Anorectal & GU

Question 1

What is transanal hemorrhoidal dearterialization (THD)

Answer 1

Doppler-guided arterial ligation with hemorrhoidopexy

Question 2

Detection of lymphogranuloma venereum

Answer 2

Gram stain usually negative, can be detected by DNA probe

Question 3

Management of lymphogranuloma venereum

Answer 3

Tetracycline immediately (to avoid fistulas and severe rectal stricture)

Question 4

Evaluation of fecal incontinence due to incompetent anal sphincter

Answer 4

Endoanal US

Question 5

Most common type of bladder injury

Answer 5

Extraperitoneal, usually in setting of pelvic fracture

Question 6

Management of extraperitoneal bladder injury

Answer 6

Prolonged Foley and follow-up cysto unless: UTI, bony fragments in bladder, injury to bladder neck, female genital lacerations, or other injuries requiring laparotomy

Question 7

Management of Paget disease of anus

Answer 7

Wide local excision (APR if concurrent malignancy of rectum/anal canal)
LN dissection if palpable lymphadenopathy
1/2 of patients have occult internal malignancy

Question 8

Nigro protocol

Answer 8

Used for locoregional anal squamous cell cancer
5-FU + mitomycin C and radiation

Question 9

Management of metastatic anal SCC

Answer 9

chemo + RT followed by nivolimumab/pembrolizumab

Question 10

Order of addressing hilar structures in nephrectomy

Answer 10

Mobilize vein to obtain access to artery, ligate renal artery, then ligate renal vein

Question 11

Management of a ureteral injury between ureteropelvic junction and pelvic brim

Answer 11

Repair by ureteroureterostomy

Question 12

Treatment of perianal sepsis

Answer 12

Antibiotics and wide local drainage

Question 13

Innervation of internal anal sphincter

Answer 13

Sympathetics from L5 and S2-S4

Question 14

Innervation of external anal sphincter

Answer 14

Inferior rectal branch of pudendal nerve (S1-3 nerve roots) and perineal branch of S4 nerve root

Question 15

Verrucous carcinoma

Answer 15

Local aggressive type of squamous cell carcinoma

Question 16

Most common location of anal fissure

Answer 16

Posterior midline (if lateral, look for other causes)

Question 17

Bowen disease

Answer 17

High grade squamous intraepithelial lesion - 10% progress to invasive SCC

Question 18

Management of Bowen disease

Answer 18

Topical therapy like imiquimod (excision only for lesions that don’t respond to topical therapy)

Question 19

Approach for radical orchiectomy for testicular mass

Answer 19

Inguinal approach (if scrotum is violated, metastatic spread to RP and inguinal nodes may occur)

Question 20

Management of fecal incontinence with a confirmed sphincter defect

Answer 20

Overlapping sphincteroplasty
(Or sacral nerve stimulation)

Question 21

Surgical treatment for chronic anal fissures

Answer 21

Lateral internal sphincterotomy

Question 22

High risk patients for prostate cancer

Answer 22

African American, first degree relative <65, BRCA

Question 23

Prostate cancer screening

Answer 23

Start at age 40-45 with PSA q1-2yrs
For standard risk patients, start at 50yrs