Colorectal 🎗

Question 1

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

Answer 1

CRP ✅💛

Question 2

45 male did rigid sigmoidscopy & found ulcer
Biopsy showed adenoCa what’s next
A. Ct abd
B. Sigmoidectomy
C. Colonoscopy
D. Us abdominal

Answer 2

C. Colonoscopy ✅💛

Note : 1st make sure there is no other cancers then go for staging the same cancer you found

Question 3

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

Answer 3

D. IV antibiotics ✅💛

Question 4

About fistula with discharge , located posterior to anal sphincter what is your mx?
- fistulagram ? Or graphy not sure
- fistulectomy
- lateral internal sphinctertomy
- ??

Answer 4

• fistulectomy ✅

Question 5

Surgery in C3 colon cancer is ?
1. Curative
2. Palliative
3. Diagnostic

Answer 5

1. Curative ✅💛

Question 6

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

Answer 6

1. Focal occult blood annually ✅💛

Note :
- She is above 50y so she can screened via multiple methods
- Colonoscopy > every 10y
- Sigmoidoscopy > every 5y

Question 7

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

Answer 7

1. Observation ✅

Note :
post polypectomy , you will do for them colonoscopy screening later every 5y

Question 8

Q: Sigmoid resection what is the highest rate of the histopathology to be
malignant:
A:
1. Villous = Vilene
2. Tubulovillous

Answer 8

1. Villous = Vilene ✅💛

Question 9

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”

Answer 9

2. Low risk 50 - High risk 10 years younger ✅ 💛

Note : this recommendation is for adult “not male only”

Question 10

patient with UC diagnosed before 6 years on treatment, now complains of perianal pain, asking about when to do colonoscopy screening, you should say

Answer 10

8-10y after the Dx. ✅💛

Question 11

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

Answer 11

1. Colonoscopy ✅💛
   Note :
   it hints you to metastatic CA cancer.

Question 12

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.

Answer 12

Colonoscopy ✅💛

Question 13

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

Answer 13

B-I&D ✅💛

Question 14

🟡 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

Answer 14

Second ✅💛

Question 15

Adenoma screening via colonoscopy timeline ?

Answer 15

🔘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

Question 16

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

Answer 16

Colonoscopy ✅💛

Note :
Dx crohn disease

Question 17

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

Answer 17

Colonoscopy ✅💛

He is old + had 🩸

Question 18

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

Answer 18

drainage ✅💛

Question 19

Q: 65 heavly smoker came for check up what screening inv to do:
A:
1. Osteoporosis
2. Colon cancer
3. Abdomina aortic aneurysm

Answer 19

Colon cancer ✅💛

Note :
All answers are correct but colon cancer consider as (A) in the recommendation , both osteoporosis and AAA consider as (B)

Question 20

Most common site of anal fissure ?
A) Anterior midline
B) Posterior midline

Answer 20

Posterior midline. ✅💛

Question 21

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.

Answer 21

LMWH ✅💛

Question 22

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

Answer 22

Medial posterior 💛✅

Question 23

45y man no Family hx of colon cancer, no risk factor, came for screening ?
A) start screening at 50y
B) start screening now

Answer 23

start screening now ✅💛

Question 24

Which of the following is associated with pruritus ani?
A- Colon cancer
B- Diverticulitis
C- Hemorrhoid
D- Anal abscess

Answer 24

Note :
🔹 Painless pruritus Hemorrhoids
🔹 Painful pruritus Abscess

Question 25

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

Answer 25

Oral Abx ✅💛
And better to go for MRI to see the fistula

Question 26

Female patient came with anal fissure in 6 and 12 hour for 4 weeks

What is the initial treatment?

Deltiazim cream
Surgery
Oral steroid

Answer 26

Deltiazim cream ✅💛

Question 27

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

Answer 27

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

Question 28

Patient complaining of rectal bleeding, sclerotic agent has injected in hemorrhoids, which type of hemorrhoids it was ?
1- external
2- internal
3- thrombosd
4-

Answer 28

internal ✅💛

Question 29

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

Answer 29

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

Question 30

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)

Answer 30

Lifestyle modification (healthy diet and exercise) 💛✅

Note :
It is very low risk adenoma should scope him every 10y

Question 31

25 sep

What is the difference between Crohn and UC
A- Noncaseating granulomas
B- involved the colon
C- Extraintestinal symptoms
D- aphthous ulcer

Answer 31

Noncaseating granulomas 💛✅

Note :

Noncaseating granulomas founded in crohn

Question 32

Elderly female, asymptomatic maybe or just fatigued.
Labs showed microcytic anemia what to do NEXT?
A/ Occult fecal blood
B/ Endoscopy& colonscopy

Answer 32

Next would be Occult fecal blood ✅💛
For screening

Question 33

✅️✅️
#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

Answer 33

antibiotic and observation ✅💛

Note it is small abscess

Question 34

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

Answer 34

B. Us guided drainage ✅💛

Question 35

38 y male complain of constipation for 2 days painful perianal whth positive crack on 6 clock
A. Anal fissure
B. abscess

Answer 35

Anal fissure ✅💛

Question 36

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 )

Answer 36

Surgical debridement ✅💛