Final

Question 1

1. Human papilloma virus infection (HPV) is pathogenetically associated with:
   (A) Melanoma
   (B) Bronchogenic carcinoma
   (C) Carcinoma of cervix and esophageal cancer
   (D) Carcinoma of the stomach
   (E) Mesothelioma

Answer 1

(C) Carcinoma of cervix and esophageal cancer

• HPV types 16 and 18
• Mesothelioma - associated with asbestos

Question 2

2. An 18 yo presents with a well-circumscribed 2-cm mass in her right breast. The mass is painless and has a
   rubbery consistency and discrete borders. It appears to move freely through the breast tissue. What is the likeliest diagnosis?
   (A) Carcinoma
   (B) Cyst
   (C) Fibroadenoma
   (D) Cystosarcoma phyllodes
   (E) Intramammary lymph node

Answer 2

(C) Fibroadenoma

• Most common benign breast tumor in young women
• Fibroadenomas are common, benign, mobile, well-circumscribed, and rubbery
• Cyst are typically not rubbery or mobile
• Carcinomas are harder, fixed and maybe painful

Question 3

3. Which of the following factors has NOT shown to increase a woman’s risk for breast cancer?
   (A) Human papilloma virus infection (HPV)
   (B) Previous history of benign breast biopsies
   (C) Atypia seen on pathology from previous breast cancer
   (D) First-degree relative with history of breast cancer
   (E) Increasing age

Answer 3

(A) Human papilloma virus infection (HPV)

Question 4

4. Which of the following statements regarding lung cancer is NOT true?
   (A) Lung cancer is the most common cause of cancer-related death in both women and man.
   (B) Small-cell lung cancer has a relatively good prognosis compared to non-small-cell lung cancer
   (C) Bronchogenic carcinoma is seen predominantly in men between the ages of 55 and 60.
   (D) Cough is principal presenting symptom.
   (E) Hemoptysis is seen in half of all patients

Answer 4

(B) Small-cell lung cancer has a relatively good prognosis compared to non-small-cell lung cancer

• Small cell lung cancer spreads rapidly and has poor prognosis

Question 5

5. Postoperative chemotherapy for colon cancer is recommended for patients with:
   (A) Dukes’E
   (B) Dukes’A
   (C) Dukes’B
   (D) Dukes’C
   (E) Dukes’D

Answer 5

(D) Dukes’C

1. Dukes’ A: Early, local—surgery is enough.
2. Dukes’ B: May need chemo if high-risk features.
3. Dukes’ C involves lymph nodes, needs adjuvant chemo.
4. Dukes’ D: Advanced/metastatic, palliative chemo used

Question 6

6. A patient presents with a pigmented nevus. You perform an excisional biopsy and send it for microscopic
   analysis. You would expect an almost 95% cure rate with simple excision alone if the Breslow level was:
   (A) < 1mm
   (B) > 2,1mm
   (C) > 2,5mm
   (D) < 2,7mm
   (E) > 4mm

Answer 6

(A) < 1mm

• increasing depth = worse prognosis
• <1mm - high survival and cure with excision

Question 6

7. A 45 yo woman presents with bloody nipple discharge. The most likely cause of this problem is:
   (A) Fibrocystic breast disease
   (B) Intraductal papilloma
   (C) Pituitary tumor
   (D) Invasive ductal carcinoma
   (E) Lobular carcinoma

Answer 6

(B) Intraductal papilloma

Question 7

8. A 65 yo man presents with squamous cell carcinoma of the anus. He is in good health other wise. Metastatic
   workup is negative. The treatment of choice for this cancer is:
   (A) Radiotherapy
   (B) Chemotherapy
   (C) A&B
   (D) Abdomino-perineal resection
   (E) Wide local excision

Answer 7

(C) A&B

• Nigro protocol (chemoradiotherapy) - standard

Question 8

9. Risk factors of melanoma include all of the following EXCEPT:
   (A) Exposure to sunlight
   (B) Family history of melanoma
   (C) Exposure to asbestos
   (D) Spitz nevi
   (E) Xeroderma pigmentosum

Answer 8

(C) Exposure to asbestos

Question 9

10. The sentinel lymph node (SNB) biopsy has rapidly become a standard procedure for patients with:
    (A) Ovarian cancer
    (B) Gastric and esophageal cancer
    (C) Melanoma and breast cancer
    (D) Lung cancer
    (E) Colon cancer

Answer 9

(C) Melanoma and breast cancer

Question 10

11. The characteristic features of a malignant tumor include the following EXCEPT:
    (A) Typically non-encapsulated
    (B) Pleomorphism correlates with the degree of maligancy
    (C) Often encapsulated
    (D) Histologically, malignant cells and their nuclei often vary widely in shape and size from the cells of origin
    tissue
    (E) Poorly defined, irregular outline due to local tissue invasion

Answer 10

(C) Often encapsulated

Question 11

13. Bronchogenic carcinoma:
    (A) May be a largely preventable disease
    (B) Has a 50% cure rate
    (C) Responds to tamoxifen
    (D) Is synonymous with “coin” lesion
    (E) Responds well to X-rays

Answer 11

(A) May be a largely preventable disease

• strong link to smoking - prevention possible
• prognosis is poor

Question 11

12. The marker used in the diagnosis and management of colorectal cancer is:
    (A) PSA
    (B) CA 15.3
    (C) CA 19.9
    (D) CEA and AFP
    (E) BRCA 1 and BRCA

Answer 11

(D) CEA and AFP

• PSA: Prostate cancer
• CA 15.3: Breast cancer
• CA 19.9: Pancreatic/gastrointestinal
• CEA is the main marker for colorectal cancer; AFP may also be elevated in some GI tumors
• BRCA1/BRCA2: Breast and ovarian cancer.

Question 12

14. Risk factors of esophageal squamous cell carcinoma include all of the following EXCEPT:
    (A) Alcohol and tobacco use
    (B) Exposure to sunrays
    (C) HPV (Human papillomavirus - subtypes 16,18)
    (D) Pickled vegetables, smoked meats and fish
    (E) Hot liquids

Answer 12

(B) Exposure to sunrays

• HPV 16 and 18
• hot drinks = mucosal injury

Question 13

15. A middle-aged male developes unusual appearing mole on his upper back. He says that his wife has noted a
    recent change in its color and shape. The lesion measures 0.7 cm and has ill-delined margins and irregular
    pigmentation. The patient is otherwise healthy and takes no medication. Which of the following is the most
    appropriate next step in management?
    (A) Follow—up examination in 6 months
    (B) Cryotherapy witl1 liquid nitrogen
    (C) Shave biopsy
    (D) Incisional biopsy
    (E) Excisional biopsy

Answer 13

(E) Excisional biopsy

• excisional biopsy - gold standard, allows assessment of depth

Question 13

16. A 40 yo woman consults a physician about a “mole” on her neck. The lesion is 2 cm in diameter and slightly irregular, and has a variegated dark red to brown to black color. Wide excision of the lesion demonstrates a malignant neoplasm that extends to a depth of 3 mm. This tumor would be most likely to stain for which of the following tumor markers?
    (A) Alpha-fetoprotein
    (B) CA—125
    (C) Leukocyte common antigen (LCA)
    (D) Prostate specific antigen (PSA)
    (E) S-100

Answer 13

(E) S-100

• S-100 = classic immunohistochemsitry marker for melanoma
• CA -125 - ovarian cancer marker
• LCA - lymphoma marker

Question 14

18. Which of the following is not typical symptom of late-stage colorectal cancer:
    (A) Anemia
    (B) Change in bowel habits
    (C) Blood in stool
    (D) Weight loss
    (E) Cardiac arrhythmias

Answer 14

(E) Cardiac arrhythmias

Question 14

17. The characteristic features of radiotherapy include the following EXCEPT:
    (A) Primary cure for tumours technically difficult to remove (head, neck, larynx)
    (B) Adjuvant radiotherapy- is applied to local tissues and regional lymph nodes after (or occasionally before)
    surgery to eliminate micrometastases
    (C) Neoadjuvant radiotherapy- short time before surgery, enhances the cure rate for surgery or down-stages a
    cancer to make surgery possible
    (D) Brachytherapy - local application of radioisotopes
    (E) Widely used for renal cell carcinoma

Answer 14

(E) Widely used for renal cell carcinoma

• RCC - radioresistant, surgery is preferred

Question 15

19. According to American Cancer Society (ACS) Guidelines, the optimal age to start colorectal cancer
    screening test is:
    (A) 25
    (B) 35
    (C) 60
    (D) 50
    (E) 40

Answer 15

(D) 50

• A, B and E - too early unless high risk patient (FAP, IBD)
• 60 - too late = delayed detection reduces outcomes

Question 16

20. Nowadays leading cause of cancer death worldwide is:
    (A) Ovarian cancer
    (B) Gastric cancer
    (C) Prostate cancer
    (D) Lung cancer
    (E) Breast cancer

Answer 16

(D) Lung cancer

Question 17

22. Epidemiologic features associated with increased risk of developing breast cancer include all the following
    EXCEPT:
    (A) Nulliparous state
    (B) First pregnancy occurring late in reproductive life
    (C) High fat diet
    (D) Trauma
    (E) Family history of breast cancer

Answer 17

(D) Trauma

• Nulliparity - increased exposure to estrogen
• Late first pregnancy also has longer exposure to hormones

Question 17

21. Recommendations for early cancer detection include all of the following EXCEPT:
    (A) Regular visits to the general practitioner
    (B) Patient education
    (C) PET (Positron Emission Tomography)
    (D) Regular oncological consultation (in higher risk group)
    (E) Screening programs

Answer 17

(C) PET (Positron Emission Tomography)

• PET = diagnostic tool, not for general population screening
• reserved for staging/monitoring

Question 18

23. Courvoisier’s sign is referred to:
    (A) Obstruction of the duct of Wirsung by carcinoma of the pancreas leading to gall bladder enlargement.
    (B) Obstruction of the common bile duct by carcinoma of the pancreas leading to gall bladder enlargement.
    (C) Obstruction of the duct of Santorini by carcinoma of the pancreas leading to gall bladder enlargement
    (D) Obstruction of the duodenum by carcinoma of the pancreas leading to gall bladder enlargement.
    (E) Obstruction of the hepatic duct by carcinoma of the pancreas leading to gall bladder enlargement.

Answer 18

(B) Obstruction of the common bile duct by carcinoma of the pancreas leading to gall bladder enlargement.

• Courvoisier’s sign is a painless, enlarged gallbladder with jaundice, typically caused by obstruction of the common bile duct, usually by a pancreatic head carcinoma

Question 19

24. A pain at the top of the left shoulder referred from diaphragmatic irritation is:
    (A) Kupffer sign.
    (B) Kussmaul’s sign.
    (C) Allen’s sign.
    (D) Kehr’s sign.
    (E) Goldflam’s sign.

Answer 19

(D) Kehr’s sign

• due to blood/fluid in peritoneal cavity

Question 20

25. Murphy’s sign is referred to: (A) Tenderness in right epigastrium. (B) Tenderness in mid epigastrium. (C) Tenderness in left epigastrium. (D) Tenderness in right hypogastrium. (E) Tenderness in left hypogastrium.

Answer 20

(A) Tenderness in right epigastrium * sign for acute cholecystitis

Question 21

27. A 38 yo man is admitted to the hospital after sustaining a pulmonary embolism. The patient has a past medical history significant for two idiopathic deep venous thromboses and takes only an aspirin daily. Three hours ago, he developed acute shortness of breath, pleuritic chest pain, and palpitations. He was taken by ambulance to the hospital. In the emergency department, he was diagnosed with a pulmonary embolus on the basis of clinical signs and symptoms and a ventilation perfusion scan. He was started on IV unfractionated heparin at that time. Which of the following laboratory tests would be most appropriate to guide therapy with this drug? (A) Bleeding time (B) Factor Xa levels (C) Platelet count (D) Prothrombin time (PT) (E) Partial thromboplastin time (PTT)

Answer 21

(E) Partial thromboplastin time (PTT) * meausres intrinsic and common coagulation pathways affected by heparin

Question 22

26. Glasgow Coma Scale assesses one of the following: (A) Best tongue movement. (B) Presence of the Battle’s sign. (C) Best vocal response. (D) Best motor response. (E) The presence of Babinski sign

Answer 22

(D) Best motor response. ** GCS assesses three main components of a patient's neurologic function: Eye opening response Best motor response Best verbal (vocal) response

Question 22

28. A 16 yo boy is brought to ER after he was assaulted. Witnesses claim that he was hit on the head with a lead pipe, after which he was unconscious for several minutes. No seizure activity was witnessed. On arrival, he complains of a headache, particularly severe at the point where he was hit in the right frontoparietal region. On examination, he is found to have swelling and ecchymosis over this region. He is awake, alert, and fully oriented. A complete neurologic examination reveals no deficit. Plain radiographs of the skull show a linear, nondepressed skull fracture in the frontoparietal skull that crosses the groove of the medial meningeal artery. During the following hour, he becomes sleepier and begins to vomit. A repeat neurologic examination at that time reveals him to be lethargic but without weakness, numbness, paresthesia, or other focal deficit. What is the most likely cause of the neurologic deterioration? (A) Diffuse axonal injury (DAI) (B) Todd’s phenomenon (C) Subdural hematoma (D) Epidural hematoma (E) Trigeminal ganglion hematoma

Answer 22

(D) Epidural hematoma * Classic presentation is a "lucid interval": the patient is initially unconscious, then awake and lucid, then deteriorates due to expanding hematoma.

Question 23

29. A young male is brought to the hospital unconscious after being resuscitated in an ambulance from the site of a motor vehicle accident. No other history or information is available. On general inspection, he is found to have multiple bruises over his body and has a massively swollen left thigh. His vital signs are stable with HR of 120/min and BP 150/75 mm Hg and respiratory rate is 40/min He is obtunded and does not follow commands or open his eyes. He withdraws his left arm and leg from painful stimuli, but not his right. His left pupil is 3 mm in diameter, and it is sluggishly reactive to light, while his right is 5 mm in diameter and fixed. Corneal reflexes are present bilaterally. To avoid injury to his spinal cord by an unstable cervical spine, an order is issued to not perform testing of his doll’s eye reflex. Intracranial hemorrhage causing increased intracranial pressure is suspected, along with a right uncal herniation. What is the next step in management? (A) Intubation of his airway for hyperventilation and administration of intravenous mannitol (B) Immediate CT scanning of the brain to confirm the presence of the suspected intracranial hemorrhage (C) Intubation of his airway for hyperventilation and intravenous administration of corticosteroids (D) Immediately evacuation of the suspected intracranial hematoma (E) Controlled hypoventilation

Answer 23

(A) Intubation of his airway for hyperventilation and administration of intravenous mannitol * Hyperventilation reduces CO2, causing cerebral vasoconstriction, temporarily lowering ICP. * Mannitol (osmotic diuretic) reduces brain edema.

Question 24

30. A 30 yo man is injured in the tigh with a knife. What is the first mechanism responsible for hemostasis? (A) exitrinsic clotting system (B) vessel constriction (C) intrinsic clotting system (D) platelet activation (E) fibrinolytic system

Answer 24

(B) vessel constriction * Immediate vasoconstriction of injured blood vessel to reduce blood loss. * Extrinsic clotting system: Activated next, seconds later by tissue factor. * Intrinsic clotting system: Activated after extrinsic. * Platelet activation: Important but follows vasoconstriction

Question 24

31. A 55 yo woman after motor vehicle crash with associated head trauma. She withdraws to pain and is intubated for airway protection. In order to calculate the Glasgow Coma Scale score, which of the following components of the neurologic examination are necessary? (A) Motor response, verbal response, corneal reflexes (B) Motor response, eye opening, verbal response (C) Eye opening, pupillary light reflexes, motor response (D) Pupillary light reflexes, motor response, verbal response (E) Corneal reflexes, pupillary light reflexes, motor response

Answer 24

(B) Motor response, eye opening, verbal response

Question 25

32. A 55-year-old man involved in an automobile accident is unresponsive and is intubated. On arrival in the emergency department, he responds to painful stimulation. His systolic BP is 60 mm Hg, his HR is 140 bpm, his neck veins are distended, and his breath sounds are absent on the left side. Immediate management should involve which of the following? (A) CT scan of head (B) Insertion of an 18-gauge needle in the left second intercostal space (C) Pericardiocentesis (D) Peritoneal lavage (E) Insertion of a central venous line on the right side

Answer 25

(B) Insertion of an 18-gauge needle in the left second intercostal space * Signs indicate tension pneumothorax: - Unilateral absent breath sounds - Distended neck veins (jugular venous distension) - Hypotension and tachycardia ** Needle thoracostomy in the second intercostal space midclavicular line decompresses tension pneumothorax emergently = life-saving procedure before imaging or chest tube placement.

Question 26

33. A 50 yo patients sustains numerous injuries of the abdomen and lower extremities. During the perioperative period, patient is resuscitated with 11 L of Ringer’s lactate and 3 U of packed red blood cells (RBC). After initial improvement, patient develops severe dyspnoea on the second postoperative day. Which of the following is the most useful initial diagnostic test? (A) Computed tomography (CT) scan of abdomen. (B) Analysis of arterial blood gas. (C) Insertion of a central venous line. (D) Ventilation-perfusion scan. (E) Electrocardiogram (ECG)

Answer 26

(B) Analysis of arterial blood gas * Severe dyspnea post large-volume resuscitation raises suspicion for pulmonary complications such as fluid overload, ARDS, or pulmonary edema. * ABG is a quick, bedside test to assess oxygenation, ventilation, and acid-base status.

Question 27

34. On examination, patients presenting with appendicitis typically show maximal tenderness over which of the following? (A) Immediately above the umbilicus (B) Inguinal region (C) At a point between the outer one-third and inner two-thirds of a line between the umbilicus and the anterior superior iliac spine (D) At a point between the outer two-thirds and inner one-third of a line between the umbilicus and the anterior superior iliac spine (E) At the midpoint of a line between the umbilicus and the anterior superior iliac spine

Answer 27

(C) At a point between the outer one-third and inner two-thirds of a line between the umbilicus and the anterior superior iliac spine ** Point is called McBurney's point, classically the site of maximal tenderness in appendicitis. * Corresponds anatomically to the base of the appendix.

Question 28

Question 35-36: A young female patient presents on physical examination pain and tenderness in the right iliac fossa. Her last menstrual cycle was 2 weeks previously and findings on gynecologic examination and leukocyte count are normal. A provisional diagnosis of acute appendicitis is made. 35. Her white blood cell (WBC) count is 13,000 and temperature is 100.6°F. In ER the uncomplicated appendicitis is confirmed and laparoscopic appendectomy is offered. Which of the following concerning laparoscopic appendectomy is TRUE? (A) Wound complication rate is greater than with open technique. (B) Length of hospital stay is longer than with open technique. (C) Procedure cost is less than with open technique. (D) Return to full feeding is longer than with open technique. (E) It can be performed safely with minimal morbidity compared to open technique.

Answer 28

(E) It can be performed safely with minimal morbidity compared to open technique. ** Laparoscopic appendectomy is safe and associated with fewer complications and faster recovery. ** Generally has lower morbidity and less postoperative pain.

Question 29

36. Possible advantages of the laparoscopic techniques include all EXCEPT? (A) Post hospital recovery is shorter. (B) Less scar formation. (C) Less wound-related complications. (D) Longer operative time. (E) Treatment for nonappendical disease still possible.

Answer 29

(D) Longer operative time

Question 30

37. A young male patient is complaining of pain in the umbilical region that moves to the right iliac fossa. Which is a corroborative sign of acute appendicitis? (A) Referred pain in the right side with pressure on the left (Rovsing)sign (B) Increase of pain with testicular elevation (C) Relief of pain in lower abdomen with extension of thigh (D) Relief of pain in lower abdomen with internal rotation of right thigh (E) Hyperanesthesia in the right lower abdomen

Answer 30

(A) Referred pain in the right side with pressure on the left (Rovsing)sign * Rovsing’s sign: Pressing left lower quadrant increases pain in right lower quadrant—classic for appendicitis. ** Sign supports diagnosis by eliciting peritoneal irritation.

Question 31

38. Plain abdominal films reveal following EXCEPT: (A) Spleen. (B) Calcifications. (C) Bowels. (D) Gas in abnormal places. (E) Foreign bodies.

Answer 31

(A) Spleen ** Plain films show gas patterns, bowel outlines, calcifications, foreign bodies, and abnormal gas collections

Question 32

39. Which of the following is the most useful diagnostic procedure of upper gastrointestinal tract diseases: (A) ERCP. (B) USG. (C) CT. (D) EGD. (E) MRI

Answer 32

(D) EGD * gold standard for diagnosing most UGI diseases like ulcers, tumors, and bleeding * Esophagogastroduodenoscopy

Question 33

40. A 42 yo man has had recurrent symptoms of peptic ulcer disease for 3,5 years. Endoscopy reveals an ulcer located on the greater curvature of the stomach. A mucosal biopsy reveals Helicobacter. pylori. Choose a TRUE statement about H. pylori? (A) Active organisms can be discerned by serology. (B) It is protective against gastric carcinoma. (C) It is associated with chronic gastritis. (D) It causes gastric ulcer but not duodenal ulcer. (E) It can be detected by the urea breath test in <60% of cases.

Answer 33

(C) It is associated with chronic gastritis.

Question 34

41. An elderly patient has suffered from dysphagia for 4 years, which has become progressively worse. The patient also complaints of a sense of a lump on the left side of his neck, gurgling sounds during swallowing and regurgitation. What is the diagnosis? (A) Carcinoma of the esophagus (B) Foreign body in the esophagus (C) Plummer-Vinson (Kelly-Patteson) syndrome (D) Zenker’s diverticulum (E) Scleroderma

Answer 34

(D) Zenker’s diverticulum ** Zenker’s diverticulum is a pharyngoesophageal pouch causing dysphagia, regurgitation, neck lump, and gurgling sounds. Symptoms worsen gradually over years.

Question 35

42. A symptomatic patient has a barium swallow revealing a 3-cm Zenker’s diverticulum. The next step in management is? (A) H2 blockers (B) Anticholinergic drugs (C) Elemental diet (D) Watchful waiting (E) Surgery (cricopharyngeal myotomy and diverticulectomy)

Answer 35

(E) Surgery (cricopharyngeal myotomy and diverticulectomy)

Question 36

44. An elderly female is admitted to the hospital with a mild UGI hemorrhage that stopped spontaneously. She did not require transfusion. She had ingested large amounts of aspirin in the past 4 months to relieve the pain caused by severe back pain. Endoscopy reveals the presence of a duodenal ulcer and a biopsy is performed. What is the next step in the management of a duodenal ulcer associated with a positive biopsy for H. pylori? (A) H2 blockers (B) Bipolar electrocautery of the ulcer (C) Triple therapy (D) Photocoagulation (E) Elective surgery

Answer 36

(C) Triple therapy ** Triple therapy (PPI + 2 antibiotics) eradicates H. pylori, heals ulcer, and prevents recurrence.

Question 36

43. A patient is diagnosed with Boerhaave’s syndrome. Which of the following is the proper management? (A) IV antibiotics and total parenteral nutrition (TPN). (B) IV antibiotics and TPN, a chest tube and a nasogastric tube (C) IV antibiotics and TPN, and insertion of a nasogastric tube (D) Resuscitation and emergency surgery either by laparotomy or thoracotomy (E) Resuscitation and elective surgical intervention when the general status of the patient improves

Answer 36

(D) Resuscitation and emergency surgery either by laparotomy or thoracotomy ** Boerhaave’s is a full-thickness esophageal rupture requiring urgent surgical repair after resuscitation. Delay increases morbidity and mortality.

Question 37

45. Which of the following is not typical of acute pancreatitis: (A) Pancreatic calcifications on CT scanning (B) Gallstones on USG. (C) Plasma amylase peak. (D) Serum lipase peak. (E) Acute peripancreatic fluid collection on CT scanning.

Answer 37

(A) Pancreatic calcifications on CT scanning ** Pancreatic calcifications are typically seen in chronic pancreatitis

Question 38

46. Transmural inflammatory bowel disease is characteristic of: (A) Ulcerative colitis. (B) Crohn’s disease. (C) Both of them. (D) None of them. (E) Irritable bowel disease.

Answer 38

(B) Crohn’s disease.

Question 39

47. Rectal bleeding is characteristic of: (A) Ulcerative colitis. (B) Crohn’s disease. (C) Both of them. (D) None of them. (E) Irritable bowel disease.

Answer 39

(A) Ulcerative colitis.

Question 40

48. Diarrhea is characteristic of: (A) Ulcerative colitis. (B) Crohn’s disease. (C) Both of them. (D) None of them. (E) Irritable bowel disease

Answer 40

(C) Both of them.

Question 41

49. Bowel strictures and fistulas are characteristic of: (A) Ulcerative colitis. (B) Crohn’s disease. (C) Both of them. (D) None of them. (E) Irritable bowel disease.

Answer 41

(B) Crohn’s disease.

Question 41

50. Surgery is required: A) Commonly in Crohn’s disease. (B) In fulminant ulcerative colitis. (C) With evidence of dysplasia or malignancy in ulcerative colitis. (D) A,B,C are correct. (E) Only A is correct

Answer 41

(D) A,B,C are correct.