General Surgery — MCQs
On this page
A 57-year-old woman undergoes colonoscopy for investigation of iron deficiency anaemia. A 3.5 cm ulcerating lesion is identified in the ascending colon, and biopsies confirm moderately differentiated adenocarcinoma. Staging CT shows no evidence of metastatic disease. Which mechanism best explains how this patient's colonic adenocarcinoma developed?
What is the characteristic relationship between a direct inguinal hernia and the inferior epigastric vessels?
A 34-year-old man presents to the emergency department with a 24-hour history of right iliac fossa pain, anorexia, and vomiting. On examination, his temperature is 37.8°C, pulse 92 bpm, and BP 128/76 mmHg. There is tenderness and guarding in the right iliac fossa. His white cell count is 13.2 × 10⁹/L with neutrophilia. A CT scan confirms acute appendicitis. What is the definitive treatment of choice for this patient?
A 70-year-old woman with a family history of colorectal cancer (mother diagnosed at age 68, maternal aunt at age 72) undergoes genetic testing which identifies a pathogenic mutation in the MLH1 gene. She has no personal history of cancer. Colonoscopy shows pan-colonic multiple adenomatous polyps with several showing high-grade dysplasia. What is the most appropriate surgical management?
A 26-year-old man presents with right iliac fossa pain for 36 hours. Clinical examination reveals localised peritonism in the right iliac fossa. His inflammatory markers show WCC 11.2 × 10⁹/L, CRP 85 mg/L. Alvarado score is calculated as 7. CT scan shows a normal appendix but reveals terminal ileitis with mesenteric lymphadenopathy. The caecum appears normal. There is no collection or free fluid. What is the most likely diagnosis and appropriate management?
A 58-year-old man undergoes curative resection for a T3 N1 M0 sigmoid adenocarcinoma and completes adjuvant chemotherapy. He undergoes surveillance colonoscopy at 1 year which is normal. A CT chest, abdomen and pelvis at 18 months shows three lesions in the right lobe of the liver, the largest measuring 3.2 cm. These were not present on initial staging. His CEA has risen from 2.1 to 45.3 μg/L. PET-CT confirms the liver lesions are FDG-avid with no other sites of disease. His performance status is good (ECOG 0). What is the most appropriate management?
Which of the following is a recognised absolute contraindication to laparoscopic appendicectomy in acute appendicitis?
A 72-year-old man presents with a 4-month history of iron deficiency anaemia (Hb 89 g/L, MCV 72 fL, ferritin 8 μg/L). Colonoscopy identifies a circumferential tumour in the hepatic flexure which is biopsied. CT staging shows a T3 tumour with no evidence of lymphadenopathy or distant metastases. He also has a 5 mm polyp in the descending colon which is removed and shows a tubular adenoma. What is the most appropriate surgical procedure?
During emergency laparotomy for perforated appendicitis in a 34-year-old man, the surgeon identifies clear fluid and multiple white nodules scattered across the peritoneal surfaces of the small bowel, omentum, and parietal peritoneum. The appendix is perforated with a mucocele. Frozen section histology of a peritoneal nodule shows abundant mucin with no epithelial cells. What is the most appropriate intraoperative management?
A 55-year-old woman is diagnosed with a sessile serrated lesion (SSL) measuring 15 mm in the ascending colon with dysplasia on screening colonoscopy. The polyp is completely excised with clear margins. What is the recommended surveillance interval according to current UK guidelines?
General Surgery UK Medical PG Practice Questions and MCQs
Question 141: A 57-year-old woman undergoes colonoscopy for investigation of iron deficiency anaemia. A 3.5 cm ulcerating lesion is identified in the ascending colon, and biopsies confirm moderately differentiated adenocarcinoma. Staging CT shows no evidence of metastatic disease. Which mechanism best explains how this patient's colonic adenocarcinoma developed?
- A. Accumulation of multiple genetic mutations following the adenoma-carcinoma sequence through chromosomal instability (Correct Answer)
- B. Germline mutation in the APC gene leading to uncontrolled cell proliferation
- C. Chronic inflammation from inflammatory bowel disease causing dysplasia-carcinoma progression
- D. Defective DNA mismatch repair genes causing microsatellite instability
- E. Direct malignant transformation of normal colonic epithelium without adenomatous precursor
Explanation: ***Accumulation of multiple genetic mutations following the adenoma-carcinoma sequence through chromosomal instability*** - Approximately 85% of **sporadic colorectal cancers** develop through the **chromosomal instability (CIN) pathway**, involving a progressive accumulation of **genetic mutations** (e.g., APC, KRAS, TP53). - This well-established **adenoma-carcinoma sequence** describes the stepwise progression from normal colonic epithelium to adenoma and eventually adenocarcinoma. *Germline mutation in the APC gene leading to uncontrolled cell proliferation* - This mechanism is characteristic of **Familial Adenomatous Polyposis (FAP)**, where patients typically develop hundreds to thousands of polyps at a young age. - The patient's presentation with a single 3.5 cm lesion at 57 years old is not consistent with an inherited **germline mutation** leading to widespread polyposis. *Chronic inflammation from inflammatory bowel disease causing dysplasia-carcinoma progression* - This pathway applies to **colorectal cancer associated with inflammatory bowel disease (IBD)**, such as ulcerative colitis or Crohn's disease. - The patient has no history or symptoms of IBD, making this an unlikely mechanism for her sporadic adenocarcinoma. *Defective DNA mismatch repair genes causing microsatellite instability* - This mechanism, known as the **Microsatellite Instability (MSI) pathway**, is associated with **Lynch syndrome** or sporadic cases due to MLH1 promoter hypermethylation. - While the **ascending colon** is a common site for MSI-high tumors, the **chromosomal instability pathway** is overall the most frequent cause of sporadic colorectal cancer. *Direct malignant transformation of normal colonic epithelium without adenomatous precursor* - The vast majority of **colorectal adenocarcinomas** arise from pre-existing **adenomatous polyps** rather than through direct de novo transformation. - This
Question 142: What is the characteristic relationship between a direct inguinal hernia and the inferior epigastric vessels?
- A. The hernia passes lateral to the inferior epigastric vessels through the deep inguinal ring
- B. The hernia passes medial to the inferior epigastric vessels through Hesselbach's triangle (Correct Answer)
- C. The hernia passes through the femoral canal below the inguinal ligament
- D. The hernia passes superior to the inferior epigastric vessels above the inguinal ligament
- E. The hernia passes through the obturator foramen medial to the obturator vessels
Explanation: ***The hernia passes medial to the inferior epigastric vessels through Hesselbach's triangle***- Direct inguinal hernias occur due to an acquired weakness in the **transversalis fascia**, protruding **medial** to the **inferior epigastric artery**.- This protrusion occurs within **Hesselbach’s triangle**, bounded by the rectus abdominis, inguinal ligament, and inferior epigastric vessels.*The hernia passes lateral to the inferior epigastric vessels through the deep inguinal ring*- This describes an **indirect inguinal hernia**, which enters the **deep inguinal ring** and is often congenital in nature.- These hernias are found **lateral** to the inferior epigastric vessels and are covered by all three layers of **spermatic fascia**.*The hernia passes through the femoral canal below the inguinal ligament*- This describes a **femoral hernia**, which exits through the **femoral ring** medial to the femoral vein.- These are distinct from inguinal hernias because they emerge **inferior** to the **inguinal ligament**.*The hernia passes superior to the inferior epigastric vessels above the inguinal ligament*- While all inguinal hernias are superior to the inguinal ligament, the relationship **medial or lateral** to the vessel is the clinical differentiator.- Passing "superior" to the vessels does not define the specific anatomical pathway of a direct hernia compared to an indirect one.*The hernia passes through the obturator foramen medial to the obturator vessels*- This describes an **obturator hernia**, a rare type that protrudes through the **obturator canal**.- It is not an inguinal hernia and typically presents with symptoms of **bowel obstruction** or pain in the inner thigh (Howship-Romberg sign).
Question 143: A 34-year-old man presents to the emergency department with a 24-hour history of right iliac fossa pain, anorexia, and vomiting. On examination, his temperature is 37.8°C, pulse 92 bpm, and BP 128/76 mmHg. There is tenderness and guarding in the right iliac fossa. His white cell count is 13.2 × 10⁹/L with neutrophilia. A CT scan confirms acute appendicitis. What is the definitive treatment of choice for this patient?
- A. Intravenous antibiotics alone for 48 hours followed by interval appendicectomy at 6-8 weeks
- B. Laparoscopic appendicectomy within 24 hours of presentation (Correct Answer)
- C. Conservative management with antibiotics and observation for 72 hours
- D. Open appendicectomy via McBurney's incision immediately
- E. Nasogastric tube insertion, nil by mouth, and broad-spectrum antibiotics with reassessment in 24 hours
Explanation: ***Laparoscopic appendicectomy within 24 hours of presentation*** - **Laparoscopic appendicectomy** is the definitive gold standard treatment for acute appendicitis, offering lower **wound infection rates** and faster recovery. - Performing surgery within **24 hours** is critical to prevent complications such as **perforation**, abscess formation, or peritonitis. *Intravenous antibiotics alone for 48 hours followed by interval appendicectomy at 6-8 weeks* - **Interval appendicectomy** is typically reserved for patients who initially present with an **appendiceal mass** or abscess, which is not indicated by this CT. - Using antibiotics as a bridge in uncomplicated cases increases the risk of **disease progression** and does not provide definitive early resolution. *Conservative management with antibiotics and observation for 72 hours* - While **non-operative management** with antibiotics can be successful in select cases, it carries a high rate of **recurrence** compared to surgery. - **Observation for 72 hours** unnecessarily delays treatment in a patient with a confirmed diagnosis and active symptoms like **neutrophilia** and guarding. *Open appendicectomy via McBurney's incision immediately* - While a valid surgical approach, **open appendicectomy** is no longer the first-line treatment of choice when **laparoscopic facilities** are available. - Compared to the laparoscopic approach, open surgery is associated with increased **post-operative pain** and longer hospital stays. *Nasogastric tube insertion, nil by mouth, and broad-spectrum antibiotics with reassessment in 24 hours* - This approach is more appropriate for managing **small bowel obstruction** or an **appendiceal phlegmon**, rather than acute uncomplicated appendicitis. - Delaying definitive surgery for **reassessment** increases the likelihood of the appendix becoming **gangrenous** or perforating.
Question 144: A 70-year-old woman with a family history of colorectal cancer (mother diagnosed at age 68, maternal aunt at age 72) undergoes genetic testing which identifies a pathogenic mutation in the MLH1 gene. She has no personal history of cancer. Colonoscopy shows pan-colonic multiple adenomatous polyps with several showing high-grade dysplasia. What is the most appropriate surgical management?
- A. Total colectomy with ileorectal anastomosis and lifelong rectal surveillance (Correct Answer)
- B. Segmental colonic resections targeting areas with most polyps
- C. Total proctocolectomy with end ileostomy
- D. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA)
- E. Colonoscopic polypectomy with annual surveillance
Explanation: ***Total colectomy with ileorectal anastomosis and lifelong rectal surveillance***- A **pathogenic mutation in MLH1** confirms **Lynch syndrome** (HNPCC); for individuals requiring surgical intervention due to high-risk lesions, a **total abdominal colectomy (TAC)** is preferred over segmental resection to prevent **metachronous cancers**.- Preservation of the rectum through **ileorectal anastomosis (IRA)** maintains better functional outcomes, provided the patient undergoes strict **annual endoscopic surveillance** of the remaining rectal stump.*Segmental colonic resections targeting areas with most polyps*- This approach is associated with a significantly high risk (up to 16% at 10 years) of developing **metachronous colorectal cancer** in the remaining segments of the colon in Lynch syndrome patients.- Lynch syndrome is characterized by a **germline defect** in DNA mismatch repair, meaning the entire colonic mucosa is at an elevated risk for malignancy.*Total proctocolectomy with end ileostomy*- This procedure is considered overly aggressive and unnecessary for Lynch syndrome, as it results in a permanent **stoma** and significantly reduces the quality of life.- Unlike **Familial Adenomatous Polyposis (FAP)**, where the rectal burden of polyps is often extreme, the rectum in Lynch syndrome can usually be safely managed and preserved with surveillance.*Total proctocolectomy with ileal pouch-anal anastomosis (IPAA)*- **IPAA** is the gold standard for **FAP** (APC gene mutations) or refractory **Ulcerative Colitis**, but it is generally not indicated for Lynch syndrome unless there is synchronous rectal cancer.- This procedure carries higher surgical morbidity and risk of functional complications (e.g., **pouchitis**) compared to an ileorectal anastomosis.*Colonoscopic polypectomy with annual surveillance*- While surveillance is a cornerstone of management, it is inadequate in this patient due to the presence of **multiple pan-colonic adenomas** with **high-grade dysplasia**.- High-grade dysplasia indicates a failed preventive strategy through endoscopy alone and warrants **prophylactic surgical resection** to mitigate the high risk of progression to invasive adenocarcinoma.
Question 145: A 26-year-old man presents with right iliac fossa pain for 36 hours. Clinical examination reveals localised peritonism in the right iliac fossa. His inflammatory markers show WCC 11.2 × 10⁹/L, CRP 85 mg/L. Alvarado score is calculated as 7. CT scan shows a normal appendix but reveals terminal ileitis with mesenteric lymphadenopathy. The caecum appears normal. There is no collection or free fluid. What is the most likely diagnosis and appropriate management?
- A. Crohn's disease; commence immunosuppression with azathioprine
- B. Yersinia ileocolitis; conservative management with supportive care (Correct Answer)
- C. Acute appendicitis with secondary ileal inflammation; proceed to appendicectomy
- D. Intestinal tuberculosis; commence anti-tuberculous therapy
- E. Mesenteric adenitis; conservative management with observation
Explanation: ***Yersinia ileocolitis; conservative management with supportive care***- The CT findings of **terminal ileitis** and **mesenteric lymphadenopathy** in a patient with right iliac fossa pain and a **normal appendix** are highly suggestive of **Yersinia enterocolitica** infection.- This condition is typically **self-limiting** in immunocompetent individuals, and **supportive care** (hydration, analgesia) is the appropriate management, avoiding unnecessary interventions.*Crohn's disease; commence immunosuppression with azathioprine*- While Crohn's disease can cause **terminal ileitis**, initiating **immunosuppression** with azathioprine is inappropriate for an acute presentation without a definitive diagnosis and exclusion of infectious causes.- Azathioprine has a **slow onset of action** and is primarily used for maintenance therapy, not for acute symptom management in an undiagnosed patient.*Acute appendicitis with secondary ileal inflammation; proceed to appendicectomy*- The CT scan explicitly identified a **normal appendix**, which definitively rules out **acute appendicitis** as the primary diagnosis, even with concomitant ileal inflammation.- An **appendicectomy** is not indicated as the appendix is normal, and it would not address the underlying pathology of terminal ileitis.*Intestinal tuberculosis; commence anti-tuberculous therapy*- **Intestinal tuberculosis** typically presents with more chronic symptoms and often involves **caecal thickening** or **strictures**, and lymph nodes may show **caseous necrosis**, none of which are described in this acute presentation with a normal caecum.- Diagnosis requires **histological or microbiological confirmation** of acid-fast bacilli; empirical anti-tuberculous therapy is not indicated for acute RIF pain.*Mesenteric adenitis; conservative management with observation*- While **mesenteric adenitis** also presents with mesenteric lymphadenopathy and is managed conservatively, the presence of significant **terminal ileitis** on CT scan differentiates this case.- Mesenteric adenitis primarily involves inflamed lymph nodes, whereas the prominent **terminal ileitis** points more specifically to an infectious enteritis affecting the bowel itself, such as Yersinia.
Question 146: A 58-year-old man undergoes curative resection for a T3 N1 M0 sigmoid adenocarcinoma and completes adjuvant chemotherapy. He undergoes surveillance colonoscopy at 1 year which is normal. A CT chest, abdomen and pelvis at 18 months shows three lesions in the right lobe of the liver, the largest measuring 3.2 cm. These were not present on initial staging. His CEA has risen from 2.1 to 45.3 μg/L. PET-CT confirms the liver lesions are FDG-avid with no other sites of disease. His performance status is good (ECOG 0). What is the most appropriate management?
- A. Palliative chemotherapy with FOLFOX
- B. Right hepatectomy
- C. Selective internal radiation therapy (SIRT) with yttrium-90 microspheres
- D. Radiofrequency ablation of all three lesions
- E. Referral to hepatobiliary MDT for consideration of liver resection (Correct Answer)
Explanation: ***Referral to hepatobiliary MDT for consideration of liver resection*** - In patients with **colorectal liver-only metastases** and good performance status (ECOG 0), the potential for curative resection makes **multidisciplinary team (MDT)** assessment crucial to determine the optimal management strategy. - The MDT will evaluate the **resectability** of the lesions, plan for potential **neoadjuvant chemotherapy**, and consider the patient's overall health to maximize the chances for **long-term survival**.*Palliative chemotherapy with FOLFOX* - **Palliative chemotherapy** is not the most appropriate initial step for **oligometastatic disease** confined to the liver, as this presentation offers a chance for **curative intent** therapy. - Chemotherapy may be considered as **neoadjuvant** or **conversion therapy** to downstage lesions or reduce recurrence risk, but not primarily for palliation in this context.*Right hepatectomy* - While **surgical resection** is the ultimate goal, committing to a specific major procedure like **right hepatectomy** before a comprehensive MDT evaluation is premature. - The MDT will thoroughly assess factors such as the **future liver remnant (FLR)**, the possibility of **parenchymal-sparing surgery**, or the need for a **two-stage hepatectomy**.*Selective internal radiation therapy (SIRT) with yttrium-90 microspheres* - **SIRT** is generally reserved for patients with **unresectable** liver-dominant metastatic disease or those who are not candidates for or have failed systemic chemotherapy. - It is not a first-line treatment for a patient who potentially qualifies for **curative surgical resection**.*Radiofrequency ablation of all three lesions* - **Radiofrequency ablation (RFA)** is typically less effective than surgical resection for lesions larger than **3 cm**, and one lesion in this case is 3.2 cm. - While RFA can be an adjunct, **surgical resection** remains the gold standard for achieving clear margins and optimal long-term outcomes in fit patients with resectable disease.
Question 147: Which of the following is a recognised absolute contraindication to laparoscopic appendicectomy in acute appendicitis?
- A. Pregnancy in the third trimester
- B. Previous lower abdominal surgery
- C. Suspected perforated appendicitis
- D. Haemodynamic instability despite resuscitation (Correct Answer)
- E. Body mass index greater than 35 kg/m²
Explanation: ***Haemodynamic instability despite resuscitation*** - **Haemodynamic instability** is a recognized **absolute contraindication** because the **pneumoperitoneum** created during laparoscopy can further decrease venous return and cardiac output. - In unstable patients, the delay in establishing laparoscopic access and the physiological stress of **increased intra-abdominal pressure** necessitate a rapid **open approach**. *Pregnancy in the third trimester* - This is considered a **relative contraindication** as laparoscopy is technically challenging due to the **gravid uterus** shadowing the appendix. - While often performed via an open approach in the late stages, it is not absolute and can be performed safely by **experienced surgeons** using modified port placement. *Previous lower abdominal surgery* - This may lead to **dense adhesions**, increasing the risk of bowel injury during trocar insertion and visualization. - It is a **relative contraindication** only; surgeons may use an **Open (Hasson) technique** for safe primary port entry to circumvent these risks. *Suspected perforated appendicitis* - Modern surgical practice treats this as an indication for laparoscopy rather than a contraindication because it allows for **superior peritoneal toilet** and lavage. - Laparoscopy in perforated cases significantly reduces the incidence of **postoperative wound infections** compared to the open technique. *Body mass index greater than 35 kg/m²* - **Obesity** is actually a relative indication for laparoscopy because it avoids large abdominal incisions that carry a high risk of **surgical site infection**. - While technically more demanding due to extra-peritoneal fat, the benefits of **reduced wound complications** and faster recovery are more pronounced in this population.
Question 148: A 72-year-old man presents with a 4-month history of iron deficiency anaemia (Hb 89 g/L, MCV 72 fL, ferritin 8 μg/L). Colonoscopy identifies a circumferential tumour in the hepatic flexure which is biopsied. CT staging shows a T3 tumour with no evidence of lymphadenopathy or distant metastases. He also has a 5 mm polyp in the descending colon which is removed and shows a tubular adenoma. What is the most appropriate surgical procedure?
- A. Right hemicolectomy
- B. Extended right hemicolectomy (Correct Answer)
- C. Transverse colectomy
- D. Subtotal colectomy
- E. Segmental resection of hepatic flexure
Explanation: ***Extended right hemicolectomy*** - For tumors located at the **hepatic flexure**, this procedure is preferred as it ensures oncological clearance by ligating the **middle colic artery** at its origin. - It involves removing the terminal ileum, cecum, ascending colon, and the **proximal transverse colon**, providing a more extensive **lymphadenectomy** than a standard right hemicolectomy. *Right hemicolectomy* - This procedure typically involves the ligation of the **ileocolic** and **right colic** arteries, which may provide insufficient lymphatic drainage for a tumor at the **hepatic flexure**. - It is generally reserved for tumors of the **cecum** or **ascending colon** rather than those at the junction with the transverse colon. *Transverse colectomy* - This approach is technically more challenging and often fails to provide better **oncological outcomes** compared to an extended right hemicolectomy for flexure tumors. - It focuses specifically on the **transverse colon**, which might not adequately address the blood supply and lymphatic basin involved in a hepatic flexure malignancy. *Subtotal colectomy* - This radical procedure involves removing nearly the entire colon and is considered **excessive** for a solitary T3 tumor without evidence of **hereditary non-polyposis colorectal cancer (HNPCC)**. - While it would address the distal polyp, that polyp was a **tubular adenoma** already successfully removed, making such an extensive resection unnecessary. *Segmental resection of hepatic flexure* - A localized segmental resection is oncologically **inadequate** because it does not include a wide enough **mesenteric resection** to capture regional lymph nodes. - Modern surgical standards for colon cancer require **en-bloc resection** of the primary tumor with its associated vascular and lymphatic supply.
Question 149: During emergency laparotomy for perforated appendicitis in a 34-year-old man, the surgeon identifies clear fluid and multiple white nodules scattered across the peritoneal surfaces of the small bowel, omentum, and parietal peritoneum. The appendix is perforated with a mucocele. Frozen section histology of a peritoneal nodule shows abundant mucin with no epithelial cells. What is the most appropriate intraoperative management?
- A. Proceed with appendicectomy only and close
- B. Appendicectomy, peritoneal washout, and biopsy of nodules (Correct Answer)
- C. Appendicectomy and right hemicolectomy
- D. Extensive peritonectomy and heated intraperitoneal chemotherapy (HIPEC)
- E. Close abdomen without intervention and refer to specialist centre
Explanation: ***Appendicectomy, peritoneal washout, and biopsy of nodules*** - The primary goal in an emergency setting is to remove the **underlying source** of the mucin (the appendix) and to obtain tissue for a definitive **histopathological diagnosis**. - A **peritoneal washout** helps reduce the volume of acellular mucin, while definitive cytoreductive surgery is deferred to a specialized center for elective management. *Proceed with appendicectomy only and close* - Simply performing appendicectomy without a **peritoneal washout** fails to reduce the immediate burden of mucinous material within the cavity. - Skipping **biopsies** of the peritoneal nodules is inappropriate as definitive staging and grading of the **pseudomyxoma peritonei (PMP)** are critical for future prognosis. *Appendicectomy and right hemicolectomy* - A **right hemicolectomy** is generally not indicated for an appendiceal mucocele or low-grade appendiceal mucinous neoplasms (LAMN) unless the **caecal base** is clearly involved. - This procedure increases morbidity in an emergency setting without providing additional oncological benefit compared to a high-quality **appendicectomy**. *Extensive peritonectomy and heated intraperitoneal chemotherapy (HIPEC)* - This is a complex, high-risk procedure that should only be performed by a **specialist multidisciplinary team** in a designated center after complete staging. - Attempting **HIPEC** during an emergency laparotomy for a perforated appendix is contraindicated due to lack of preparation and high potential for **postoperative complications**. *Close abdomen without intervention and refer to specialist centre* - Leaving the **perforated appendix** in situ is inappropriate as it allows the ongoing leakage of mucin-secreting cells into the peritoneal cavity. - The acute pathology (perforated appendicitis) requires **source control**, and biopsy is essential for the specialist center to plan subsequent management.
Question 150: A 55-year-old woman is diagnosed with a sessile serrated lesion (SSL) measuring 15 mm in the ascending colon with dysplasia on screening colonoscopy. The polyp is completely excised with clear margins. What is the recommended surveillance interval according to current UK guidelines?
- A. No further surveillance required
- B. Repeat colonoscopy in 6 months
- C. Repeat colonoscopy in 12 months
- D. Repeat colonoscopy in 3 years (Correct Answer)
- E. Repeat colonoscopy in 5 years
Explanation: ***Repeat colonoscopy in 3 years*** - According to **BSG 2020 guidelines**, a **sessile serrated lesion (SSL)** measuring **≥10 mm** or any SSL containing **dysplasia** is classified as high-risk, requiring surveillance at **3 years**. - This interval is necessary because SSLs with dysplasia represent a more advanced stage of the **serrated pathway** to colorectal cancer compared to those without dysplasia, justifying close monitoring. *No further surveillance required* - This option is incorrect as the patient has **high-risk findings**: an SSL size of **15 mm** (≥10 mm) and the presence of **dysplasia**. - Discharging to the **National Bowel Cancer Screening Programme** is only appropriate for low-risk findings, such as small SSLs <10 mm without dysplasia. *Repeat colonoscopy in 6 months* - A **6-month follow-up** is generally reserved for cases where there is concern regarding **incomplete excision** or after **piecemeal EMR** of a large polyp. - Since this lesion was **completely excised** with clear margins, an early 6-month check is not indicated under current UK protocols for surveillance. *Repeat colonoscopy in 12 months* - A **12-month interval** is not standard for a single high-risk SSL with dysplasia; it does not align with the **stratified surveillance** intervals defined by the BSG. - This timeframe is typically used in specific contexts like **hereditary syndromes** or following the removal of very complex, high-risk pathology not meeting the 3-year criteria. *Repeat colonoscopy in 5 years* - While **5 years** may be considered for patients with lower-risk adenomas or smaller SSLs without dysplasia, it is too long for this specific lesion. - The **presence of dysplasia** in a serrated lesion significantly increases the risk of metachronous lesions, necessitating the shorter **3-year window**.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free