Total Mesorectal Excision

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Q) Which of the following is not true about TME  ( total mesorectal excision)  a. For all rectal cancer b. For all even after NACRT c. Less Neuro injury vs conventional dissection d) Less recurrence Another question on complete Mesorectal excision

Rectal Intussusception

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Q) Pick the true statement about rectal intussusception a) It is a rare finding in defecography b) When found, it is found to be a common cause of refractory constipation c) Biofeedback therapy and fibre intake is the mainstream treatment of choice d) Rectopexy has had good long term results

Genetics ca rectum

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Q) Good prognosis seen in – ca rectum. A) MSI-H B) MSI-L C) BRAF D) KRAS

Neoadjuvant Response in Rectal cancer

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Q) In Regression of tumour after Neoadjuvant CTRT for rectal cancer are all except A) Decrease in size B) Nodal regression C) Mucosal venous invasion in mri D) Depth change  

Perioperative steroid management in IBD

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Q) All are true  regarding perioperative management Of IBD on steroid except a) Minor procedure needs only routine steroidal dose supplementation b) Major procedures  needs Hydrocort 100-150 mg tds 3.Chronic steroid use causing adrenal failure that  presents with hypotension, vomiting, fever, lethargy 4.All cases of UC need supraphysiological dose of steroid.

Pouchitis Disease severity index

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Q) Pouchitis disease activity index includes all except (AIIMS 2019) a)  Fever b)  Malaise c)  Fecal urgency d)  Bleeding PR Pouchitis is commonly asked in AIIMS and JIPMER MCH exams. Previous year questions are here and here 

ELAPE (Extra Levator Abdomino perineal Excision)

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Q) What is not true about  extra levator Abdomino Perineal Resection (APE) (AIIMS 2019)  a) Anal canal dissected from levator b) Patient  in prone jack knife position c) Specimen is resected en block with sacrum d) Entire levator is resected along with mesorectum

FAP

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Q) False regarding FAP a) Mean age of development of cancer is 40 b)50% population develop gastric polyp and duodenal adenoma c) 2nd most common cause of death is desmoid d)  AIIMS November MCQs

Cancer lower rectum

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Q) False statement about management of cancer rectum a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement  b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment. c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake

Juvenile Polyposis Coli

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Q) In juvenile polyposis coli, all true except a)  SMAD 4 mutation b)  No risk of cancer c) Polyps most common in ileum d)  Autosomal Dominant with high penetrance

Pouchitis after IPAA in ulcerative colitis

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Q) Which of the following is Not a risk factor for pouchitis post IPAA in ULcerative colitis A) Smoking B ) NSAIDs use post op C) Elderly patients D) UC with extra intestinal manifestation Ans a Pouchitis is the complication of Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative colitis. The incidence of pochitis for the same proedure for familial Adenomatous polyposis is less than 10% but for ulcerative colitis can go as high as 50%. Risk factors for development of pouchitis are Previous extra intestinal manifestations of IBD especially arthritis ANCA positive cases of UC NOD2insC  positive patients Smoking prevents the development of puchitis after IPAA in ulcerative colitis. 5. Other reported factors that may associate with pouchitis include extent of UC, thrombocytosis,and PPI use with  NSAId Ref – https://onlinelibrary.wiley.com/doi/full/10.1111/den.12744