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Question No.

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Clinical History of colon and rectum cancer
a. Patients with cancers proximal to the sigmoid are
more likely to present as emergencies, or
asymptomatic iron deficiency anemia
b. A positive family history need At least four of first
degree relatives to have colorectal cancer regardless
of the age at diagnosis
c. In patients with FAP disease 40% of the cases are
new mutations
d. Sigmoid tumors usually present as left sided mass
e. Tenesmus is a significant symptom in proximal tumors



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Question No.2
In Clinical examination for colon and rectum cancer
a. It is likely that left-sided abdominal mass will be
of greater diagnostic value than right-sided
b. In view of a higher prevalence of a palpable
sigmoid colon, the patient should be referred
immediately for endoscopy
c. Vaginal examination is necessary in assessing
rectal tumors
d. Only 30% of rectal tumors can be picked up by
PR
e. To estimate the distance of rectal tumor from
the anal verge you have to get above the tumor

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Question No.3
If Complete Colonic imaging can not be performed pre-
operatively then it should be done
a. As soon as possible
b. Not needed unless CEA is high
c. Within 6 months
d. After 6 months of closing the temporary
stoma ( if present)
e. After one year to give time for adjuvant
therapy to be completed
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Question No.4
In the diagnosis of rectal tumors
a. Endoscopy is superior to PR in assessing the tumor
b. Biopsy is best taken from the center of the tumor or
ulcer
c. Hsitopathological confirmation of the tumor is a
must
d. Histopathology can give a good idea on the grade
,type and stage of the tumor
e. Complete colonic imaging is not needed



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Question No.5
Regarding the use Of MRI in staging Rectal Tumors
a. Rectal distension should not be used
b. LNs more than 0.5cm in size are more likely to be
involved by tumor
c. Pelvic MRI is good for both T, N and M stage
d. It is superior to Endo-rectal ultrasound in staging
early tumors
e. Most of the LNs detected are more than 1.0 cm


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Question No.6
In Familial Adenomatous polyposis(FAP)
a. It is an autosomal dominant hereditary disease with
low penetrance
b. Risk of CA reaches 90% by the age of 70 without
prophylactic surgery
c. Risk of gastro-duodenal CA is 15%
d. 5% of cases are new mutations , negative F Hx
e. Heritable factors account for 10% of the risk of
developing colorectal cancer




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Question No.7
Pre-operative preparation for colo-rectal cancer
a. A combination of graduated compression stockings and
Aspirin prophylaxis should be used for thrombo-prophylaxis
b. Antibiotic prophylaxis should be used; best regimen is first
dose started shortly before surgery, and continued for five
days post-op
c. Wound infection rate should be less than 10%
d. If a patient may require stoma, adequate marking and fitting
of the stoma should be performed preoperatively only by the
surgeon
e. Bowl preparation should be done for all patients with left
sided and rectal tumors



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Question No.8
In Surgery for rectal cancer
a. The term curative resection should be based on surgical
confirmation of complete excision
b. It is recommended that total meso-rectal excision (TME)
should be performed for all rectal tumors and in APER.
c. If distal clearance of 1cm can be achieved a low rectal
cancer may be suitable for anterior resection
d. Local excision in rectal cancer is appropriate only for Pt1and
Pt2 cancers which are graded well or moderately well
differentiated and less than 3cm in diameter
e. The formation of a colonic pouch has become obsolete






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