1. M62 QUESTIONS 2006

2. Question 1 Option list A. Shigella B. Amoebiasis C. Syphillis D. Gonorrhoea E. Salmonellosis F. Lymphogranuloma venerum G. HIV H. CMV colitis I. Enterobius vermicularis infection J. Clostridium difficile Select the infection that would be detected by the tests detailed below. Each option may be used once, more than once, or not at all. 1. Culture of rectal swab 2. Prescence of bacterial toxin 3. Multiple colonic biopsy 4. Microscopy of faeces 5. Dark field microscopy of fresh scrapings

3. Question 2 Option list A. Four yearly colonoscopy B. Annual flexible sigmoidoscopy C. Three yearly colonoscopy D. No screening E. Sigmoidoscopy in three months F. Bi-annual colonoscopy G. Five yearly colonoscopy H. Sigmoidoscopy in six months I. Colonoscopy at 55 J.One off colonoscopy From each of the scenarios below, the patient has had their colon fully assessed by colonoscopy, choose the most appropriate follow up from the list of options. Each option may be used once, more than once, or not at all. 6. 50 year old man with a MSH2 mutation 7. 15 year old teenager with a mutation in the APC gene 8. 60 year old woman with a 5mm tubular adenoma 9. 80 year old woman following polypectomy of a large sessile tubulovillous adenoma in the sigmoid colon. 10. 45 year old man having a normal colonoscopy who has a first degree relative with colorectal cancer diagnosed aged 40

4. Question 3 Option list A. Radiation colitis B. Ulcerative colitis C. Eosinophilic colitis D. Ischaemic colitis E. Lymphocytic colitis F. CMV colitis G. Indeterminate colitis H. Diversion colitis I. Neutropaenic colitis J. Infective colitis From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all. 11. Macroscopic; mild to moderate patchy inflammation Micoscopic; mild diffuse chronic inflammation with prominent lymphoid follicular hyperplasia

5. Question 3 Option list A. Radiation colitis B. Ulcerative colitis C. Eosinophilic colitis D. Ischaemic colitis E. Lymphocytic colitis F. CMV colitis G. Indeterminate colitis H. Diversion colitis I. Neutropaenic colitis J. Infective colitis From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all. 12. Macroscopic; multiple erythematous patches Microscopic; mucin depleted epithelium, inclusions in vascular endothelial cells

6. Question 3 Option list A. Radiation colitis B. Ulcerative colitis C. Eosinophilic colitis D. Ischaemic colitis E. Lymphocytic colitis F. CMV colitis G. Indeterminate colitis H. Diversion colitis I. Neutropaenic colitis J. Infective colitis From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all 13. Macroscopic; thin atrophic mucosa with multiple telangiectases Microscopic; mild focal chronic inflammation, fibrosis and thickened submucosal arterioles

7. Question 3 Option list A. Radiation colitis B. Ulcerative colitis C. Eosinophilic colitis D. Ischaemic colitis E. Lymphocytic colitis F. CMV colitis G. Indeterminate colitis H. Diversion colitis I. Neutropaenic colitis J. Infective colitis From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all 14. Macroscopic; large serpinginous ulcers, oedema with petechial haemorrhages Micoscopic; erosions, early fibrosis, epithelial regeneration

8. Question 3 Option list A. Radiation colitis B. Ulcerative colitis C. Eosinophilic colitis D. Ischaemic colitis E. Lymphocytic colitis F. CMV colitis G. Indeterminate colitis H. Diversion colitis I. Neutropaenic colitis J. Infective colitis From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all 15. Macroscopic; opaque granular mucosa, loss of normal vascular pattern, patchy erythema and mucopus Microscopic; diffuse chronic inflammation, crypt abscess

9. Question 4 Option List A.Diltiazem B.Metronidazole C.Infliximab D.Vancomycin E.Azathioprine F.Methotrexate G.Tazocin (piperacillin) H.Cefotaxime I.Diclofenac J.Nicorandil Which of the drugs in the options list are known side effects of the following drugs. Each option may be used once, more than once, or not at all. 16. Perianal ulceration 17. Exacerbation of the effect of warfarin 18. Recrudescence of tuberculosis 19. Colonic mucosal ulceration 20. Peripheral neuropathy

10. Question 21 Which of the following statement about patients with both ulcerative colitis and sclerosing cholangitis is false A. There is an increased risk of colorectal cancer compared to patients without ulcerative colitis alone B. Following ileo-anal pouch formation, there is an increased risk of pouchitis C. There is an increased risk of portal hypertension D. There in an increased risk of cholangiocarcinoma E. There is an increased risk of pouch related fistulae

11. Question 22 What is the correct treatment for a patient who presents with Hinchey Stage IV diverticulitis A. Intravenous fluids and broad spectrum antibiotics B. CT guided drainage C. Defunctioning stoma D. Hartmann’s procedure E. Resection with anastomosis and proximal stoma

12. Question 23 Which of the following is not included in the ACPGBI mortality risk assessment for elective colorectal cancer resection A. ASA grade B. Gender C. Cancer resected or not D. Age E. Dukes stage

13. Question 24 Which of the following statements about radiotherapy for rectal cancer are false A. Endocavity irradiation is an acceptable technique for the treatment of small distal tumours B. Short course radiotherapy is not effective in down staging tumours C. Post operative radiotherapy is associated with a greater risk of side effects D. Complete sterilisation of the cancer following long course pre-operative radiotherapy is associated with improved surgical outcomes E. Reductions in local recurrence almost always translate to better 5-year survival rates

14. From each of the scenarios below, choose the most likely diagnosis from the macroscopic and microscopic appearances from the list of options. Each option may be used once, more than once, or not at all. 11. Macroscopic; mild to moderate patchy inflammation Micoscopic; mild diffuse chronic inflammation with prominent lymphoid follicular hyperplasia 12. Macroscopic; multiple erythematous patches Microscopic; mucin depleted epithelium, inclusions in vascular endothelial cells 13. Macroscopic; thin atrophic mucosa with multiple telangiectases Microscopic; mild focal chronic inflammation, fibrosis and thickened submucosal arterioles 14. Macroscopic; large serpinginous ulcers, oedema with petechial haemorrhages Micoscopic; erosions, early fibrosis, epithelial regeneration 15.Macroscopic; opaque granular mucosa, loss of normal vascular pattern, patchy erythema and mucopus Microscopic; diffuse chronic inflammation, crypt abscess