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Questions on Rectal surgery. MCQs on surgery of Rectum from various examinations.

Answers are provided at the end of 5 questions with references from surgery books.
Specific topic wise questions can be found using the links above. For details see
here.The questions are free to download

Q1. Most common site of Colo Rectal cancer is

a) Hepatic Flexure b) Sigmoid colon

c) Anal canal d) Rectum Colon Questions 1-5

Rectum
Colitis
Q2. All are premalignant for carcinoma esophagus except Pouchitis
Anal Canal
a) Diverticulum b) Caustic burn
Gastrectomy
c) Mediastinal fibrosis d) Human papillloma virus Gastric Ulcer
Duodenum
Hiatus hernia
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 Hiatus hernia
Q3. Lipoma which undergo malignant degeneration is

a) Retroperitoneal b) Subserosal

c) subfascial d) Submucosal

Q4. Most important prognostic factor for carcinoma esophagus is

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a) cellular differentiation b) Depth of esophagus involvement
» Atlas of Pelvic Surgery
c) length of esophagus involvement d) age of the patient » Surgery Instruments and Handling

Q5 Contraindication to anterior resection of rectum is

a) Age more than 60 b) poorly differentiated carcinoma

c) Sigmoid lymph nodes d) single hepatic metastasis

Answers

1) d
Rectal Cancer is a common malignany of the lower GI tract and rectal pain is relatively a late feature.
Rectum is the most common site of malignany in all colo rectal tumors. Other sites in order of decreasing
frequency are

Rectum -38%, Sigmoid colon 21% Hepatic flexure of colon - 2%, Caecum 12%, Anal Canal 2%

2) c

Risk factors for carcinoma of esophagus are Alcohol, tobacco, beverages( low), nitrosamines, polycyclic
aromatic hydrocarbons, croton flaveus, trace element deficiencies

Tylosis, achlasia (midesophagus), strictures due to lye ingestion, chronic esophagitis are other risk
factors.

Barrets esophagus, congenital rests of columnar epithelium predispose to carcinoma esophagus and Follow this blog
particularly adeno carcinoma.

Diverticula have a very small risk of carcinoma, HPV 16 and HPV 18 lead to carcinoma esophagus.

schakelford 5th editionpg 316

3) c
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 Lipoma of retroperitoneum and mediastinum are the most common to undergo malignant degeneration
and change into carcinoma.

4) b

Most important is depth of involvement of wall of esophgus and lymph node involvement of the
surrounding esophageal tissue.

Length of esophagus involvement is not that important because esophagus has extensive submucosal
lymph supply and for complete cure 10 cm excision margin would mean removal of almost total
esophagus.

5b

APR (Abdomino perineal resection) is done if carcinoma Rectum or Anal Canal is poorly differentiated, Subscribe to Surgery MCQ
sphincters cannot be preserved or there is no continence

The new edition of Sabiston text

book of surgery is out

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Shashi B Kohli · Works at Oman Medical College Bengal
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Regarding question 3 oesophageal atresia -all cases of oesophageal atresia maynot be associated
mins ago with tracheo
oesophageal fistula and in these cases of atresia without a fistula there will be no gas in the abdomen.
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 Absolutely correct.
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