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73 The anus and anal canal BV Praveen and Pradip K Datta Multiple choice questions ➜ Anatomy and physiology C Pelvic dyssynergia can be identified by 1. Which of the following statements are evacuatory proc...

73 The anus and anal canal BV Praveen and Pradip K Datta Multiple choice questions ➜ Anatomy and physiology C Pelvic dyssynergia can be identified by 1. Which of the following statements are evacuatory proctogram. true? D Megarectum might be a finding in rectal A The junction between the rectum and hyposensitivity. anal canal is the anorectal ring. E Perineal position and descent reflects B The puborectalis muscle is an important pelvic floor and pudendal nerve component of the continence function. mechanism. ➜ Imperforate anus C The external sphincter forms the bulk of 4. Which of the following statements are the anal sphincter complex. true? except D The longitudinal muscle is a direct A Imperforate anus are classified into high continuation of the smooth muscle of ❌ and low types. the outer muscle coat of the rectum. B Fistula with the urethra is uncommon. E The internal anal sphincter is the continuation of the circular muscle coat of the rectum. is a fistula into the vagina. most❌ C The most common abnormality in girls common defect in girls is a rectovestibular fistula D The finding of a single perineal orifice 2. The following statements are true suggests a persistent cloaca. except: E Meconium on the perineum indicates a A The dentate line (pectinate line) divides low defect. the anal canal into an upper two-thirds and lower one-third. ➜ Pilonidal sinus B The mucosa and submucosa above the 5. The following statements are true dentate line form anal cushions. except: C The anal glands drain into the anal A The condition always occurs in the natal sinuses and are the source of anal sepsis. cleft. men in their third decade. D The lymphatics from the anal canal drain B It is a disease of the elderly. into the inguinal group of lymph nodes. C The condition predominantly affects E The lower part of the anal canal is lined males. by stratified squamous epithelium. D Recurrent abscesses are common. E Treatment is always surgical excision. ➜ Special investigations Surgical excision of the track is not always necessary ➜ Anal incontinence on the ano-rectum 6. Which of the following statements are 3. Which of the following statements are true? all true true? except A Neurological pathways must be intact to A The resting tone is a reflection of maintain anal continence. internal sphincter activity. B Structural integrity of the gastrointestinal B A maximal anal pressure of 60 cm of tract and pelvic floor musculature is water is abnormal. essential to maintain continence. 692  C History and clinical examination might ➜ Anorectal abscesses 73: THE ANUS AND ANAL CANAL be enough to determine aetiology. 10. Which of the following statements D Surgical treatment is tailored to the cause. are true? except E A permanent stoma is a choice. A Anorectal abscesses might be a ➜ Anal fissure manifestation of a generalised disease. B Primary colorectal disease might be a 7. Which of the following statement(s) cause. except ‫ﻣﻤﻜﻦ ﻳﺠﻲ‬ is/are false? posterior midline at 6 o’clock position C The main cause is infection of the anal A Anal fissure occurs most commonly on glands. the anterior midline at 12 o’clock position. D Presentation is always as a very tender, B Acute anal fissure results from trauma indurated lump fluctuant lump in the perianal region. from the passage of a hard stool. E Immediate fistulotomy should be not C A fissure at an unusual site might have performed if a fistula is present. an underlying cause. Conservative D Operation is the treatment of choice. ➜ Fistula-in-ano Lateral anal E Anal dilatation should be tried as the 11. The following statements are true sphincterotomy or first surgical procedure. anal advancement flap except: ❌ ➜ Haemorrhoids A There is always an underlying associated specific cause. 8. Which of the following statements are B The most common cause is persistent true? all true false ‫ أو‬except ‫ﻳﻐﻴﺮ وﺣﺪة وﻳﺨﻠﻲ‬ infection of the anal glands. A Haemorrhoids are symptomatic anal cushions. B Traditionally, four degrees are cases. ❌ C MRI is an essential investigation in all D Classification is into high and low-anal recognised. fistula. C Conservative treatment should be the E The majority can be treated by first line of management. fistulotomy. D Urgent surgery is justified in certain complications. 12. Which of the following statements E Operation when indicated is usually are true? except A MRI and EUS should be undertaken not ❌ necessary carried out by the ‘open technique’. before surgery before surgical treatment. ➜ Pruritis ani B Fistulotomy is the treatment for 9. Which of the following statements are intersphincteric and trans-sphincteric not true? types. A Usually there is an underlying cause. C Setons are used in the treatment of high B Diabetes must be excluded. and complicated fistulae. C Treat the cause of pruritis ani. D Anal advancement flaps aims to Conservative D Surgical treatment is required in the preserve anatomy and function. majority. surgery not treatment E Biological agents have been used with E Hydrocortisone should be the first line variable results. of conservative treatment. Hydrocortisone ointment should not be used Extended matching questions ➜ Diagnoses 1 Anal fissure 2 Anal incontinence 3 Anal intraepithelial neoplasia (AIN) 693