GI: Anorectal Disease

Question 1

pt. p/w:

Bright Red Bleeding with BM

Pruritus

Prolapse, sense of perianal fullness

Answer 1

hemorrhoids

Question 2

Which hemorrhoid type is painful?

Answer 2

external

Question 3

Which hemorrhoid Grade?

bulge in anal canal

no prolapse

Answer 3

Grade I

Question 4

Which hemorrhoid Grade?

prolapse reduces spontaneously

Answer 4

Grade II

Question 5

Which hemorrhoid Grade?

prolapse requires manual reduction

Answer 5

Grade III

Question 6

Which hemorrhoid Grade?

chronic prolapse

Answer 6

Grade IV

Question 7

1st line tx for hemorrhoids

Answer 7

Fluid & Fiber

+/- Short Course CS creams/suppositories

Question 8

Procedure for external hemorrhoid…

Answer 8

excision

Question 9

procedure for internal hemorrhoid

Answer 9

rubber band ligation

Question 10

2 indications for hemorrhoidectomy

Answer 10

Grade IV internal

symptomatic Grade III

Question 11

Patient presents w.

Intense itching & Burning
Circumferential erythema

Answer 11

pruritis ani

Question 12

Tx for pruritis ani…

Answer 12

witch hazel

zinc oxide

Question 13

pt. p/w:

Passing glass, sitting on a knife

Bright red blood on TP

Answer 13

anal fissue

Question 14

MC location for anal fissure

Answer 14

posterior midline

Question 15

2 topicals for anal fissure

Answer 15

lidocaine

nifedipine/nitro

Question 16

What condition?

a/w perianal crohn disease
progress to fistula

Answer 16

perianal abscess

Question 17

pt. p/w

Localized anal/rectal pain

Erythematous, palpable fluctuant mass

Surrounding Edema

Answer 17

perianal abscess

Question 18

in addition to DRE, what must be done in PE for perianal abscess?

Answer 18

palpate for inguinal LAD

Question 19

imaging for perianal abscess…

Answer 19

CT/MRI pelvis

Question 20

What condition?

Chronic manifestation of abscess

a/w CD

Answer 20

perianal fistula

Question 21

pt. p/w:

Abscess Drainage
Palpable cord

Answer 21

perianal fistula

Question 22

imaging if complex/recurrent perianal fistula

Answer 22

MRI pelvis

Question 23

imaging if IBD concern w. perianal fistula

Answer 23

colonoscopy

Question 24

Dx imaging for anal condyloma

Answer 24

anoscopy

Question 25

causative agent of anal condyloma

Answer 25

HPV

Question 26

Tx options for anal condyloma

Answer 26

podofilox, imiquimod

in office trichloroacetic acid

Question 27

Cell type for anal cancer?

Answer 27

squamous cells

Question 28

Inguinal LAD should be concerning for…

Answer 28

anal CA

Question 29

patient p/w…what should be on DDx?

Bleed,
Anorectal pain
Sensation of mass
Warts
Skin irritation
Friable ulcerations
External lesions

Answer 29

anal CA

Question 30

anal CA dx…

Answer 30

Scope + Bx

Question 31

Pt. complains of…

constipation/fecal incontinence
Incomplete evacuation
Seepage
Mass protruding thru anus

Answer 31

rectal prolapse

Question 32

On PE, you notice…

Protrusion when straining

Answer 32

rectal prolapse

Question 33

on DRE you notice

Mucosa of rectal wall feels floppy, loose

Answer 33

rectal prolapse

Question 34

2 tests in addition to clinical presentation for rectal prolapse…

Answer 34

defecography, anorectal manometry

Question 35

Tx for rectal prolapse

Answer 35

surgery

Question 36

Patient p/w…

Need to apply pressure on vagina to defecate
Pelvic pressure
Constipation
Fecal incontinence
Sexual dysfunction

Answer 36

rectocele