Lower GI

Question 1

The initial step for case of massive lower GI bleeding is […]

Answer 1

NGT aspiration
to r/o UGIB

Question 2

Lower GI bleeding
ABC - NGT aspiration is negative -» […]
Your next step is

Answer 2

Colonoscopy

Question 3

Lower GI bleeding
NGT aspiration greenish -» colonoscopy normal mucosa -» […]
Your next step

Answer 3

99Tc
to look for angiodysplasia

Question 4

Lower GI bleeding
ABC - […] -» […] -» […]

Answer 4

NGT aspiration -» colonoscopy -» 99Tc

Question 5

Most common cause of lower GI bleeding

Answer 5

Diverticular disease

Question 6

Elderly + recurrent painless lower GI bleeding
Colonoscopy: normal mucosa
Most likely diagnosis […]

Answer 6

Angiodysplasia

Question 7

Pediatric + recurrent painless lower GI bleeding
Colonoscopy: normal mucosa
Most likely diagnosis […]

Answer 7

Meckel’s diverticulum

Question 8

LLQ pain case of uncomplicated small size diverticulitis.
Most appropriate management:

Answer 8

Conservative IV Antibiotics

Question 9

LLQ pain case of diverticulitis size >6cm, unstable.
Most appropriate management:

Answer 9

Percutaneous Drainage

Question 10

Most common (preventable) cause of Blood in stool in pediatric patient:

Answer 10

anal fissure

Question 11

Presentation of anal fissure:

Answer 11

Pain while Pooping
blood on toilet Paper
located Posteriorly (Poorly Perfused)

Question 12

Anal fissure
Management:

Answer 12

1: diltiazem (chemical sphincterotomy)

#2: LIS
Lateral internal sphincterotomy

Question 13

Anal fistula
May present with Pain, discharge & recurrent perirectal abscess
Management is […]

Answer 13

Fistulotomy

Question 14

Most common anal fistula internal opening is […]

Answer 14

medial posterior

Question 15

[…] disease should be considered with fistula in ano. […] is recommended to confirm

Answer 15

Crohn’s
Colonoscopy

Question 16

If patient of Crohn’s present with complicated anal fistula. (complicated fistula: recurrent, multiple, with discharge)
Your next step is […]

Answer 16

MRI
Antibiotics & infliximab

Question 17

Anal pathologies presentation:
[…]: Pain with defecation, blood in toilet paper
[…]: Pain, discharge (pus)
[…]: painless perianal swelling
[…]: tender perianal swelling
[…]: tender perianal swelling + fever & 🔺wbc

Answer 17

[Fissure]
[Fistula]
[prolapsed pile]
[Thrombosed pile/hematoma]
[Anal abscess]: I&D

Question 18

When should patient with IBD be screened for colon cancer?

Answer 18

8-10 years after diagnosis

Question 19

Case of IBD with contrast barium: single stricture at terminal ileum 1 cm from ileocecal valve.
Most appropriate management:

Answer 19

Segmental resection with ileostomy

Question 20

Stages of hemorrhoids:

Answer 20

1: no prolapse
2: spontaneously reduced
3: manually reduced
4: irreducible

Question 21

Treatment for stage2 hemorrhoids:

Answer 21

Conservative
Then band ligation

Question 22

Treatment for stage3 hemorrhoids:

Answer 22

If bleeding: band ligation
No bleeding: hemorrhoidectomy

Question 23

Treatment for stage4 hemorrhoids:

Answer 23

Hemorrhoidectomy

Question 24

[…] hemorrhoid can be treated with sclerotherapy

Answer 24

Internal
Sclerotherapy = scarring

Question 25

Elderly + hemorrhoids & IDA
Your next step in management […]

Answer 25

Colonoscopy

Question 26

Anal pruritus, weight loss
O/E: anal mass that is 2 cm away from anal verge, cauliflower like & friable
Diagnosis: […]

Answer 26

Anal cancer

Question 27

A male truck driver has painful swelling between his gluteal fold.
Most likely diagnosis : […]
Tx : […]

Answer 27

Pilonedal abscess
Surgical drainage

Question 28

[…] may be a complication post hemorrhoidectomy present with perianal pain and constipation

Answer 28

Anal stenosis