1. Shane McNevin MD FASCRS Spokane, WA

2.  None except I took the ABCRS qualifying/certifying exam before the emphasis on good question writing

3.  Why write test questions for ABCRS  Goals for good question writing  Inspiration for questions  Techniques for writing a good stem

4.  Disadvantages  Hard work  After hours  No recognition  Advantages  Deeper clinical knowledge  Participation in education  Route to leadership position

5.  Clinical knowledge  Does examinee have the requisite knowledge to practice colorectal surgery  Education  Imparting clinical knowledge to next generation of surgeons

6.  We take the written and oral boards everyday!  Derive questions from your own clinical practice  Take pictures of interesting clinical phenomena  Save radiographs from exemplary clinical situations

7.  ABCRS Manual for Question Writers  Read it  Know it  Live it  A good question writes itself from a good key concept

8.  Bad key concept  Management of anal fissures  Good key concept  Chronic anal fissure failing medical management can be treated with lateral internal sphincterotomy

9.  A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The most appropriate treatment is:

10.  Concise  Non-ambiguous  Testing clinical knowledge not English comprehension  Controversial/Judgement  consistent with ASCRS textbook

11.  A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a family history of colorectal cancer. He occasionally has fecal urgency with liquid stool. His vital signs show a heart rate of 65 and blood pressure of 130/80. He has a posterior fissure, grade II internal hemorrhoids and several small anal tags on examination. He has been treated with topical diltiazem ointment without improvement. He is also taking docusate sodium, hydrocodone and ibuprofen. The most appropriate treatment is:

12.  A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The least appropriate treatment is:

13.  A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. Which of the following is true regarding the CEA?

14.  A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. All of the following are true regarding the CEA except:

15.  Surgeons taking this exam are newly out of fellowship  We want people to hit singles not swing for the fence  Usually direct people to the safest and most conservative approach

16.  A 25 year old man with genetically proven familial polyposis presents for discussion of prophylactic colectomy. His rectum is carpeted with polyps and he would prefer a sphincter preserving option. The most appropriate management is:  Total colectomy with ileorectal anastomosis  One stage restorative proctocolectomy  Two stage restorative proctocolectomy  Proctocolectomy with ileostomy

17.  A 45 year old healthy woman is taken to surgery urgently for class III sigmoid diverticulitis. Intra-operatively her vital signs are normal, she has limited purulent peritonitis and a short segment of inflamed sigmoid colon. The most appropriate management is:  Resection, primary anastomosis  Resection, protected anastomosis  Hartmann’s resection  Loop transverse colostomy

18.  A good question answers itself!  1 + 2 = ?

19.  A 35 year old man presents with a 6 month history of severe anal pain and bleeding during defecation. He has a posterior fissure on examination. He has been treated with topical diltiazem ointment without improvement. The most appropriate treatment is:

20.  A 50 year old man is diagnosed with a cecal cancer. Computed tomography of the abdomen shows no evidence of metastatic disease. His preoperative CEA is 25. The clinical impact of the elevated preoperative CEA is:

21.  Clinical practice in reality  Synthesize clinical information  Make a diagnosis  Develop a plan  First order questions  Simply making diagnosis  “simple recall”  Second order questions  Develop plan based on scenario  Preferred

22.  A 42 year old woman presents with a newly diagnosed mucinous adenocarcinoma of the cecum. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most likely diagnosis is:

23.  A 42 year old woman presents with a newly diagnosed mucinous adenocarcinoma of the cecum. Her family history is significant for her mother having endometrial cancer at age 52 and maternal grandmother having colon cancer at age 48. The most appropriate next step is:

24.  A 52 year old woman is diagnosed with a cecal cancer. Staging computed tomography is shown. The most appropriate treatment is:

25.  A 30 year old woman presents with a history of recurrent perineal and perianal infections. Physical examination findings are shown. The pathophysiology of this disorder is:

26.  Use the ABCRS Manual for Question Writers  Keep questions concise, non-ambigous and appropriately formatted  Avoid controversial topics and answers  Write questions that don’t require the answers to complete  Write second order questions when possible  HAVE FUN