Colorectal Surgery — Advanced Sub-topics MCQs

Surgery · 10 free questions with answers & explanations.

1. A 55-year-old woman presents with a 2 cm anal squamous cell carcinoma (SCC) with inguinal lymph node involvement. The TNM stage is T2 N1 M0. The standard of care treatment is:
2. A 62-year-old man has a 4 cm adenocarcinoma of the mid-rectum. MRI shows T3 disease with the tumour invading the mesorectal fascia at one point. Which surgical plane during TME (total mesorectal excision) would reduce local recurrence most effectively?
3. A 55-year-old man presents with haematuria, right loin pain, and a palpable right flank mass — the classic triad. CT urography reveals a 7 cm heterogeneous right renal mass with renal vein thrombus extending into the IVC below the hepatic veins (Neves stage II IVC thrombus). The recommended surgical procedure is:
4. A 40-year-old man presents with sudden-onset severe scrotal pain and a horizontal ('bell clapper') lie of the right testis. The right testis is swollen and elevated. Doppler ultrasound shows absent right testicular blood flow. What is the management?
5. A 70-year-old man presents with a carotid duplex showing a 75% stenosis of the right internal carotid artery following a transient ischaemic attack (TIA) 3 days ago. He has fully recovered neurologically. The NASCET criteria define symptomatic carotid stenosis ≥70% as benefiting from carotid endarterectomy (CEA). When should CEA be performed?
6. A 65-year-old diabetic with chronic limb-threatening ischaemia (CLTI) has an ankle-brachial pressure index (ABPI) of 0.45 on the right. Angiography shows a long (18 cm) SFA (superficial femoral artery) occlusion with a patent popliteal artery and two-vessel run-off to the foot. He has a suitable great saphenous vein. The preferred revascularisation is:
7. A 55-year-old woman presents with intermittent right upper quadrant pain and elevated liver enzymes. MRCP shows dilated intrahepatic and extrahepatic bile ducts with multiple filling defects within the ducts and a stricture at the right hepatic duct bifurcation. This is consistent with primary sclerosing cholangitis (PSC) with cholangiocarcinoma. Which tumour marker combination is most useful for surveillance in PSC?
8. A 50-year-old woman is found to have a 3.5 cm gallbladder polyp on ultrasound, with echogenic foci (no acoustic shadow) and no wall thickening. She has no symptoms. The most appropriate management is:
9. A 65-year-old man with dysphagia is found to have a T3 N1 M0 squamous cell carcinoma of the mid-thoracic oesophagus. He is fit for surgery (ECOG PS 1). According to current ESMO/NICE guidelines, the optimal treatment is:
10. A 45-year-old woman is incidentally found to have a 3.5 cm branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. The MRI shows mural nodules within the cyst, the main pancreatic duct is 4 mm (normal), and she has new-onset diabetes. According to the revised Fukuoka 2017 guidelines, this cyst has which worrisome features, and what action is warranted?