ColoRectal

Question 1

Colon actively secretes ___ and ___

Answer 1

K and HCO3

Question 2

Superior rectal artery origin: ____
Middle origin: ____
Inferior origin: ____

Answer 2

Superior off IMA; middle off internal iliac; inferior off internal pudendal (off internal iliac)

Question 3

External sphincter innervated by ___ and ___.

Answer 3

inferior rectal branch of internal pudendal nerve and perineal branch S4

Question 4

Rx for squamous cell CA of anal canal _____

Rx for recurrent disease ____

Answer 4

Nigro protocol (chemo and XRT), not surgery;
APR for recurrent disease

Question 5

Transformation of polyp to cancer takes ___ (time)

Answer 5

~8 years

Question 6

T1 colon cancer: limited to ___

T1 Rectal adeno cancer excision method: ___

Answer 6

submucosa; transanally

Question 7

T2 colon cancer; ___% are node positive

Recommended rx: ____

Answer 7

20% node positive; recommend APR

Question 8

Do not do transanal resection of T2 colon cancer if:

___, ___

Answer 8

poor differentiation, neuro/vasc invasion

Question 9

Stage III colon cancer (node +) rx:
___ (yes/no) chemo?
___ (yes/no) XRT?

Answer 9

gets chemo, no XRT

Question 10

Stage II, and III rectal cancer rx:
___ (yes/no) chemo?
___ (yes/no) XRT?

Answer 10

gets chemo and XRT

Question 11

Colon cancer mutations:
___% ras mutation
p53 absent in ___%
___% DCC

Answer 11

50% ras
p53 absent in 85%
70% DCC

Question 12

Familial adenomatous polyposis:
____ inheritancy
Cancer by age ___
___ gene

Answer 12

autosomaal dominant; cancer by age 40; APC gene

Question 13

Familial adenomatous polyposis inheritant Rx:

__________________

Answer 13

need total colectomy prophylactically

Question 14

Familial adenomatous polyposis:

Have ____ as well and need to survey ___ for cancer

Answer 14

UGI polyps, survey duodenum

Question 15

Familial adenomatous polyposis:

Also have ___ tumors, benign but very difficult to manage

Answer 15

desmoids

Question 16

For FAP; ____ makes polyps recede

Answer 16

Sulindac

Question 17

Hereditary non-polyposis colon cancer:

Lynch I: Right or left? Multiple or solitary ca? Young or old?

Answer 17

Lynch I: R sided; multiple Ca’s; young

Question 18

Hereditary non-polyposis colon cancer:

Lynch II: associated with cancer of ___, ___, ___

Answer 18

ovary, bladder and stomach (and colon obvi)

Question 19

___ associated with DNA mismatch repair gene mutations

Answer 19

Hereditary non-polyposis colon cancer; lynch I and II

Question 20

Hereditary non-polyposis colon cancer:

Amsterdam Criteria: ______________

Answer 20

3 1st degree relatives, over 2 generations

Question 21

Gardner’s syndrome:

________ and ________

Answer 21

colon cancer and desmoid tumors

Question 22

Turcot’s syndrome:

______ and _________

Answer 22

colon cancer and brain tumors

Question 23

Peutz Jeghers:

______ ( not ________) and __________

Answer 23

polyposis (not colon cancer) and mucocutaneous pigmentation

Question 24

Sigmoid Volvulus Rx strategy:

____________, _________, ___________

Answer 24

decompress with scope, prep bowel, do sigmoid colectomy that admission

Question 25

Cecal volvulus rx strategy: | ________, _____, ______________, _________

Answer 25

likely will not decompress, take to OR, most recommend R hemicolectomy with ileo-transverse anastomosis, cecopexy is alternative

Question 26

Carcinoid of appendix: | _________ or ______ = do Right hemicolectomy, otherwise appendectomy only

Answer 26

>2cm or involving base

Question 27

If operating for appy and find normal appy and chrons disease.... unless...

Answer 27

Take appendix (unless cecum involved in inflammation); does not increase fistula rate (Every year)

Question 28

HLA B27 associated with ____.

Answer 28

sacroiliitis

Question 29

Pouchitis Rx: | ___ or ___

Answer 29

flagyl or short chain fatty acid enemas

Question 30

Pyoderma gangrenosum Rx: | ____ and/or ___

Answer 30

Dapson and/or steroids (topical or systemic)

Question 31

Fissue in Ano: | ___% anterior in ___ (men/women). nearly all others ___.

Answer 31

10% anterior; posterior midline

Question 32

Fissure in Ano INITIAL Rx: | ___ and ___ for ___.

Answer 32

sitz baths, regular loose BM (water/fiber)

Question 33

PERSISTENT fissure in ano rx: | _____________________

Answer 33

lateral internal sphincterotomy

Question 34

Alternative Rx for fissure in ano: | ___ or ____.

Answer 34

nitroglycerine creams (increase O2 for ischemia) or botox (relax sphincter)

Question 35

Fissure not in midline, think: | ___, ____, ____

Answer 35

IBD, TB, syphilis

Question 36

Bowen's diesease: ___________ ___% invasisve Rx: _______

Answer 36

intraepidermal squamous cell carcinoma; 5% invasive; rx is wide local excision

Question 37

______: rare intraepidermal neoplasm of apocrine glands. _____ (long/short) pre-invasive phase? ____ (+/-) PAS stain

Answer 37

Perianal paget's; long pre-invasive phase; +PAS stain

Question 38

___% of patients with AVM also have ___. | ___% have ___.

Answer 38

25% have aortic stenosis; | 50% have CAD

Question 39

___ (disease): may see aphthous ulcers on colonoscopy

Answer 39

campylobacter infectious colitis