AIt is usually congenital.BThe primary sinuses are always in themidline between the sacrococcygeal jointand the tip of coccyx.CBascom’s procedure involves a midlineincision directly over the sinus cavity.DThe Karydakis operation avoids a midlinescar.EIt is more common in women.➜Anal incontinence5. Which of the following statementsabout anal incontinence are true?AThe most common cause of analsphincter disruption is obstetricdamage.BAnal incontinence cannot occur in theabsence of sphincter disruption.CDouble overlap repair is the standardtechnique to repair discrete muscledisruption.DGracilis muscle transposition can beeffective in approximately 20 per cent ofpatients in the long term.ESacral nerve stimulation works byneurophysiological modulation of thehindgut by stimulation of the sacral nerveroots.
69:THE ANUS AND ANAL CANAL505➜Anal fissure6.Which of the following statementsregarding anal fissure are true?AIt is a longitudinal split in the lowerrectal mucosa.BIt is most common in the posterior wall.CThe common finding is a hypotonicanal sphincter.DOperation can be avoided in about 50per cent of patients by the use of localagents like glyceryl trinitrate (GTN) orDiltiazem.EThe most important complicationafter lateral internal sphincterotomy isincontinence, which may affect up to30 per cent of patients.➜Haemorrhoids7.Which of the following statementsabout haemorrhoids are true?AMost haemorrhoids are congenital.BPain is rare in uncomplicated grade1 haemorrhoids.CPiles which remain permanentlyprolapsed are called grade3 haemorrhoids.DPortal pyaemia is a rare but knowncomplication of haemorrhoids.EProfuse haemorrhage is never seen.8.Which of the following statementsregarding management of piles aretrue?ASubmucosal injection of 50 per centphenol is an effective treatment forgrade 1 piles.BBanding of piles involves application oftight elastic bands onto the base of thepedicle which cause ischaemic necrosisof the piles.CCryotherapy and infrared coagulationare also methods of treating piles.DMilligan–Morgan haemorrhoidectomyis a closed technique where the pilesare excised and the mucosa completelyclosed.EStapled haemorrhoidectomy is amethod where a special stapling gunis used to excise a strip of mucosa andsubmucosa.➜Pruritus ani9.Which of the following statementsregarding pruritus ani are true?AIt is a common problem.BThe perianal skin is usually normal.CThreadworms need to be excluded,especially in young patients.DSkin biopsies may sometimes beneeded to confirm diagnosis.EWashing the area with soap can behelpful.➜Perianal abscess10. Which of the following statementsregarding perianal abscesses are true?AThey present as a painful, throbbingswelling in the perianal area.
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