VSIM Marvin Hayes: Rectal Cancer | Final
Exam Study Guide – Clinical Q&A
Note: This guide contains 100 structured questions and answers covering core concepts for the
Marvin Hayes VSIM on Rectal Cancer. A ✔ denotes the single best or correct answer.
Section 1: Patient History & Risk Factors
1. What is the most significant risk factor for colorectal cancer identified in Marvin Hayes'
history?
a) High-fiber diet
b) Family history of prostate cancer ✔
c) Occasional alcohol use
d) History of hemorrhoids
2. Marvin Hayes' family history includes a father with colorectal cancer at age 68. How does
this affect his risk?
a) It doubles his lifetime risk. ✔
b) It has no significant impact.
c) It triples his risk only if the relative was under 50.
d) It is only relevant if the mother had it.
3. What modifiable risk factor for colorectal cancer is evident in Marvin's initial presentation?
a) Smoking history ✔
b) Sedentary lifestyle
c) High red meat consumption
d) Obesity
4. Which symptom reported by Marvin is a classic "red flag" for rectal cancer?
a) Intermittent headache
b) Tenesmus (feeling of incomplete evacuation) ✔
c) Generalized fatigue
d) Occasional heartburn
Section 2: Clinical Presentation & Assessment
,5. Marvin presents with hematochezia. What is the key clinical distinction of this in rectal
cancer vs. hemorrhoids?
a) Color of the blood (bright red vs. dark)
b) The blood is mixed with stool or mucus in cancer. ✔
c) Pain always accompanies hemorrhoidal bleeding.
d) There is no reliable clinical distinction.
6. Which finding on digital rectal exam (DRE) is most suggestive of a rectal tumor?
a) Internal hemorrhoids
b) A palpable, firm, ulcerated mass ✔
c) Good sphincter tone
d) Occult blood alone
7. What is the primary purpose of a colonoscopy in Marvin's diagnostic workup?
a) To relieve obstruction
b) To visualize the lesion and obtain a biopsy ✔
c) To stage the cancer
d) To assess for distant metastasis
8. Why is a rigid proctoscopy/sigmoidoscopy particularly useful in rectal cancer?
a) It requires no bowel prep.
b) It more accurately measures the tumor's distance from the anal verge. ✔
c) It is less painful for the patient.
d) It can visualize the entire colon.
Section 3: Diagnostics & Staging
9. What is the gold standard diagnostic test for confirming rectal adenocarcinoma?
a) CT scan
b) Carcinoembryonic Antigen (CEA) level
c) Histopathological analysis of biopsy ✔
d) Positron Emission Tomography (PET) scan
10. The biopsy of Marvin's lesion returns as adenocarcinoma. What is the next critical step in
management?
a) Immediate surgery
b) Local staging with MRI pelvis ✔
c) Initiation of chemotherapy
d) Palliative care referral
,11. Why is an MRI of the pelvis essential for local staging of rectal cancer?
a) To evaluate the liver for metastasis.
b) To assess the mesorectal fascia, T-stage, and N-stage accurately. ✔
c) It is cheaper than a CT scan.
d) To diagnose lung metastases.
12. A CT scan of the chest, abdomen, and pelvis is performed primarily to evaluate for what?
a) Local tumor invasion depth
b) Synchronous colon lesions
c) Distant metastasis (M-stage) ✔
d) Lymphovascular invasion
13. What does the "T3 N1b M0" staging classification indicate?
a) Tumor invades submucosa with one lymph node involved.
b) Tumor invades through the muscularis propria into perirectal tissue, with 2-3 regional lymph
nodes involved, no distant mets. ✔
c) Tumor invades adjacent organs with extensive nodal disease.
d) Tumor confined to mucosa with distant metastasis.
14. What is the significance of the tumor being 6 cm from the anal verge?
a) It is always considered a low rectal cancer.
b) It influences surgical options (e.g., potential for sphincter-sparing surgery). ✔
c) It automatically means a permanent colostomy is needed.
d) It has no bearing on treatment.
15. An elevated CEA level at diagnosis is used primarily for what purpose?
a) As a definitive diagnostic tool.
b) To monitor response to therapy and recurrence. ✔
c) To determine the need for radiation.
d) To assess tumor differentiation.
Section 4: Treatment Principles & Neoadjuvant Therapy
16. For a locally advanced rectal cancer (like T3 N+), what is the current standard of care
before surgery?
a) Surgery first, followed by chemoradiation.
b) Neoadjuvant chemoradiation therapy (nCRT) ✔
c) Chemotherapy alone
d) Radiation therapy alone
, 17. What is the primary goal of neoadjuvant chemoradiation for rectal cancer?
a) Cure metastatic disease.
b) Downstage the tumor, increase resectability, and lower local recurrence. ✔
c) Relieve symptoms of obstruction.
d) Replace the need for surgery.
18. Which chemotherapy agent is most commonly combined with radiotherapy in nCRT for
rectal cancer?
a) Irinotecan
b) Oxaliplatin
c) 5-Fluorouracil (5-FU) or Capecitabine ✔
d) Bevacizumab
19. After completing neoadjuvant chemoradiation, what is the typical waiting period before
surgery?
a) 1-2 weeks
b) 6-12 weeks ✔
c) 6 months
d) Immediately
20. What is the purpose of the post-nCRT waiting period?
a) To allow the patient to recover strength.
b) To allow for maximum tumor regression. ✔
c) To repeat all staging scans.
d) To start adjuvant chemotherapy.
Section 5: Surgical Management
21. The planned surgery for Marvin is a low anterior resection (LAR). What does this
procedure involve?
a) Removal of the rectum and anus with permanent colostomy.
b) Removal of the rectal tumor with anastomosis, preserving the anal sphincter. ✔
c) Local excision of the tumor via the anus.
d) Diverting loop colostomy only.
22. What critical surgical principle for rectal cancer involves removal of the fatty tissue
surrounding the rectum?
a) Hemicolectomy
b) Total Mesorectal Excision (TME) ✔
Exam Study Guide – Clinical Q&A
Note: This guide contains 100 structured questions and answers covering core concepts for the
Marvin Hayes VSIM on Rectal Cancer. A ✔ denotes the single best or correct answer.
Section 1: Patient History & Risk Factors
1. What is the most significant risk factor for colorectal cancer identified in Marvin Hayes'
history?
a) High-fiber diet
b) Family history of prostate cancer ✔
c) Occasional alcohol use
d) History of hemorrhoids
2. Marvin Hayes' family history includes a father with colorectal cancer at age 68. How does
this affect his risk?
a) It doubles his lifetime risk. ✔
b) It has no significant impact.
c) It triples his risk only if the relative was under 50.
d) It is only relevant if the mother had it.
3. What modifiable risk factor for colorectal cancer is evident in Marvin's initial presentation?
a) Smoking history ✔
b) Sedentary lifestyle
c) High red meat consumption
d) Obesity
4. Which symptom reported by Marvin is a classic "red flag" for rectal cancer?
a) Intermittent headache
b) Tenesmus (feeling of incomplete evacuation) ✔
c) Generalized fatigue
d) Occasional heartburn
Section 2: Clinical Presentation & Assessment
,5. Marvin presents with hematochezia. What is the key clinical distinction of this in rectal
cancer vs. hemorrhoids?
a) Color of the blood (bright red vs. dark)
b) The blood is mixed with stool or mucus in cancer. ✔
c) Pain always accompanies hemorrhoidal bleeding.
d) There is no reliable clinical distinction.
6. Which finding on digital rectal exam (DRE) is most suggestive of a rectal tumor?
a) Internal hemorrhoids
b) A palpable, firm, ulcerated mass ✔
c) Good sphincter tone
d) Occult blood alone
7. What is the primary purpose of a colonoscopy in Marvin's diagnostic workup?
a) To relieve obstruction
b) To visualize the lesion and obtain a biopsy ✔
c) To stage the cancer
d) To assess for distant metastasis
8. Why is a rigid proctoscopy/sigmoidoscopy particularly useful in rectal cancer?
a) It requires no bowel prep.
b) It more accurately measures the tumor's distance from the anal verge. ✔
c) It is less painful for the patient.
d) It can visualize the entire colon.
Section 3: Diagnostics & Staging
9. What is the gold standard diagnostic test for confirming rectal adenocarcinoma?
a) CT scan
b) Carcinoembryonic Antigen (CEA) level
c) Histopathological analysis of biopsy ✔
d) Positron Emission Tomography (PET) scan
10. The biopsy of Marvin's lesion returns as adenocarcinoma. What is the next critical step in
management?
a) Immediate surgery
b) Local staging with MRI pelvis ✔
c) Initiation of chemotherapy
d) Palliative care referral
,11. Why is an MRI of the pelvis essential for local staging of rectal cancer?
a) To evaluate the liver for metastasis.
b) To assess the mesorectal fascia, T-stage, and N-stage accurately. ✔
c) It is cheaper than a CT scan.
d) To diagnose lung metastases.
12. A CT scan of the chest, abdomen, and pelvis is performed primarily to evaluate for what?
a) Local tumor invasion depth
b) Synchronous colon lesions
c) Distant metastasis (M-stage) ✔
d) Lymphovascular invasion
13. What does the "T3 N1b M0" staging classification indicate?
a) Tumor invades submucosa with one lymph node involved.
b) Tumor invades through the muscularis propria into perirectal tissue, with 2-3 regional lymph
nodes involved, no distant mets. ✔
c) Tumor invades adjacent organs with extensive nodal disease.
d) Tumor confined to mucosa with distant metastasis.
14. What is the significance of the tumor being 6 cm from the anal verge?
a) It is always considered a low rectal cancer.
b) It influences surgical options (e.g., potential for sphincter-sparing surgery). ✔
c) It automatically means a permanent colostomy is needed.
d) It has no bearing on treatment.
15. An elevated CEA level at diagnosis is used primarily for what purpose?
a) As a definitive diagnostic tool.
b) To monitor response to therapy and recurrence. ✔
c) To determine the need for radiation.
d) To assess tumor differentiation.
Section 4: Treatment Principles & Neoadjuvant Therapy
16. For a locally advanced rectal cancer (like T3 N+), what is the current standard of care
before surgery?
a) Surgery first, followed by chemoradiation.
b) Neoadjuvant chemoradiation therapy (nCRT) ✔
c) Chemotherapy alone
d) Radiation therapy alone
, 17. What is the primary goal of neoadjuvant chemoradiation for rectal cancer?
a) Cure metastatic disease.
b) Downstage the tumor, increase resectability, and lower local recurrence. ✔
c) Relieve symptoms of obstruction.
d) Replace the need for surgery.
18. Which chemotherapy agent is most commonly combined with radiotherapy in nCRT for
rectal cancer?
a) Irinotecan
b) Oxaliplatin
c) 5-Fluorouracil (5-FU) or Capecitabine ✔
d) Bevacizumab
19. After completing neoadjuvant chemoradiation, what is the typical waiting period before
surgery?
a) 1-2 weeks
b) 6-12 weeks ✔
c) 6 months
d) Immediately
20. What is the purpose of the post-nCRT waiting period?
a) To allow the patient to recover strength.
b) To allow for maximum tumor regression. ✔
c) To repeat all staging scans.
d) To start adjuvant chemotherapy.
Section 5: Surgical Management
21. The planned surgery for Marvin is a low anterior resection (LAR). What does this
procedure involve?
a) Removal of the rectum and anus with permanent colostomy.
b) Removal of the rectal tumor with anastomosis, preserving the anal sphincter. ✔
c) Local excision of the tumor via the anus.
d) Diverting loop colostomy only.
22. What critical surgical principle for rectal cancer involves removal of the fatty tissue
surrounding the rectum?
a) Hemicolectomy
b) Total Mesorectal Excision (TME) ✔
