Colorectal 🎗 Flashcards
216.Patient with sudden severe epigastric pain for 8h associated with
vomiting and nausea, on examination epigastric tenderness,,,labs only
given elevated amylase. What is most helpful to determine the disease
severity or some thing like thing:?
A.Procalcitonin
B.ESR
C.CRP
D.Alt
CRP ✅💛
45 male did rigid sigmoidscopy & found ulcer
Biopsy showed adenoCa what’s next
A. Ct abd
B. Sigmoidectomy
C. Colonoscopy
D. Us abdominal
C. Colonoscopy ✅💛
Note : 1st make sure there is no other cancers then go for staging the same cancer you found
26 Y.O female diagnosed with Crohn’s disease. On endoscopy she had 1cm
stricture in the terminal ilium. What is the most appropriate next step?
A. Strictureplasty
B. Small bowel resection
C. Resection with ileostomy
D. IV antibiotics
D. IV antibiotics ✅💛
About fistula with discharge , located posterior to anal sphincter what is your mx?
- fistulagram ? Or graphy not sure
- fistulectomy
- lateral internal sphinctertomy
- ??
- fistulectomy ✅
Surgery in C3 colon cancer is ?
1. Curative
2. Palliative
3. Diagnostic
- Curative ✅💛
Q: A 52 y/o female came to your clinic for colon cancer screen, not known to have any
chronic disease before, with negative family history, what to tell her ?
A:
1. Focal occult blood annually
2. Colonoscopy every 5 years
3. Sigmoidoscopy every 10 years
- Focal occult blood annually ✅💛
Note :
- She is above 50y so she can screened via multiple methods
- Colonoscopy > every 10y
- Sigmoidoscopy > every 5y
Q: Patient had a sigmoid polyp removed. They found on histopathology well
differentiated adenocarcinoma and the margins are free from cancer. What is the
best next step?
A:
1. Observation
2. Segmoidectomy
3. Segmental colectomy
4. Fulguration of the polyp site
- Observation ✅
Note :
post polypectomy , you will do for them colonoscopy screening later every 5y
Q: Sigmoid resection what is the highest rate of the histopathology to be
malignant:
A:
1. Villous = Vilene
2. Tubulovillous
- Villous = Vilene ✅💛
Q: 45 yo female came for colonoscopy screening ?
A:
1. Till her that screening start at 50 of age
2. Low risk 50 - High risk 10 years younger
Note : this recommendation is for adult “not male only”
- Low risk 50 - High risk 10 years younger ✅ 💛
Note : this recommendation is for adult “not male only”
patient with UC diagnosed before 6 years on treatment, now complains of perianal pain, asking about when to do colonoscopy screening, you should say
8-10y after the Dx. ✅💛
Q: Pt with abdominal pain, imaging shows: increase thickness of sigmoid and thumb print due to edema. What is the next step??
A:
1. Colonoscopy
2. Diagnostic laparoscopy
3. Exploratory laparotomy
- Colonoscopy ✅💛
Note :
it hints you to metastatic CA cancer.
Q: Old patient with worsening of his constipation, labs shows
positive occult blood in stool. Colon cancer suspected what to do?
A:
1. Colonoscopy
2. sigmoidoscopy
3. CT abdomen.
Colonoscopy ✅💛
44 YO presents with perianal pain. He complains of perinal pain accompanied by loose stools which are sometimes bloody. He also complains of colicky abdominal pain on and off for a few months.
O/E there is a hot, tender perianal mass with fluctuation.
Vitals:
BP: 123/65
HR: 106
T: 39.1
O2: 100%
Labs:
WBC 19
Most appropriate step of treatment
A-IV antibiotics
B-I&D
C-MRI pelvis
D-Abdominal ultrasound
B-I&D ✅💛
🟡 554-case of LGIB, in examination there is internal hemorrhoids and described it ( prolapse and spontaneously reduced, which degree?
1. A- first
2. B- second
3. C- third
4. B- fourth
Second ✅💛
Adenoma screening via colonoscopy timeline ?
🔘1cm or above :
Any type it would be > every 3y
🔘Less than 1cm :
🔸Low risk :
1-2 tubular adenom
screen every 10y
🔸Intermittent risk :
3-4 tubular adenoma or
Seesile serrated polyps
Screen every 5y
34 male foul smell opening at 3,5,7 o’clock Proctoscope normal, no git s/ s what to do:
A. Colonoscope
B. Fistulogram
C. Pelvic mri
D. Rectal ultrasound
Colonoscopy ✅💛
Note :
Dx crohn disease
Elderly male pt present with hx of bleeding on defecation On examination there is anal hemorrhoid stage 3 What is your next step in management?
A) Colonoscopy
B) Excision
C) CT abdomen
D) Band ligation
Above 40y + hemorrhoids → must be scoped
Colonoscopy ✅💛
He is old + had 🩸
Q: Old male with a history of Crohn’s after abdominal surgery with about 1 month
developed vague abdominal pain & fever. By rectal examination, there was boggy swelling anteriorly. What is the next step in management?
A:
1. AB
2. drainage
3. metronidazole
4. steroids
drainage ✅💛
Q: 65 heavly smoker came for check up what screening inv to do:
A:
1. Osteoporosis
2. Colon cancer
3. Abdomina aortic aneurysm
Colon cancer ✅💛
Note :
All answers are correct but colon cancer consider as (A) in the recommendation , both osteoporosis and AAA consider as (B)
Most common site of anal fissure ?
A) Anterior midline
B) Posterior midline
Posterior midline. ✅💛
A 66 years old female admitted to general surgery ward after major rectal surgery, on the second day she developed leg swelling on the side of the operation. investigations showed DVT on the femoral vein. the best management to this patient is:
A. LMWH.
B. Thrombolytic therapy.
C. Warfarin.
D. Inferior vena cava filter.
LMWH ✅💛
Patient found to have anal fistula on 7 o’clock. Most common anal fistula internal opening is ?
A. Left lateral
B. Medial posterior
C. Medial anterior
Medial posterior 💛✅
45y man no Family hx of colon cancer, no risk factor, came for screening ?
A) start screening at 50y
B) start screening now
start screening now ✅💛
Which of the following is associated with pruritus ani?
A- Colon cancer
B- Diverticulitis
C- Hemorrhoid
D- Anal abscess
Note :
🔹 Painless pruritus Hemorrhoids
🔹 Painful pruritus Abscess
Young male presented complaining of perianal discharge not febrile and no other associated Sx. On PE perianal external fistula was appreciated. What is the next strp
A- oral abx
B- discharge and review in outpatient clinic
C- pelvic CT
D- bedside aspiration
Oral Abx ✅💛
And better to go for MRI to see the fistula
Female patient came with anal fissure in 6 and 12 hour for 4 weeks
What is the initial treatment?
Deltiazim cream
Surgery
Oral steroid
Deltiazim cream ✅💛
63 years old male came with rectal bleeding with unintentional weight loss, he was pale, on PE empty rectum and no masses were identified but bleeding with fresh blood was noted. Which of the following is most appropriate next step?
- proctoscopy
- colonoscopy
- UGI Endoscopy
- fecal occult blood
colonoscopy ✅💛
Note :
If there is things rise your suspicion for upper GI go for endoscopy otherwise go with B
1. Hemodynamic instability
2. Clot are indicator for lower
3. High BUN or creatinine
4. Orthostatic hypotension
Patient complaining of rectal bleeding, sclerotic agent has injected in hemorrhoids, which type of hemorrhoids it was ?
1- external
2- internal
3- thrombosd
4-
internal ✅💛
Case scenario for pt post Low anterior resection 10th day
develop fever and abdominal pain CT abdomen revealed 8x8 cm
pelvic collection at site of anastamosis
what is the next:
A. Percutaneous drainage
B. Re exploration and anastomosis repair
C. Drainage with stoma
D. Conservative It with Abx
Percutaneous drainage ✅💛
Note :
According to UTD
Initial is CT
Next
If free fluid or signs of peritonitis = re explore
If collection:
Less than 3cm = broad IV Abx
More than 3cm (same in our case) = Percutaneous drainage
After resection of a pedunculated polyp the results was benign adenoma and patient has no family history
of colon cancer what to advice for reduction of colon cancer?
A. Prophylactic sigmoidectomy
B. Prophylactic colectomy
C. Annual colonoscopy
D. Lifestyle modification (healthy diet and exercise)
Lifestyle modification (healthy diet and exercise) 💛✅
Note :
It is very low risk adenoma should scope him every 10y
25 sep
What is the difference between Crohn and UC
A- Noncaseating granulomas
B- involved the colon
C- Extraintestinal symptoms
D- aphthous ulcer
Noncaseating granulomas 💛✅
Note :
Noncaseating granulomas founded in crohn
Elderly female, asymptomatic maybe or just fatigued.
Labs showed microcytic anemia what to do NEXT?
A/ Occult fecal blood
B/ Endoscopy& colonscopy
Next would be Occult fecal blood ✅💛
For screening
✅️✅️
#colorectal
64 years old, male, abominal pain with bloody diarrhea O / E: left lower abominal tenderness Ct showed 2x2cm (20ml) collection in the sigmoid:
1 diagnostic laproscopy
2 expl lap
3 antibiotic and observation
4 us guided aspiration
antibiotic and observation ✅💛
Note it is small abscess
Patient did surgery after rectal perforation after 3 days developed a spiking fever, the surgical wound is clean and no discharge, upon Digital rectal exam you found boggy mass, WBC is high, what is the most appropriate action:
A. IV ABX
B. Us guided drainage
B. Us guided drainage ✅💛
38 y male complain of constipation for 2 days painful perianal whth positive crack on 6 clock
A. Anal fissure
B. abscess
Anal fissure ✅💛
9- Immunocomprimised patient present with painful perianal mass, showing flucutation , crepitus and foul smelling , most appropriate treatmemt is :
1- Penecillin G infusion
2- Surgical debridement
3- Aspiration
4-Forget but irrelvant
( No other Abx or drainge at all )
Surgical debridement ✅💛
