of the following except:
A. Chronic constipation and laxative abuse.
B. Chronic rectal proplapse.
C. Chronic traumatic paralysis.
D. Medical management of Parkinson’s disease.
29. Which of the following statements is not true about inhereted susceptibility to colon cancer?
A. There is no known genetic susceptibility to colon cancer.
B. There are known genetic susceptibilities to colon cancer, but they are always associated with multiple adenomatous polyps.
C. There are known genetic susceptibilities to colon cancer, but they are always associated with specific ethnic or racial groups.
D. None of the above.
30. Which of the following recommendations for adjuvant chemotherapy of colorectal carcinoma are true?
A. Patients with Stage I or Dukes A and B1 disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU.
B. Patients with Stage III or Dukes C disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU.
C. There is no role for adjuvant therapy for colon cancer at any stage.
D. Adjuvant chemotherapy is active in colon cancer only when combined with radiotherapy.
31. Optimal front-line treatment of squamous cell carcinoma of the rectum includes:
A. Abdominal perineal resection.
B. Low anterior resection when technically feasible.
C. Radiation therapy.
E. Combined radiation and chemotherapy.
32. Which of the following statement(s) is/are true about the maintenance of continence?
A. It depends on both the internal and external sphincters as well as the puborectalis.
B. Resting pressure offers a high-pressure zone that increases resistance to the passage of stools.
C. Maximal squeeze pressure can last no more than 1 minute.
33. Which of the following statement(s) about complete rectal prolapse, or procidentia is/are true?
A. Rectal prolapse results from intussusception of the rectum and rectosigmoid.
B. The disorder is more common in men than in women.
C. Continence nearly always is recovered after correction of the prolapse.
D. All of the above are true.
34. Which of the following statements about hemorrhoids is/are not true?
A. Hemorrhoids are specialized “cushions” present in everyone that aid continence.
B. External hemorrhoids are covered by skin whereas internal hemorrhoids are covered by mucosa.
C. Pain is often associated with uncomplicated hemorrhoids.
D. Hemorrhoidectomy is reserved for third- and fourth-degree hemorrhoids.
35. The widely accepted treatment of most localized epidermoid, cloacogenic, or transitional cell carcinoma of the anal canal is:
A. Surgical resection.
B. Chemotherapy alone.
C. Radiotherapy alone.
D. Combined chemoradiation.
36. Which statement(s) is/are true about hidradenitis suppurativa?
A. It is a disease of the apocrine sweat glands.
B. It causes multiple perianal and perineal sinuses that drain watery pus.
C. The sinuses do not communicate with the dentate line.
D. The treatment is surgical.
E. All of the above.
37. Which of the following statements regarding the vasculature of the colon and rectum is/are correct?
a. The middle colic artery is a branch of the superior mesenteric artery
b. The inferior mesenteric artery supplies the descending and sigmoid segments of the colon
c. An complete anastomotic arcade paralleling the colon wall is present in only 15 to 205 of individuals
d. The middle colic artery is a branch of the inferior mesenteric artery
Answer: a, b, c
38. Which of the following agents have been proposed as sensory neurotransmitters for the colon?
b. Substance P
c. Calcitonin gene-related peptide
Answer: b, c
39. How much of the daily insensible water loss is due to loss in stool?
a. 200 ml
b. 400 ml
c. 600 ml
d. 800 ml
e. 1000 ml
40. A 52-year-old woman is involved in an automobile accident and sustains an open fracture of the fight femur, compression fractures of the 10th and 11th thoracic vertebrae and right pulmonary contusion. On the fourth day after injury, her abdomen is noted to be distended, tympanitic and diffusely tender. Abdominal radiographs reveal gaseous distension of the ascending and transverse segments of the colon. The cecum is 13 cm in greatest diameter. Appropriate management includes which of the following as the next step?
a. Right hemicolectomy
b. Operative cecostomy
d. Contrast enema
LARGE INTESTINE Interview Questions and Answers ::
41. Which of the following features is/are consistent with a diagnosis of colonic inertia?
a. Alternating episodes of severe constipation and normal bowel activity
b. Total bowel transit time of 24 hours
c. Total bowel transit time of 48 hours
d. Total bowel transit time of 96 hours
e. Marfinoid habitus
42. Which of the following statements regarding the myenteric plexus of the colon is/are correct?
a. The myenteric plexus is located between the longitudinal and circular layers of the bowel wall
b. The myenteric plexus contains only sensory neurons
c. The density of neurons with the colonic plexuses decreases along the length of the bowel
d. Neurons of the myenteric plexus control the motor function of the colon
Answer: a, c, d
43. Which of the following ocular manifestations of ulcerative colitis respond to therapy with steroids or immunosuppressive agents?
c. Retrobulbar neuritis
d. Ulcerative panophthalmitis
Answer: a, b, c
44. Which of the following statements regarding the risk of cancer in the context of ulcerative colitis is/are correct?
a. After 10 years of active disease, the risk of cancer approximates 20% to 30%
b. After 10 years of active disease, the risk of cancer approximates 2% to 3%
c. The risk of colon cancer in ulcerative colitis is identical to controls
d. After 20 years of disease activity, the risk of colon cancer approximates 80%
45. Which of the following features would be more consistent with Crohn’s disease than with ulcerative colitis?
a. Transmural inflammation
b. Microscopic evidence of granulomas within mucosal biopsies
c. Microscopic evidence of submucosal thickening and fibrosis
d. Microscopic evidence of submucosal inflammation
Answer: a, b, c, d
46. A 19-year-old male is seen in consultation with complaints of bloody diarrhea (10 bowel movements per day), and weight loss (10 pounds). Physical examination reveals the presence of two circular, 4 cm erythematous lesions on the trunk. Each lesion has an area of necrosis in the center. The abdominal examination reveals mild hypogastric tenderness. The stool is guaiac positive. The most appropriate next diagnostic step includes which of the following?
a. Barium enema
b. Flexible sigmoidoscopy
c. Liver biopsy
d. Chest x-ray
47. Which of the following statement(s) regarding ulcerative colitis is/are correct?
a. The most common age of onset for ulcerative colitis is in early adulthood
b. Approximately 25% of cases of ulcerative colitis occur after the age of 60
c. Males are affected approximately twice as frequently as females
d. Approximately 10% to 25% of patients with ulcerative colitis have first degree relatives with the disease
Answer: a, d
48. Many patients with ulcerative colitis are operated upon electively with total abdominal colectomy, rectal mucosectomy, formation of a small intestinal reservoir, and ileoanal anastomosis. The most common postoperative complication after this operation is which of the following?
a. Enterocutaneous fistula
b. Small bowel obstruction
c. Pulmonary embolism
d. Urinary retention
49. A 25-year-old woman with known ulcerative colitis presents to the emergency room with a 24-hour history of abdominal pain, distention, and obstipation. Physical examination reveals a temperature of 38.6° C, abdominal distention, and diffuse abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most pronounced in the transverse colon. Laboratory examination reveals a white blood count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and intravenous antibiotics. The most appropriate management for this patient would include which of the following?
a. Decompressive colonoscopy
b. Proctocolectomy with formation of end ileostomy
c. Total abdominal colectomy with formation of Hartmann pouch and end ileostomy
50. The most common postoperative complication after formation of a continent ileostomy (Kock pouch) is which of the following?
a. Nipple valve failure
b. Small bowel obstruction
d. Ischemic necrosis of the pouch
51. One year following ileal pouch-anal anastomosis, the mean 24-hour stool frequency is which of the following?
a. Two to three
b. Five to six
c. Eight to nine
d. Eleven to twelve
52. A 30-year-old male two years postoperative after total abdominal colectomy with ileoanal anastomosis reports a sudden increase in stool frequency, nocturnal leakage, and low-grade fevers. Physical examination is unremarkable. Flexible endoscopic examination of the small intestinal pouch reveals a friable erythematous mucosa. Biopsies of the mucosa are obtained. While awaiting biopsy results, which of the following is the most appropriate empiric therapy?
a. Oral corticosteroids
b. Oral vancomycin
c. Oral metronidazole
d. Corticosteroid enema
53. A 72-year-old man returns to the hospital 2 weeks following right hip arthroplasty with complaints of 48 hours of mucoid diarrhea, fever, and crampy abdominal pain. Physical examination reveals dehydration, diffuse abdominal tenderness, and a temperature of 102°F. Outpatient medications have included digoxin, propranolol, and cephalothin. If antibiotic-associated colitis is suspected, which of the following is/are appropriate diagnostic tests?
a. Fecal leukocyte smear
b. Stool culture for C difficile
c. Measurement of C difficile toxin in stool
d. Barium enema
e. Computed topography of abdomen
Answer: a, b, c
54. For the patient in the preceding question, after obtaining diagnostic samples, the most appropriate management would include which of the following?
a. Oral metronidazole
b. Intravenous metronidazole
c. Oral vancomycin
d. Intravenous vancomycin
e. Oral bacitracin
55. A 72-year-old woman undergoes anterior resection for a rectal cancer located 7 cm proximal to the anal verge. Pathologic examination of the resected specimen reveals invasion of the tumor into the muscularis propria. Five of 8 lymph nodes contain microscopic tumor. There is no evidence of disseminated disease. Appropriate subsequent management includes which of the following?
a. Postoperative radiation plus intravenous 5FU
b. Postoperative radiation alone
d. Postoperative radiation plus intravenous adriamycin
56. Which of the following are tumor suppressor genes that have been associated with the development of colorectal cancer?
a. The DCC gene
b. The APC gene
c. The P53 gene
d. The Rb gene
Answer: a, b, c
57. Which of the following statement(s) is/are correct with regard to the use of carcinoembryonic antigen (CEA) determinations in management of colorectal cancer?
a. CEA determination has 95% specificity when used for screening for colon cancer development in patients with ulcerative colitis
b. CEA levels are increased in 20% of patients with local recurrence after resectional therapy
c. CEA measurements are increased in 90% of patients with disseminated disease
d. CEA levels are increased in 90% of patients with local recurrence after resectional therapy
Answer: b, c
58. The most common oncogene abnormality observed in association with colorectal cancer is which of the following?
a. Overexpression of the N-myc oncogene
b. Amplification of the K-ras oncogene
c. Suppression of the erbB oncogene
d. Amplification of the L-myc oncogene
59. Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration?
a. Tubular adenoma
b. Tubulovillous adenoma
c. Villous adenoma
d. Hamartomatous polyp
60. A 52-year-old man undergoes a right hemicolectomy for a carcinoma of the ascending colon. Pathological examination of the resected specimen reveals invasion of the tumor to the level of the muscularis propria. Three of 17 lymph nodes contain microscopic tumor. What is the correct Dukes classification (Aster-Coller modification) and associated 5-year survival for this lesion?
a. Dukes C2, 45% 5-year survival
b. Dukes B1, 75% 5-year survival
c. Dukes C1, 45% 5-year survival
d. Dukes B3, 65% 5-year survival
61. An pedunculated polyp, discovered incidentally at colonoscopy, is removed by snare polypectomy from the ascending colon. Invasive cancer to the level of the submucosa is identified histologically within the polyp. The lesion is well-differentiated. No lymphatic or vascular invasion is noted. The cauterized margin is negative for neoplasm. Appropriate subsequent management includes which of the following?
a. Repeat endoscopy at 6 months
b. Right hemicolectomy
c. Subtotal colectomy
d. Repeat endoscopy with fulguration of the polypectomy site
62. Dietary risk factors thought to play a causative role in development of colorectal cancer include which of the following?
a. High fat intake
b. Low fiber intake
c. High smoked food intake
d. High vegetable intake
Answer: a, b
63. Which of the following statements with regard to resection of rectal cancers is/are true?
a. A distal margin of 5 cm should be obtained because 42% of patients have microscopic evidence of intramural spread beyond 3 cm from the palpable tumor
b. A distal margin of 3 cm should be obtained because only 3% of patients have microscopic evidence of intramural spread beyond 2 cm from the palpable tumor
c. Local recurrence rates correlate strongly with distal margins less than 4 cm
d. There is no correlation between local recurrence and distal margins beyond 2 cm
Answer: b, d
64. A 58-year-old male undergoes resection of a Dukes C2 colon cancer via right hemicolectomy. Three years postoperatively, rising CEA levels prompt evaluation including abdominal computed tomography. Two lesions, each measuring 2 cm, are noted in the right hepatic lobe. No other abnormalities are noted. A right hepatic lobectomy is performed without complication. Which of the following most closely approximates anticipated 5-year survival?
65. An asymptomatic 52-year-old man is undergoing screening sigmoidoscopy. In the rectum, at 6 cm from the anal verge, a 2 cm yellow, submucosal nodule is noted. Deep endoscopic biopsies are consistent with carcinoid. Appropriate management includes which of the following?
b. Transanal excision
c. Low anterior resection
d. Abdominoperineal resection
66. A 72-year-old woman complains of anal itching and burning. Physical examination reveals an erythematous, scaly lesion, 3 cm in circumference, within the anal canal. The intersphincteric groove can not be appreciated in the area of the lesion. The remainder of the physical examination is normal. Appropriate initial management includes which of the following?
a. Acyclovir 200 mg QID for 10 days
b. Hydrocortisone cream 0.1% topically for 14 days
c. Incisional biopsy
d. Metronidazole 250 mg PO QID for 14 days
67. For the patient in the preceding question, biopsy revealed an invasive apocrine gland neoplasm. The deep margins included striated muscle infiltrated by neoplastic cells. Appropriate management includes which of the following?
a. Primary radiation
b. Abdominoperineal resection with bilateral inguinal lymph node dissection
c. Abdominoperineal resection only
d. Carbon dioxide laser fulguration
68. A 43-year-old woman presents with complaints of anal pain and spotting of blood with defecation. Physical examination reveals a 2 3 cm area of ulceration within the anal canal. The remainder of the physical examination is normal. Incisional biopsy is positive for squamous cell carcinoma. Appropriate management includes which of the following?
a. Abdominoperineal resection
b. Wide local excision, skin grafting, proximal diverting colostomy
c. Primary radiation therapy
d. Local excision and primary closure
69. Recurrent episodes of sigmoid colonic diverticulitis prompt operative therapy. Which of the following describe the appropriate margins for resection?
a. Proximal margin, splenic flexure; distal margin, rectosigmoid junction
b. Proximal margin, descending colon; distal margin, rectosigmoid junction
c. Proximal margin, descending colon; distal margin, mid-rectum
d. Proximal margin, transverse colon; distal margin, mid-rectum
70. An elderly man presents with complaints that he is passing gas with urination. The past medical history is positive for one episode of diverticulitis, treated medically, transurethral resection of the prostate for benign prostatic hypertrophy, and diabetes. Which of the following diagnostic tests is most appropriate initially?
a. Computed tomography of the abdomen and pelvis
c. Barium enema
d. Intravenous pyelography
71. For the patient in the preceding question, a colovesical fistula originating from the sigmoid colon is demonstrated. Colonoscopy reveals diverticula and excludes carcinoma. During laparotomy, a thickened sigmoid colon is found to be adherent to the dome of the bladder. A definite fistula is not observed. Appropriate operative management includes which of the following?
a. Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder
b. En-bloc resection of sigmoid colon and adjacent bladder wall, primary colonic anastomosis, suprapubic cystostomy
c. En-bloc resection of sigmoid colon and adjacent bladder wall, formation of descending colostomy and Hartmann’s pouch, suprapubic cystostomy
d. Sigmoid resection, primary colonic anastomosis, bilateral percutaneous nephrostomies
72. A 65-year-old woman develops obstipation, lower abdominal pain, and fever. Physical examination reveals a temperature of 38.5°C, left lower quadrant tenderness, and an ill-defined lower abdominal mass. White blood count is 17,500 per mm3. Intravenous hydration, broad spectrum antibiotics, and analgesics are ordered. After 48 hours, symptoms have not improved. Appropriate management includes which of the following?
a. Barium enema
b. Computed tomography of the abdomen
c. Immediate laparotomy
d. Intravenous pyelogram
73. Which of the following statement(s) relating to anal sphincteric function is/are correct?
a. When the rectum is distended, the internal anal sphincter relaxes and the external anal sphincter contracts
b. When the rectum is distended, the internal anal sphincter contracts and the external anal sphincter relaxes
c. The external anal sphincter is responsible for resting anal pressure
d. The internal anal sphincter is responsible for resting anal pressure
Answer: a, d
74. The most common complication after hemorrhoidectomy is which of the following?
a. Urinary retention
b. Rectal bleeding
d. Wound infection
75. Appropriate treatment of chlamydial proctitis includes which of the following?
a. Tetracycline 500 mg QID
b. Metronidazole 250 mg QID
c. Acyclovir 200 mg QID
d. Erythromycin 500 mg QID
Answer: a, d
76. A 65-year-old man presents with complaints of mucous discharge and perianal discomfort. Physical examination reveals a fistulous opening lateral to the anus. Anoscopic examination permits passage of a probe through the fistula tract. The fistula traverses the internal anal sphincter, the intersphincteric plane, and a portion of the external anal sphincter. The fistula is categorized as which type?
77. For the patient in the preceding question, appropriate management includes which of the following?
a. Division of the tissues over the probe with electrocautery, leaving the wound open to heal by secondary intention
b. Division of the tissues over the probe with electrocautery, closing the wound using a pedicled skin flap
c. Division of the internal anal sphincter using electrocautery, encircling the external sphincter with a seton
d. Proximal diverting colostomy and antibiotics