Week 8 2015- The large intestine- 26 Questions

1. What is incorrect regarding Meckel’s diverticulitis:

 All are symptomatic
 Correct: pain like appendicitis + bleeding in the rectum

2. Diverticulitis should be managed be:

 Drainage of abscess via percutaneous drainage via catheter
 Recurrence of divertulitis is an indication of surgical resection
 INCORRECT= peritonitis should be managed conservatively + if fistula formation occurs with the
bladder then it should only be tied up

3. Signs + symptoms of diverticulitis:

 Tachycardia
 Palpable abdominal mass

4. True regarding colon cancer:

 Left sided cancer is annular
 Tubulo-villous adenoma is premalignant

5. The pathological diagnosis of acute appendicitis rests on the:

 Presence of neutrophils in the muscularis propria

6. Function of the appendix:

 Colonic immunity and biofilm synthesis

7. In UC which of the following factors increases the risk for malignancy:

 Total involvement of the colon
 Disease present for more than 10 years
 Dysplastic changes seen on biopsy

8. What is the end-point that we strive for during resuscitation?

 Normal cerebration
9. The drug used to flush the colon before a colonoscopy?
 Polyethylene glycol

10. True regarding the sympathetic innervations of the colon?

 Stimulation causes sphincter contraction

11. A female on pain medication complains of constipation: what is the most likely cause?
 Morphine

12. Reabsorption of sodium in the colon is facilitated via?

 Aldosterone

13. Diverticulae is the most common in the?

 Sigmoid colon

14. Diverticulae is the most likely to rupture in?

 The extremes of age

15. Regarding the appendix:

 It is 10 cm long
 It is a true diverticulum

16. Bacteria compete for the following:

 Vitamin C + cyanocobalamin + choline

17. True regarding the presentation of appendicitis?

 Paraumbilical pain that radiates to the L. iliac fossa
 Can present with R. upper quadrant pain

18. A lady with a known diagnosis of irritable bowel syndrome presents with mm spasms of the
colon- what will be the drug of choice?
 Mebeverine
19. The best Rx for colonic perforation of a diverticulum of a female age 76 years old + has organ
dysfunction?
 Sigmoid colectomy + Hartmann’s procedure

20. True regarding the colon:

 Can absorb paracetamol + cyclizine

21. True statements:

 UC is premalignant
 Polypoid coli is premalignant
 R. sided colon cancer can present with an iron deficient anaemia

22. The sodium [ ] of Ringer’s lactate:

 131 mmol/L

23. The potassium [ ] in maintelyte?

 25

24. Male with a history of many diverticuli in previous colonoscopy comes with abdominal pain +
passing of hard stool and nothing else of significance: Rx is?
 Give nutritional and lifestyle advice

25. A female comes in with a fever + general pain of the abdomen + pain in the L. iliac fossa has a
previous history of constipation/diverticuli: what should be done?
 Give fluid
 Antibiotics
 Analgesics

26. A male in the acute surgery ward + presents with peri-umbilical pain and had a previous history of
diverticuli and already received fluid resuscitation + antibiotics: what is the next most appropriate
investigation?
 Pelvic + abdominal CT