COLORECTAL

SURGERY

1. What is the type of polyp seen in patients with ischemic colitis?
A. Adenomatous C. Hyperplastic
B. Inflammatory D. Hamartomatous

2. Which of the following is a condition characterized by intestinal polyposis with characteristic
melanin spots often in the buccal mucosa and lips of the patient?
A. Peutz-Jeghers syndrome
B. Familial adenomatous polyposis
C. Cowden syndrome
D. Lynch Syndrome

3. Which of the following is the genetic abnormality in patients with familial adenomatous
polyposis?
A. APC gene mutation
B. MYH mutation
C. DCC
D. P53 gene mutation

4. Which of the following is TRUE regarding fecal occult blood testing?
A. Noninvasive and may detect most polyps
B. High specificity
C. Low cost
D. Therapeutic

5. Which of the following guidelines for screening of colorectal cancer among the average risk
individuals starting at age 50 is CORRECT?
A. Annual flexible sigmoidoscopy
B. Annual air-contrast barium enema examination
C. Colonoscopy every 10 years
D. FOBT every 5 years

6. Following oncologic resection for colorectal cancer, final histopathology reported invasion of
the tumor through the muscularis propria into the subserosa with metastasis to three pericolic
lymph nodes. No distant metastasis was noted. What is the TNM stage of the disease?
A. T2N1M0
B. T2N2M0
C. T3N2M0
D. T3N1M0

7. Which of the following modalities may detect the pre-operative T and N stage of rectal
cancer?
A. Pelvic MRI
 B. Pelvic CT Scan
C. Colonoscopy
D. Barium enema

8. What is the minimum number of lymph nodes required in the resected specimen to
adequately stage the colon cancer?
A. 7
B. 10
C. 12
D. 15
E. 20

9. Identify the colon cancer stage. Tumor invades the submucosa. Metastasis to one out of
fifteen pericolic lymph node. Metastasis to left ovary. No metastasis to liver.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV

10. What is the most common site of distant metastasis in colorectal cancer?
A. Liver
B. Lung
C. Bone
D. Ovary

11. Which of the following is a good prognostic factor in colorectal cancer?
A. Well differentiated histology
B. Signet ring type of tumor
C. Lymphovascular invasion
D. Mucinous type of tumor

12. What is the best diagnostic modality to detect distant metastasis for colon cancer?
A. Ultrasound
B. CT scan
C. Abdominal Xray
D. MRI

13. Which of the following is TRUE regarding colon cancer?
A. Pre-operative evaluation maybe able to differentiate stage I, II, III, and IV
B. Lymph node metastasis may be seen in patients with stage III disease
C. Ultrasound is the best to identify the location of tumor
D. Colonoscopy is the best to identify the location of tumor

14. What is the most common extracolonic malignancy associated with Hereditary
Nonpolyposis Colon Cancer?
A. Ovarian Cancer
B. Pancreatic Cancer
C. Endometrial Cancer
D. Small bowel Cancer

15. What is the best treatment for asymptomatic proximal ascending colon cancer without
distant metastasis?
A. Right hemicolectomy
B. Extended right hemicolectomy
C. Endoscopic removal
D. Chemotherapy

16. Which of the following is TRUE regarding adenomatous polyp?
A. About 70 percent occurs in the right side
B. Risk of synchronous lesion is about 40 percent
C. Mostly present as hematochezia or anemia
D. Occurs in 80 percent of the population older than 50 years

17. What is the best recommendation in a 60 year-old male with poorly differentiated sessile
malignant polyp in the sigmoid colon that is removed endoscopically as single specimen with
positive margins of resection?
A. Observe
B. Repeat colonoscopic resection
C. Sigmoidectomy with primary anastomosis
D. Sigmoidectomy with Hartmanns

18. When is the recommended surveillance colonoscopy following successful endoscopic
removal of a villous adenoma?
A. 10 years
B. 5 years
C. 3 years
D. Within 6 months

19. What work-up for colon cancer is best to rule out stage 4 disease?
A. Colonoscopy
B. CT scan of the abdomen and pelvis
C. Chest X-ray
D. CEA Level determination



20. Identify the TNM stage of a resected sigmoid colon cancer with no distant metastasis, with
the final histopathology report showing tumor invading the muscularis propia and with
metastasis to 1 out of 12 pericolic lymph nodes
A. T1N0M0
B. T2N0M0
C. T2N1M0
D. T3N1M0

21. What is the best recommendation in a 50-year old male who underwent sigmoidectomy for
well differentiated adenocarcinoma invading the muscularis propia and with metastasis to 1 out
of 12 pericolic lymph nodes; no distant metastasis noted?
A. Observe
B. Adjuvant chemotherapy
C. Adjuvant chemotherapy and radiation therapy
D. Adjuvant radiation therapy

22. What is the main chemotherapeutic drug for colorectal cancer?
A. Oxaliplatin
B. Cisplatin
C. Doxorubicin
D. Gemcitabine

23. What is the first line treatment for asymptomatic, resectable sigmoid colon
adenocarcinoma with unresectable distant metastasis to the liver?
A. Chemotherapy
B. Sigmoidectomy
C. Radiation therapy
D. Hepatic mestastectomy

24. Which of the following work-ups for rectal cancer best identifies the exact location of the
tumor in relation to the anal verge?
A. Colonoscopy
B. Proctosigmoidoscopy
C. Endorectal ultrasound
D. Pelvic CT scan

25. What is the recommended treatement for a 50 year-old male with cT3N1M0 rectal
adenocarcinoma starting at 1cm from the anal verge?
A. APR
B. APR -> RT -> Chemo
C. APR -> Chemo
D. RT -> APR -> Chemo


26. Which of the following is a recommended surveillance for colorectal cancer?
A. History and PE every 3 months for 5 years
B. Chest and abdominopelvic CT scan annually for 5 years
C. Colonoscopy every 6 months for 5 years
D. PET CT scan annually for 3 years

27. Which of the following inherited colorectal cancer is associated with genetic defect of errors
in mismatch repair?
A. Familial adenomatous polyposis
B. Attenuated FAP
C. Hereditary nonpolyposis colon cancer
D. Peutz-Jeghers syndrome

28. Which of the following is part of the Amsterdam criteria for Lynch syndrome?
A. 3 successive generations
B. 3 affective relative with cancer of the colon
C. 2 patients diagnosed before age 50 years
D. 2 must be a first degree relative of one of the others

29. What is the lifetime risk of developing colorectal cancer in the average risk population?
A. 2 percent
B. 6 percent
C. 12 percent
D. 15 percent

30. What is the recommended treatment for a T3 squamous cell carcinoma in the anal margin
with no distant metastasis?
A. Local excision
B. Abdominoperineal resection
C. Chemotherapy + radiation
D. Chemotherapy

31. Which of the following is part of the initial evaluation for rectal cancer?
A. Colonoscopy
B. Endorectal Ultrasound
C. Chest, Abdomen, and Pelvis CT scan
D. CEA level determination

32. Which of the following is TRUE regarding the incidence of colon cancer?
A. Approximately 50% of colon cancer are hereditary
B. Diets high in vegetable fivers and low in animal fat may contribute to the
carcinogenesis
C. The incidence of colon cancer is higher in men than in women
D. Age is the most dominant factor with incidence rising steadily 50 years
33. Which of the following types of polyp is premalignant?
A. Adenomatous polyps
B. Inflammatory polyps
C. Hamartomatous polyps
D. Hyperplastic polyps

34. What is the best screening modality for colon cancer?
A. Fecal occult blood testing
B. Flexible sigmoidoscopy
C. Colonoscopy
D. Virtual colonoscopy

35. What is the single most important predictor of lymph node metastasis for colon cancer?
A. T stage of depth of tumor invasion
B. Tumor size
C. Poor histologic differentiation
D. Lymphovascular invasion

36. What is the recommended treatment for a T1 squmaous cell carcinoma in the anal canal
with pulmonary metastasis?
A. Local excision
B. Abdominoperineal Resection
C. Chemotherapy + Radiation
D. Chemotherapy

37. Which of the following diagnostic modalities best define Hinchey staging for colonic
diverticulitis?
A. Abdominal X-ray
B. Contrast studies
C. Abdominal CT scan
D. Colonoscopy

38. What is the best recommendation for Hinchey 4 diverticulitis in the sigmoid colon?
A. CT scan guided percutaneous drainage
B. Laparoscopic lavage and drainage
C. Sigmoidectomy with anastomosis
D. Sigmoidectomy with Hartmanns

39. Which of the following is a characteristic finding of cecal volvulus in abdominal radiograph?
A. Bent inner tube appearance with the convexity of the loop lying in the right upper
quadrant
B. Bent inner tube appearance with the convexity of the loop lying in the left upper
quadrant
C. Bird beak appearance
 D. Pneumoperitoneum

40. Grade of hemorrhoids which prolapse through the anal canal and require manual reduction.
A. 1st degree hemorrhoids
B. 2nd degree hemorrhoids
C. 3rd degree hemorrhoids
D. 4th degree hemorrhoids

41. Persistent bleeding from a 3rd degree hemorrhoidal disease is best treated initially with
A. Rubber band ligation
B. Suture ligation
C. Hemorrhoidectomy
D. Conservative management consisted of high fiber diet, stool softeners, increase oral
fluid intake, and avoidance of straining

42. When is the best timing for excision of thrombosed external hemorrhoids which generally
cause intense pain?
A. 1 to 3 days after onset of thrombosis
B. 5 to 7 days after onset of thrombosis
C. 1 to 2 weeks after onset of thrombosis
D. 1 month after onset of thrombosis

43. Which of the following type of treatment for chronic anal fissure has the least rate of
recurrence?
A. Botox injection
B. Nitroglycerin ointment/ cream application
C. Lateral internal sphincterotomy
D. Conservative managemet

44. What is the most common complication of Nitroglycerin ointment for treatment of anal
fissures?
A. Diarrhea
B. Vomiting
C. Headache
D. Hypotension

45. What is the most common cause of anorectal abcess?
A. Cryptoglandular infection
B. Rectal cancer
C. Crohn’s disease
D. Tuberculosis

46. Which of the following is associated with a Horseshoe abscess?
A. Perianal abscess
 B. Ischiorectal abscess
C. Supralevator abscess
D. Intersphicteric abscess

47. Which of the following type of fistula is often secondary to ischiorectal abscess?
A. Intersphincteric
B. Transphincteric
C. Extrasphincteric
D. Suprasphincteric

48. What is the most common cause of small bowel obstruction?
A. Malignant tumors
B. Hernias
C. Crohns disease
D. Post-operative adhesions

49. Which of the following findings is/are characteristic/s of strangulated bowel obstruction?
A. Tachycardia
B. Metabolic alkalosis
C. Leukocytosis
D. Air fluid levels

50. Which of the following is the best initial imaging to diagnose small bowel obstruction?
A. Plain abdominal Xray
B. Whole abdominal ultrasound
C. MRI of the whole abdomen
D. CT scan of the abdomen