59 - Surgery mock test 3

Q1. Which of the following is not a congenital abnormality associated with Juvenile polyps ?

a) Malrotation
b) Meckel's diverticulum
c) Macrocephaly
d) Mesenteric lymphangioma


Q2. In Lynch syndrome which malignancy does not occur?

a) Bronchus
b) Ovary
c) Endometrium
d) Sebaceous Carcinoma

Q3. Which of the following is not true for malignancy of Familial Adenomatous Polyposis

a) Adrenals
b) Thyroid
c) Astrocytomas
d) Hepatoblastomas

Q4. What is not true for HNPCC

a) It is the most common hereditary colorectal cancer syndrome in USA
b) It is associated with MMR
c) It is associated with APC mutation
d) It is associated with carcinoma colon and extraintestinal cancers

Q5. Which of the following is not fermented by colonic bacteria

a) Lignin
b) Pectin
c) Cellulose
d)

Q6. True about Ulcerative Colitis with malignancy
a) It has a better prognosis
b) Is related to disease activity
c) Is related to duration of ulcerative colitis
d) Malignancy is more in anorectal ulcerative colitis

Q7. In ulcerative coilitis with toxic megacolon lowest rcurrence is seen in
a) Complete proctocolectomy and Brook's ileostomy
b) Ileo rectal anastomoses
c) kock's pouch
d) Ileo anal pull through procedure

Q8) All are precancerous for carcinoma colon except

a. crohn's disease
b. Bile acids
c. Fats
d. carotene

Answers :


1.c
In Familial Juvenile polyposis there are associated abnormalities in 20% of cases which include:

*Malrotation
*Hydrocephalus
*Cardiac lesions
*Mesenteric lymphangioma
*Meckel's Diverticulum
Ref: Sabiston 17 th page 1452 .

2. a
Lynch Syndrome is associated with cancers of :

-Endometrium and ovary
-Stomach and small intestine
-Pancreas
-Renal pelvis and ureters
-Sebaceous carcinoma
Ref: Sabiston 17th page 1452.

3. c
FAP is associated with malignancy of colon.

Rare tumors associated with it are :
-Medulloblastomas
-Glioma
-Liver
-Adrenal
-Thyroid
Ref:Sabiston 17th page 1452

4. c
HNPCC is associated with mutations of MMR (Mismatch Repair) genes and not APC gene which is mutated in FAP.
Sabistion 17th 1453

5. a
*Lignin is a non carbohydrate component of plants which is not fermented by colonic bacteria. It attracts water producing bulk.
*Lignin is used to treat constipation.
*Cellulose is partly fermented
*Pectin is completely fermented and used to treat diarrhea.

6 .c
-Carcinoma of the colon afflicts patients with ulcerative colitis 7 to 30 times more frequently than it does the general population.
-The risk of colon cancer in ulcerative colitis is related to two factors:
(1) duration of the colitis, and
(2) extent of colonic involvement.

-The risk of colon cancer for patients who have had the disease less than 10 years is low, but this risk steadily increases. The cancer risk for patients who have had disease activity for 10 to 20 years is 23 times that of the general population, while a disease duration of more than 20 years is associated with a cancer risk 32 times greater than that of the general population. The extent of colonic involvement in colitis also influences the risk of cancer. The incidence of cancer when ulcerative colitis is limited to the rectum or to the left side of the colon is much lower than when ulcerative colitis involves the entire colon.

The colonic malignancy associated with ulcerative colitis is generally an adenocarcinoma evenly scattered throughout the colon. The adenocarcinoma is often flatter than cancers in the general population and has fewer overhanging margins. It is generally considered extremely aggressive.

7. a
-Total proctocolectomy with brooke's ileostomy removes almost all of the diseased segment.
-IRA and IPAA leave behind rectal mucosa which may or may not be diseased

8) d
Carotene, Vit C and Calcium reduce the risk of colonic malignancy

58 - Risk factors for Oesophageal Carcinoma

Factors Associated with Pathogenesis of Esophageal Cancer

Factor Squamous Cell Cancer Adenocarcinoma Smoking +++ + Alcohol consumption +++ – Hot beverages + – N-nitroso compounds (e.g., pickled vegetables) + – Betel nut chewing + – Maté drinking + – Deficiencies of green vegetables and vitamins + – Low socioeconomic class + – Fungal toxin or virus + – History of radiation to the mediastinum + + Lye corrosive stricture + – History of aerodigestive malignancy +++ – Plummer-Vinson syndrome + – Obesity – ++ Achalasia + – Gastroesophageal reflux – +++ Barrett's esophagus – ++++

*Observe that Adenocarcinoma is associated with only 5 of all the factors listed above. They are Barrett's esophagus, GERD, Obesity, Smoking and radiation to the mediastinum. *Squamous cell cancer of esophagus is not associated with Obesity, GERD and Barrett's esophagus. *The most common location of squamous cell carcinoma of esophagus is the middle and lower third of esophagus. *The most common location of adenocarcinoma of esophagus is the lower third of the esophagus. *The most common type of esophageal carcinoma in WEST is adenocarcinoma, which is on the rise recently. *The most common type of esophageal carcinoma in INDIA and ASIA is squamous cell carcinoma. (reasons being less incidence of GERD, obesity and barrett's esophagus in asian population when compared to the west and high incidence of H.PYLORI, which is thought to be protective against adenocarcinoma; in asian population. )