Anorectal

Question 1

Resection in low vs. high rectal tumors

Answer 1

Low anterior resection in high tumor. Abdominoperineal resection in low tumor

Question 2

Diagnosis of rectal cancer

Answer 2

palpable on DRE (maybe), biopsy on colonoscopy or anoscopy, endorectal US or CT/MRI for staging

Question 3

Anal canal cancer associated with…

Answer 3

HPV. also cervical, vaginal cancer hx, immunosuppression, long-term steroids, cigarette smoking

Question 4

Tumor is internal, aggressive biologic behavior, non-keratinizing, and associated with HPV infection-

Answer 4

tumor of anal canal

Question 5

External tumor, well differentiated, keratinizing

Answer 5

tumor of anal margin

Question 6

Workup of anal and perianal cancer

Answer 6

DRE, anoscopy, palpation of inguinal nodes

Question 7

Tumors of the anal canal (internal cancers)

Answer 7

Epidermoid, melanoma, small cell

Question 8

Tumors of the anal margin (external cancers)

Answer 8

basal cell, bowen disease, paget disease, squamous cell

Question 9

Bowen’s disease aka

Answer 9

intraepithelial squamous cell carcinoma

Question 10

Paget disease aka

Answer 10

Intraepithelial adenocarcinoma

Question 11

Which of the anal margin tumors can crossover and involve both anal margin and anal canal?

Answer 11

Bowen’s disease

Question 12

Bowen’s disease associated with…

Answer 12

condyloma

Question 13

split or rip in the anoderm at midline…

Answer 13

anal fissure

Question 14

Patient presents with severe burning and ripping pain that is worst right after BM. It usually lasts 1-3 hours. Bleeding occurs that makes water in toilet red. Sentinel pile seen on PE. Also see hypertrophied papilla and fissure. Dx?

Answer 14

anal fissure

Question 15

triad in anal fissure

Answer 15

fissure, sentinel pile, and hypertrophied papilla

Question 16

Anal fissure tx

Answer 16

sitz baths, lidocaine, vidodin, fiber, milk of magnesia, hydrocortisone cream, nitroglycerine, nifedipine ointment, botulinum toxin injection

Question 17

origin of anorectal abscess

Answer 17

cryptoglandular

Question 18

types of anorectal abscess

Answer 18

perirectal, ischiorectal, perianal, intersphicteric

Question 19

Perianal abscess tx

Answer 19

drained under local anesthesia

Question 20

intersphincteric abscess tx

Answer 20

drained in OR under anesthesia

Question 21

Ischiorectal and perirectal abscess

Answer 21

drained by catheter placement or I&D under anesthesia

Question 22

Fistuala in ano usually result from…

Answer 22

abscess in adults

Question 23

fistula in ano emergency?

Answer 23

No

Question 24

Tx of fistula in ano if internal sphincter involved

Answer 24

internal sphincterotomy

Question 25

tx of fistula in ano if external sphincter involved

Answer 25

Collagen fistula plug, mucosal advancement flap, seton placement

Question 26

When do hemorrhoids become pathologic?

Answer 26

When they are chronically engorged with blood

Question 27

causes of hemorrhoids

Answer 27

pregnancy, obesity, straining. lifting, cirrhossi

Question 28

Locations of hemorrhoids

Answer 28

3 major pedicles- L lateral, R anterior and posterior. And 3 minor pedicles- R lateral, L anterior and posterior

Question 29

patient presents with painless rectal bleeding,mucus discharge, rectal fullness or discomfort. Cannot be palpated on DRE. ORder anoscopy- see...

Answer 29

internal hemorrhoid

Question 30

Grade 1 -IV internal hemorrhoid

Answer 30

1- do not come out. 2- come out but spontaneously reduce. 3- come out but can be pushed back in. 4- cannot push back in

Question 31

Tx of Grade 1 and II internal hemorrhoids

Answer 31

fiber, cathartics, hydrocortisone. otherwise rubber band ligation, or sclerotherapy

Question 32

tx of Grade III and IV internal hemorrhiods

Answer 32

excised, removed with PPH- removes a ring of tissue above dentate line

Question 33

tx of thrombosed external hemorrhoids and anal fissure

Answer 33

sitz baths, lidocaine, vicodine, mild of magnesia, hydrocrotisone

Question 34

Thrrombosed external hemorrhoids have severe pain that peaks at

Answer 34

48-72 hours, then subsides over a week

Question 35

Thrombosed external hemorrhoid turns into...

Answer 35

skin tag

Question 36

patient presents with severe perianal itching that is worse at night. Skin white and leathery. Dx?

Answer 36

pruritis ani

Question 37

Pruritis ani causes

Answer 37

poor hygiene/seepage, excessive hygiene, moisture, yeaast, pinworms- in children

Question 38

Pruritis ani tx

Answer 38

keep area dry, baby wipes for hygiene, avoid soap, too much hygiene not good either

Question 39

Proctalgia fugax aka

Answer 39

levator ani syndrome

Question 40

L-sided, short lived pain that awakens person from sleep.Pain relieved by heat, defecation, muscle relaxants. Migraines history, and stress can set it off

Answer 40

Proctalgia fugax

Question 41

cyst full of hair in the intragluteal fold, single or multiple sinuses in midline of intragluteal fold (in chronic form)

Answer 41

pilonidal disease

Question 42

tx of pilonidal disease

Answer 42

phase 1- abscess I&D, oral abs. Phase 2- remove focus, excise cyst and contents.

Question 43

Pilonidal disease associated with

Answer 43

poor hygiene and hairiness