Colon And Rectum: Diverticulosis- Hemorrhoids

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1/66 Questions

What are the two chronic idiopathic diseases characterized by inflammation of the bowel?
- Ulcerative Colitis and Crohn's disease
- Toxic Megacolon and Ulcerative Colitis
- Toxic Megacolon and Crohn's disease
- Diverticulosis and Diverticulitis

Colon And Rectum: Diverticulosis- Hemorrhoids - Quiz

About This Quiz

Diverticulosis, acute diverticulitis, IBD, Ulcerative Colitis, Toxic Megacolon, Chron's Dz, hemorrhoids, rectal varacies, anal fissues, periananl perirectal abscess, rectal prolapse, pruritius ani, pilonidal cysts

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2.

T/F. Smoking causes a two fold increased risk for Crohn's disease?
- True
- False
Correct Answer

A. True

Explanation

Smoking has been identified as a risk factor for Crohn's disease, a chronic inflammatory bowel disease. Multiple studies have shown that smoking increases the risk of developing Crohn's disease by approximately two-fold. The harmful effects of smoking on the gastrointestinal tract can lead to inflammation and damage, contributing to the development and progression of the disease. Therefore, it is true that smoking causes a two-fold increased risk for Crohn's disease.

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3.

T/F Pancolitis is inflammation of the entire colon and the risk of colonic malignancy is higher in pts with pancolitis that have the disease before age 15
- True
- False
Correct Answer

A. True

Explanation

Pancolitis refers to inflammation of the entire colon, which can increase the risk of colonic malignancy. This means that individuals with pancolitis have a higher likelihood of developing colon cancer. Additionally, the risk of colonic malignancy is even higher in patients who have had the disease before the age of 15. Therefore, the statement is true.

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4.

Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristics of what disease?
- Inflammatory bowel disease
- Ulcerative Colitis
- Crohn's Disease
- Internal hemorrhoids
Correct Answer

A. Crohn's Disease

Explanation

Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristic findings of Crohn's Disease. This chronic inflammatory condition primarily affects the gastrointestinal tract, causing inflammation and damage to the lining of the digestive system. The presence of granulomas, skip lesions, cobblestone appearance, and abscesses are key diagnostic features of Crohn's Disease, distinguishing it from other conditions such as ulcerative colitis or internal hemorrhoids.

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5.

What are patients at risk for during pregnancy, constipation, prolonged sitting, or ingestion of low fiber diets?
- Anal fissures
- Hemorrhoids
- Rectal varacies
- Perianal/perirectal abscess
Correct Answer

A. Hemorrhoids

Explanation

During pregnancy, patients are at risk for developing hemorrhoids. This is due to various factors such as constipation, prolonged sitting, and ingestion of low fiber diets. These factors can lead to increased pressure on the veins in the rectal area, causing them to swell and become inflamed, resulting in hemorrhoids.

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6.

What study uses a computer to measure how long it takes the sphincter to contract after the nerve is stimulated?
- Anorectal monometry
- Pudendal nerve studies
- Colonic transit time
- Defecography
Correct Answer

A. Pudendal nerve studies

Explanation

Pudendal nerve studies involve the use of a computer to measure the duration of sphincter contraction after nerve stimulation. This study helps in assessing the function of the pudendal nerve, which controls the muscles involved in bowel movements. By measuring the time it takes for the sphincter to contract, this study can provide information about nerve damage or dysfunction that may be causing issues with bowel control.

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7.

T/F Crohn'd Disease is surgically curable
- True
- False
Correct Answer

A. False

Explanation

Crohn's Disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. It is not currently considered surgically curable because it cannot be completely eliminated through surgery. While surgery may be performed to remove damaged portions of the intestine or to alleviate complications, it does not provide a permanent cure for the disease. The underlying cause of Crohn's Disease is not fully understood, and it typically requires long-term management with medication and lifestyle changes.

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8.

Hypoalbuminema, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothombinemia are all a result of ______________ in Chron's disease?
- Malabsorption
- Malnutrition
- Inflammation
- Abscess formation
- Fistula formation
Correct Answer

A. Malabsorption

Explanation

The correct answer is malabsorption. In Crohn's disease, the inflammation in the intestines can lead to damage and dysfunction of the intestinal lining, impairing the absorption of various nutrients and substances. This can result in decreased levels of albumin, cholesterol, calcium, magnesium, and prothrombin, leading to hypoalbuminemia, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothrombinemia, respectively. Malabsorption is a common complication of Crohn's disease and can contribute to malnutrition and various deficiencies.

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9.

The difference between diverticulosis and diverticulitis is that in diverticulitis
- The greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis
- The pouches always lead to abscess formation
- The accumulation of gas causes marked dilation and necrosis of the colon
- The diverticula pouches have become inflamed or infected (macro or microperforations of the diverticulum)
- Bowel becomes inflamed
Correct Answer

A. The diverticula pouches have become inflamed or infected (macro or microperforations of the diverticulum)

Explanation

Diverticulosis refers to the presence of small pouches, called diverticula, that form in the colon wall. These pouches are usually asymptomatic and do not cause any inflammation or infection. On the other hand, diverticulitis occurs when the diverticula pouches become inflamed or infected due to macro or microperforations of the diverticulum. This inflammation and infection can lead to symptoms such as abdominal pain, fever, and changes in bowel habits. Therefore, the correct answer is that in diverticulitis, the diverticula pouches have become inflamed or infected.

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10.

Which test looks at the entire colon including the cecum (and sometimes the terminal ileum for evaluation and bx)? This test also requires conscious sedation (demerol and versed) and Golytely and visicol to evacuate colon completely.
- Flexible sigmoidoscopy
- Barium enema
- CT Colonography
- Anoscopy
- Colonoscopy
Correct Answer

A. Colonoscopy

Explanation

Colonoscopy is the correct answer because it is a test that examines the entire colon, including the cecum and sometimes the terminal ileum. It requires conscious sedation and the use of medications like demerol and versed. Additionally, colonoscopy requires the use of bowel preparation medications like Golytely and visicol to completely empty the colon before the procedure.

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11.

What disease is characterized by transmural inflammation of the bowel wall that can involve any segment of the GI tract from mouth to anus, but the Ileocecal region is the most common?
- Chrohn's Disease
- Ulcerative Colitis
- Diverticulosis
- Irritable bowel syndrome
- Pilonidal cysts
Correct Answer

A. Chrohn's Disease

Explanation

Crohn's Disease is a chronic inflammatory condition that can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. It is characterized by transmural inflammation, meaning that it affects all layers of the bowel wall. While Crohn's Disease can involve any segment of the GI tract, the most common area affected is the ileocecal region, which is the junction between the small intestine and the large intestine. This inflammation can lead to various symptoms such as abdominal pain, diarrhea, weight loss, and fatigue.

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12.

What type of hemorrhoid is characterized as painless/insensitive, above the dentate line, and may bleed or prolapse through the anal canal? What type of epithelium is above the dentate line?
- Internal hemorroids, columnar epithelium
- External hemorrhoids , columnar epithelium
- Rectal varices, stratified squamous epithelium
- Anal fissures, stratified squamous epithelium
Correct Answer

A. Internal hemorroids, columnar epithelium

Explanation

Internal hemorrhoids are characterized as painless/insensitive, above the dentate line, and may bleed or prolapse through the anal canal. The type of epithelium above the dentate line is columnar epithelium.

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13.

What test uses a low density substance to coat the mucosa of the rectum then instills air into the rectum? This test also requires a preparatory enema or laxative and a clear liquid diet.
- Colonoscopy
- Flexible sigmoidoscopy
- Double contrast barium enema/ air contrast barium enema (ACBE)
- CT Colonography
Correct Answer

A. Double contrast barium enema/ air contrast barium enema (ACBE)

Explanation

The correct answer is Double contrast barium enema/ air contrast barium enema (ACBE). This test involves the use of a low density substance, such as barium, to coat the mucosa of the rectum. Air is then instilled into the rectum to provide contrast during imaging. A preparatory enema or laxative and a clear liquid diet are required to ensure the colon is empty and clear for the procedure. This test is commonly used to evaluate the colon for abnormalities such as polyps or tumors.

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14.

What test is used to look at the distal third of the colon (sigmoid and rectum) and requires no sedation? This test also requires an enema and a clear liquid diet
- Barium enema
- Colonoscopy
- Flexible sigmoidoscopy
- CT scan
- CT colonography
Correct Answer

A. Flexible sigmoidoscopy

Explanation

A flexible sigmoidoscopy is a test used to examine the distal third of the colon, specifically the sigmoid and rectum. It does not require sedation and involves the use of a flexible tube with a camera to visualize the area. Prior to the procedure, an enema is given to clear the colon, and a clear liquid diet is followed. This test allows for a direct visual inspection of the lower part of the colon, making it a suitable option for examining the sigmoid and rectum without the need for sedation.

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1
15.

What is the result of low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age on the colon?
- Greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis resulting in diverticulosis
- Obstruction due to hypertrophy of circular muscle or from inflammation, edema and spasms causing acute diverticulitis
- Autoimmunity and impaired immune regulation leading to IBD
- Infections leading to IBD
- Complications of sever acute colitis leading to toxic megacolon
Correct Answer

A. Greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis resulting in diverticulosis

Explanation

A low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age can all contribute to greater pressures within the segments of the colon. This increased pressure can cause hypertrophy, thickening, and outpouching of the mucosa through the muscularis, resulting in diverticulosis. Diverticulosis is a condition where small pouches or sacs develop in the colon wall.

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16.

A 25 year old female presents with an insidious onset of RLQ abdominal pain and cramping, prolonged diarrhea that floats and is foul smelling, anorexia, fatigue, and weight loss. Her labs indicate the presence of inflammatory activity and nutritional deficiencies. What is the most likely diagnosis?
- Crohn's disease
- Ulcerative Colitis
- Toxic Megacolon
- Mesenteric Ischemia
- Gastritis
Correct Answer

A. Crohn's disease

Explanation

The patient's symptoms, including RLQ abdominal pain, prolonged diarrhea, anorexia, fatigue, and weight loss, along with the presence of inflammatory activity and nutritional deficiencies in the labs, are consistent with Crohn's disease. Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, causing symptoms such as abdominal pain, diarrhea, and weight loss. The other options, including ulcerative colitis, toxic megacolon, mesenteric ischemia, and gastritis, do not fully explain the combination of symptoms and lab findings seen in this patient.

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17.

T/F Peripheral arthritis is an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis?

Correct Answer
True

Explanation
Peripheral arthritis is indeed an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis. This means that individuals with these inflammatory bowel diseases may experience inflammation and swelling in their joints, commonly in the peripheral joints such as the knees, ankles, and wrists. This condition is often characterized by pain, stiffness, and limited mobility in the affected joints. It is important for healthcare providers to be aware of this association and consider it when managing patients with Crohn's disease or Ulcerative Colitis.

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18.

What treatment option would be indicated if a patient had an unresolving toxic megacolon?
- Colonoscopy
- Colon resection
- Antibiotics
- Potent analgesics
- Immunosuppressants
Correct Answer

A. Colon resection

Explanation

If a patient has an unresolving toxic megacolon, colon resection would be the indicated treatment option. This procedure involves removing a portion of the colon to alleviate the symptoms and complications associated with toxic megacolon. Colon resection is often performed when other treatment options, such as antibiotics or immunosuppressants, have failed to resolve the condition. It is a more aggressive approach but may be necessary to prevent further complications and improve the patient's condition.

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19.

What study measures the pressure of the anal sphincter and sensations of fullness?
- Pudendal nerve studies
- Anorectal manometry
- Colonic transit time
- Defecography
Correct Answer

A. Anorectal manometry

Explanation

Anorectal manometry is a study that measures the pressure of the anal sphincter and sensations of fullness. This procedure involves inserting a small balloon or catheter into the rectum to measure the pressure exerted by the muscles in the anus and rectum. It helps in diagnosing various conditions related to bowel movements, such as fecal incontinence or constipation. By measuring the pressure and sensations in the anal sphincter, anorectal manometry provides valuable information about the functionality of the rectum and helps in determining the appropriate treatment for patients with bowel disorders.

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20.

How can a complicated diverticulitis such as a perforated diverticulum lead to death?
- Perforation of diverticulum leads to hemorrhage when mucosal perforation penetrates into a submucosal artery
- Perforation of ulcerated diverticulum can lead to bloody stool
- Perforation of ulcerated diverticulum allows feces into peritoneal cavity which causes fecal peritonitis and produces septic shock
- Pneumaturia leading to death
Correct Answer

A. Perforation of ulcerated diverticulum allows feces into peritoneal cavity which causes fecal peritonitis and produces septic shock

Explanation

Perforation of an ulcerated diverticulum can lead to the leakage of feces into the peritoneal cavity. This can result in fecal peritonitis, which is a severe inflammation of the lining of the abdominal cavity. Fecal peritonitis can cause infection and lead to septic shock, a life-threatening condition characterized by low blood pressure and organ failure. Therefore, the presence of feces in the peritoneal cavity due to a perforated diverticulum can ultimately result in death.

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21.

A patient's barium enema reveals outpouchings of mucosa/submucosa through the muscularis propria layer of the colon. The patient has mild symptoms of fluctuating bowel habits and abdominal pain. What is your likely diagnosis? (Image from Current not ppt- FYI- double contrast barium enema)
- Toxic megacolon
- Acute diverticulitis
- Diverticulosis
- Definite IBD
- Hemorrhoids
Correct Answer

A. Diverticulosis

Explanation

The correct answer is diverticulosis. Diverticulosis is characterized by the presence of outpouchings of the mucosa/submucosa through the muscularis propria layer of the colon. It is commonly asymptomatic, but in some cases, patients may experience mild symptoms such as fluctuating bowel habits and abdominal pain. Acute diverticulitis, on the other hand, is associated with inflammation and infection of these outpouchings, leading to more severe symptoms. Toxic megacolon, definite IBD, and hemorrhoids are not consistent with the given clinical presentation.

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22.

Which test will give you a 3-D image of the colon/bowel that uses air and liquid contrast, requires no sedation, and preparation incudes golytely and visicol?
- Colonoscopy
- Barium enema
- Flexible sigmoidoscopy
- Ultrasound
- CT Colonography
Correct Answer

A. CT Colonography

Explanation

CT Colonography, also known as virtual colonoscopy, is a test that uses a combination of air and liquid contrast to create a 3-D image of the colon/bowel. Unlike traditional colonoscopy, it does not require sedation. The preparation for CT Colonography includes drinking a solution called golytely and taking visicol. This test is a non-invasive and less uncomfortable alternative to colonoscopy, making it a suitable option for patients who may not be able to undergo sedation or prefer a less invasive procedure.

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23.

A patient presents with LLQ pain, with gradual onset and is progressively getting worse. The patient has had this pain before, but this pain is consistent and unrelenting. She has nausea, vomiting, diarrhea, low grade fever, and urinary urgency and frequency. CBC; leukocytosis, abd X ray: free air, CT: reveals soft tissue density of the pericolic fat (98%), diverticula (84%), bowel wall thickening of more than 4 mm (70%), and phlegmon or pericolic fluid (35%) (CT results from Current)What is your suspected diagnosis?
- Toxic Megacolon
- Adenocarcinoma
- Acute Diverticulitis
- Diverticulosis
- Ulcerative Colitis
Correct Answer

A. Acute Diverticulitis

Explanation

The patient's symptoms, including LLQ pain, nausea, vomiting, diarrhea, low grade fever, and urinary urgency and frequency, along with the imaging findings of diverticula, bowel wall thickening, and pericolic fat density, are consistent with a diagnosis of acute diverticulitis. This condition occurs when small pouches in the colon become infected or inflamed. The patient's history of previous episodes of pain, along with the worsening and consistent nature of the current pain, further supports this diagnosis.

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24.

A patient presents with painless pneumaturia (air in urine) and or feces mixed in with their urine. What complication of acute diverticulitis should you consider?
- Diverticular hemorrhage due to mucosal ulceration of a diverticulum that penetrated into a submucosal artery
- Colonic obstruction due to the hypertrophy of circular muscle or inflammation, edema, and spasms that accompany diverticulitis
- Colovesical fistula as a reult of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected.
- Perforated diverticulum that allowed air and feces into the peritoneal cavity
- Colovescial fistula as a result of a perforated diverticulum that allowed air into the bladder. This is a non-life threatening condition and can be surgically resected.
Correct Answer

A. Colovesical fistula as a reult of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected.

Explanation

The correct answer is colovesical fistula as a result of a chronically inflamed diverticulum that adhered to the bladder and ruptured into the lumen to form a fistula. This is a non-fatal problem and can be surgically resected. This is the most likely complication in a patient presenting with painless pneumaturia (air in urine) and feces mixed in with their urine. A colovesical fistula occurs when a diverticulum, which is a pouch-like protrusion in the wall of the colon, becomes chronically inflamed and adheres to the bladder. This can lead to the formation of a fistula, an abnormal connection between the colon and the bladder, allowing air and feces to pass into the bladder. Surgical resection is the recommended treatment for this condition.

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25.

A patient presents with perianal itching and BRB on toilet paper, underclothes, and coating the surface of their stool. What diagnostic tests and treatments would you order and prescribe?
- Ct scan, and colonoscopy
- DRE, Anoscopy, Flexible Sigmoidoscopy,
- DRE is the only way to diagnose
- Endoscopy
- CT only
Correct Answer

A. DRE, Anoscopy, Flexible Sigmoidoscopy,

Explanation

The correct answer is DRE, Anoscopy, Flexible Sigmoidoscopy. These diagnostic tests are appropriate for evaluating a patient with perianal itching and bright red blood (BRB) on toilet paper, underclothes, and stool. A digital rectal examination (DRE) can help assess the rectal area for any abnormalities. Anoscopy allows for a closer examination of the anus and lower rectum. Flexible sigmoidoscopy helps visualize the sigmoid colon and rectum for any signs of inflammation, hemorrhoids, or other causes of bleeding. These tests can help identify the underlying cause of the symptoms and guide appropriate treatment.

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26.

What is the treatment for pilonidal cysts and sinus
- Warm water, surgical opening and draining if the cyst is infected, sinus removal if cyst is persistant
- WASH (Warm water, analgesics, stool softeners, high fiber diet)
- Sitz bath, witch hazel, stool softeners, topical anestheitc, avoid prolonged straining of stools
- Sclerosis or ligation (or resolves when portal hypertension is resolved)
- I&D only
Correct Answer

A. Warm water, surgical opening and draining if the cyst is infected, sinus removal if cyst is persistant

Explanation

The treatment for pilonidal cysts and sinus involves using warm water for cleaning, and if the cyst is infected, it requires surgical opening and draining. If the cyst persists, sinus removal may be necessary.

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27.

What test requires the patient to ingest a caspule that contains radioopaque markers and sit for a series of abdominal x rays that are taken over 7 days (noting the location of the radiopaque markers)
- Pudendal nerve studies
- Defecography
- Anorectal monomety
- Colonic transit time
Correct Answer

A. Colonic transit time

Explanation

The test that requires the patient to ingest a capsule containing radioopaque markers and sit for a series of abdominal x-rays taken over 7 days is called the colonic transit time test. This test is used to evaluate the movement of stool through the colon and can help diagnose conditions such as constipation or slow transit time. The radioopaque markers allow the healthcare provider to track the movement and location of the markers in the colon through the x-rays taken over the 7-day period.

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28.

What dianosis is characterized by sudden swelling or severe continuous pain folloing spontaneous submucosal hemorrhage? What kind of epithelium is associated with this dx?
- Internal hemorrhoids, columnar epithelium
- External hemorrhoids, stratified squamous epithelium
- Internal hemorrhoids, stratified squamous epithelium
- External hemorrhoids, columnar epithelium
Correct Answer

A. External hemorrhoids, stratified squamous epithelium

Explanation

External hemorrhoids are characterized by sudden swelling or severe continuous pain following spontaneous submucosal hemorrhage. The epithelium associated with external hemorrhoids is stratified squamous epithelium.

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29.

A patient comes in with a cc of annoying itching of the anus and perianal region. What is the most likely diagnosis?
- Pruritus anal
- Pruritus ani
- Pruritus prolapse
- Pruritus fissure
Correct Answer

A. Pruritus ani

Explanation

The most likely diagnosis for a patient presenting with annoying itching of the anus and perianal region is pruritus ani. Pruritus ani refers to itching of the skin around the anus and is commonly caused by conditions such as poor hygiene, excessive moisture, certain skin conditions, or infections. It is important to rule out other possible causes and provide appropriate treatment to relieve the itching and address the underlying cause.

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30.

What is the treatment for pruritus ani?
- Mebendazole (Vermox), Pyrantel pamoate (Pin-X), improve hygeine, all members of family should be treated
- Surgery and debridment
- Antibiotics
- Soaking in warm water to eas the pain, surgical opening and draining of the infected area,
- WASH
Correct Answer

A. Mebendazole (Vermox), Pyrantel pamoate (Pin-X), improve hygeine, all members of family should be treated

Explanation

The correct answer suggests that the treatment for pruritus ani includes the use of Mebendazole (Vermox) and Pyrantel pamoate (Pin-X), which are medications used to treat parasitic infections. Additionally, improving hygiene practices and treating all members of the family are recommended. This implies that pruritus ani may be caused by a parasitic infection, and the treatment aims to eliminate the parasites and prevent reinfection.

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31.

A patient presents with abdominal distension, pain, fever (39C), tachycardia (120bpm), diarrhea and dehydration. The result of the abdominal x ray is the following: What is your diagnosis?
- Ascities
- Bowel Obstruciton
- Toxic Megacolon
- Bowel Perforation
- Diverticular Hemorrhage
Correct Answer

A. Toxic Megacolon

Explanation

Based on the symptoms described (abdominal distension, pain, fever, tachycardia, diarrhea, and dehydration) and the result of the abdominal x-ray, the correct diagnosis is Toxic Megacolon. Toxic Megacolon is a severe complication of inflammatory bowel disease, characterized by the dilation and inflammation of the colon, leading to symptoms like abdominal distension and pain. The presence of fever, tachycardia, and diarrhea further support this diagnosis. The abdominal x-ray may show signs of colonic dilation, which is consistent with Toxic Megacolon.

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32.

What disease is characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis and leads to a paralytic ileus? Eventually, the inflammation and accumulation of gas cause atony, marked dilatation and necrosis of involved segment of colon
- Sepsis due to a macropreforation of acute diverticulitis
- Perforation
- Obstruction
- Toxic Megacolon
Correct Answer

A. Toxic Megacolon

Explanation

Toxic Megacolon is a disease characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis. This condition leads to a paralytic ileus, causing inflammation and accumulation of gas. Eventually, the affected segment of the colon experiences atony, marked dilatation, and necrosis. Therefore, Toxic Megacolon is the correct answer as it matches the description given in the question.

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33.

The etiology of what disorder involves dead hair pushed into tiny abrasions in the skin forming a one ended tunnel that becomes a sinus and becomes infected? (Hint: this often developes in places where the presence of hair and poor hygeine may exist)
- Perianal/perirectal abscess
- Pilonidal cyst
- Rectal prolapse
- Anal fissures
Correct Answer

A. Pilonidal cyst

Explanation

A pilonidal cyst is a type of cyst that develops in the sacral region near the tailbone. The etiology of this disorder involves dead hair being pushed into tiny abrasions in the skin, which then forms a sinus or tunnel. This tunnel can become infected, leading to the development of a pilonidal cyst. Pilonidal cysts often develop in areas where there is the presence of hair and poor hygiene, such as the buttock crease.

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34.

Which test is initiated by inserting a barium paste into rectum, examining the patient with fluroscopy while sitting on the commode and defecating, and used to reveal rectoceles, and delayed or incomplete emptying?
- Colonic transit time
- Anorectal monometry
- Defecography
- Pudendal nerve studies
Correct Answer

A. Defecography

Explanation

Defecography is the correct answer because it involves the process of inserting barium paste into the rectum and then observing the patient with fluoroscopy while they sit on a commode and defecate. This test is specifically used to reveal conditions such as rectoceles (protrusion of the rectum into the vagina), as well as identify delayed or incomplete emptying of the rectum. It is a diagnostic procedure that provides visual information about the anatomy and function of the rectum and surrounding structures.

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35.

Identify the disease that causes this appearance of the colon
- Ulcerative Colitis
- Crohn's disease
- Diverticulosis
- Diverticulitis
- Rectal varices
Correct Answer

A. Ulcerative Colitis

Explanation

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the colon and rectum. It causes inflammation and ulcers in the inner lining of the colon, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding. This appearance of the colon is characteristic of ulcerative colitis, as it shows inflammation and ulceration throughout the colon. Crohn's disease, diverticulosis, diverticulitis, and rectal varices may have different presentations and are not typically associated with this specific appearance of the colon.

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36.

Ulcerative colitis is limited to the _______ to ___________. Inflammation is confined to the ____________ and is noted for the formation of _______________. The _________ is almost always involved
- Ileum to cecum, all layers of the intestinal wall, cobblestone appearance, ileocecal region
- Ileum to cecum, all layers of the intestinal wall, skip lesions, cecum
- Rectum to cecum, mucosa, crypt abscesses, rectum
- Rectum to cecum, mucosa, skip lesions, rectum
Correct Answer

A. Rectum to cecum, mucosa, crypt abscesses, rectum

Explanation

Ulcerative colitis is a type of inflammatory bowel disease that is limited to the rectum to cecum region of the intestine. The inflammation is confined to the mucosa, which is the innermost layer of the intestinal wall. It is characterized by the formation of crypt abscesses, which are pockets of pus within the intestinal crypts. The rectum is almost always involved in ulcerative colitis.

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37.

What are the various diagnostic tests to determine if a patient has a rectal prolapse?
- Eggs stick to a piece of tape touched to the anus and can be identified to establish diagnosis
- Barium enima, flexible sigmoidoscopy, defcography, colonic transit time, anorectal manometry, pudendal nerve studies, defecography,
- Endoanal US, locate and determine size
- Digital rectal exam, anoscopy. flexible sigmoidoscopy
Correct Answer

A. Barium enima, flexible sigmoidoscopy, defcography, colonic transit time, anorectal manometry, pudendal nerve studies, defecography,

Explanation

Endoanal US, digital rectal exam, anoscopy. These diagnostic tests are used to determine if a patient has a rectal prolapse. The barium enema, flexible sigmoidoscopy, defecography, and colonic transit time tests help visualize the rectum and identify any abnormalities. Anorectal manometry and pudendal nerve studies assess the function of the rectal muscles and nerves. Endoanal US is used to locate and determine the size of the prolapse. Finally, the digital rectal exam and anoscopy allow for a physical examination of the rectum and anus.

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38.

A patient's presents to you with bloody diarrhea, abdominal pain, and a fever. You order labs and the they reveal, leukocytosis, anemia, thrombocytosis (low platelets), elevated sedimentation rate and C reactive protein, hypoalbuminemia,hypokalemia, hypomagnesemia, and an elevated alkaline phosphatase. What disease is consistant with these findings?
- Crohn's disease
- Ulcerative Colitis
- Diverticular disease
- Angiodysplasia
- Celiac Sprue
Correct Answer

A. Ulcerative Colitis

Explanation

The given symptoms and laboratory findings are consistent with ulcerative colitis. Ulcerative colitis is a type of inflammatory bowel disease that primarily affects the colon and rectum. The symptoms of bloody diarrhea, abdominal pain, and fever are common in ulcerative colitis. The laboratory findings of leukocytosis, anemia, thrombocytosis, elevated sedimentation rate and C reactive protein, hypoalbuminemia, hypokalemia, hypomagnesemia, and elevated alkaline phosphatase are also commonly seen in ulcerative colitis. Therefore, based on the symptoms and laboratory findings, ulcerative colitis is the most likely disease.

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39.

Pruritus ani is caused by what organism?
- Human papilloma virus
- Trichuris triciura (whipworm)
- Enterobius vermicularis- Pin worm
- Herpes zoster virus
- Epstien-Barr virus
Correct Answer

A. Enterobius vermicularis- Pin worm

Explanation

Pruritus ani, or itching of the anus, is commonly caused by Enterobius vermicularis, also known as pinworm. This parasitic infection is caused by the ingestion of pinworm eggs, which then hatch and grow in the intestines. The adult female pinworms migrate to the anus to lay their eggs, causing intense itching and discomfort. Other organisms listed, such as human papilloma virus, Trichuris triciura, herpes zoster virus, and Epstien-Barr virus, are not typically associated with pruritus ani.

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40.

A 22 year old female presents with an abrupt onset of bloody diarrhea and blood per rectum. She has abdominal pain and a fever. She has a normal pulse, and does not have abdominal distension or signs of peritonitis, and does not appear dehydrated. Her labs indicate that she has leukocytosis. What diagnosis would you consider? (click all that apply)
- Acute diverticulitis
- Toxic Megacolon
- Ulcerative Colitis
- Toxic colitis
- Diverticulosis
Correct Answer

A. Ulcerative Colitis

Explanation

Based on the symptoms described, including bloody diarrhea, abdominal pain, fever, and leukocytosis, along with the absence of signs such as abdominal distension, peritonitis, and dehydration, the most likely diagnosis would be Ulcerative Colitis. This is a chronic inflammatory bowel disease that affects the colon and rectum, causing symptoms such as bloody diarrhea and abdominal pain. Acute diverticulitis, toxic megacolon, toxic colitis, and diverticulosis can also cause similar symptoms, but the absence of certain signs and the presence of leukocytosis make Ulcerative Colitis a more likely diagnosis.

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41.

What three things will you include in your treatment of Ulcerative Colitis?
- Medication
- Ongoing care- screening and surveillance colonoscopies
- Non surgical treatment
- Surgical treatment- colon resection sparing anal sphincter (ileoanal anastomosis)
- Ligation
Correct Answer(s)

A. Medication
A. Ongoing care- screening and surveillance colonoscopies
A. Surgical treatment- colon resection sparing anal sphincter (ileoanal anastomosis)

Explanation

The three things that should be included in the treatment of Ulcerative Colitis are medication, ongoing care such as screening and surveillance colonoscopies, and surgical treatment in the form of colon resection sparing the anal sphincter (ileoanal anastomosis). Medication is important for managing the symptoms and inflammation associated with the condition. Ongoing care, including regular screenings and surveillance colonoscopies, is necessary to monitor the disease and catch any complications early. In some cases, surgical treatment may be required, specifically colon resection sparing the anal sphincter, which involves removing the affected part of the colon and connecting the small intestine to the anus.

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42.

When is surgery indicated for rectal prolapse?
- Necrosis
- Incarceration or fecal incontinence
- Incarceration
- Fecal and urinal incontinence
- Fecal incontinence
Correct Answer

A. Incarceration or fecal incontinence

Explanation

Surgery is indicated for rectal prolapse when there is incarceration or fecal incontinence. Incarceration refers to the condition where the prolapsed rectum becomes trapped and cannot be pushed back into the body. This can lead to complications such as tissue death (necrosis) due to inadequate blood supply. Fecal incontinence, on the other hand, refers to the inability to control bowel movements, which can significantly impact a person's quality of life. Therefore, surgery is necessary in these cases to correct the prolapse and alleviate the associated symptoms.

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43.

The onset of Ulcerative Colitis is usually between the ages of ________ and a second peak at ________ years old
- 30-50, 60
- 20-40, 60
- 18-25, 50
- 25-55, 70
- 22-28, 50
Correct Answer

A. 20-40, 60

Explanation

Ulcerative Colitis typically begins between the ages of 20 and 40, with a second peak occurring around the age of 60. This means that individuals are most likely to develop Ulcerative Colitis during their early adulthood and then again later in life.

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44.

The onset of crohn's disease is usually between the ages of ____ -____, with a second peak between ____ to _____. Most cases begin before age ____.
- 25-50, 60-80, 40
- 15-30, 60-80, 30
- 40-50, 60-80, 30
- 10-20, 50-60, 20
Correct Answer

A. 15-30, 60-80, 30

Explanation

Crohn's disease typically starts between the ages of 15-30, with a second peak occurring between 60-80. Most cases of Crohn's disease begin before the age of 30.

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45.

Surveillance colonoscopy is highly recommended for pts with UC. Screening _____ years after onset of pancolitis, or ___-____ years of onset of left-sided colitis. Surveillance than every __-___ years after initial colonoscopy.
- 5, 5-10, 1-2
- 8, 12-15, 1-2
- 10, 5-6, 1-2
Correct Answer

A. 8, 12-15, 1-2
46.

What is the test of choice to diagnose acute diverticulitis. (remember that an endoscopy is contraindicated because it may lead to bowel perforation)
- Abdominal x ray
- Barium enema with water soluble contrast
- CT scan
- Flexible sigmoidoscopy
- Colonoscopy
Correct Answer

A. CT scan

Explanation

The test of choice to diagnose acute diverticulitis is a CT scan. This imaging technique allows for a detailed visualization of the colon and can accurately detect the presence of diverticula and any signs of inflammation or infection. Unlike endoscopy, a CT scan does not carry the risk of bowel perforation, making it a safer and more appropriate option for diagnosing acute diverticulitis. Abdominal x-ray, barium enema with water soluble contrast, flexible sigmoidoscopy, and colonoscopy are not typically used as the initial diagnostic tests for acute diverticulitis.

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47.

List the categories for IBD associations and possible causes

Correct Answer
Genetic predisposition
Impaired immune regulation
Autoimmunity
infection
smoking

Explanation
The given answer lists the categories for IBD associations and possible causes. These include genetic predisposition, impaired immune regulation, autoimmunity, infection, and smoking. These factors have been found to be associated with the development of inflammatory bowel disease (IBD). Genetic predisposition refers to certain genes that increase the risk of developing IBD. Impaired immune regulation refers to dysregulation of the immune system, which can contribute to the development of IBD. Autoimmunity refers to the immune system mistakenly attacking the body's own tissues, which is believed to play a role in IBD. Infection and smoking have also been identified as potential factors that can increase the risk of developing IBD.

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48.

What diagnostic test is used as a standard approach for most colonic mucosal disease?
- Flexible sigmoidoscopy
- Colonoscopy
- Barium enema
- CT Colonography
Correct Answer

A. Barium enema

Explanation

Barium enema is used as a standard diagnostic test for most colonic mucosal diseases. This test involves the use of a contrast material called barium, which is inserted into the rectum and colon through a tube. X-rays are then taken to visualize the lining of the colon and detect any abnormalities or diseases such as polyps, ulcers, or tumors. Barium enema is a less invasive alternative to colonoscopy and provides valuable information about the condition of the colon.

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1
49.

Why do patients suffering from Crohn's disease have anemia? (click all that apply)
- Iron malabsorption
- Immune destruction of IF
- Chronic blood loss
- Malabsorption of vitamin B-12 or folate which leads to a decrease in RBC production
- Malabsorption of vitamin B-12 wich leads to an increase in RBC production
Correct Answer(s)

A. Iron malabsorption
A. Chronic blood loss
A. Malabsorption of vitamin B-12 or folate which leads to a decrease in RBC production

Explanation

Patients suffering from Crohn's disease can have anemia due to multiple factors. Iron malabsorption is one of the reasons, as Crohn's disease can affect the small intestine's ability to absorb iron from the diet. Chronic blood loss is another factor, as inflammation in the intestines can lead to ulcers and bleeding. Malabsorption of vitamin B-12 or folate can also contribute to anemia, as these vitamins are necessary for red blood cell production. However, malabsorption of vitamin B-12 does not lead to an increase in RBC production, as mentioned in the incorrect answer choice.

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Colon And Rectum: Diverticulosis- Hemorrhoids

What are the two chronic idiopathic diseases characterized by inflammation of the bowel?

Quiz Preview

T/F. Smoking causes a two fold increased risk for Crohn's disease?

T/F Pancolitis is inflammation of the entire colon and the risk of colonic malignancy is higher in pts with pancolitis that have the disease before age 15

Granulomas in the intestinal wall, "skip lesions" in the bowel, and submucosal inflammation that has a "cobblestone" appearance and mesentery abscesses are all characteristics of what disease?

What are patients at risk for during pregnancy, constipation, prolonged sitting, or ingestion of low fiber diets?

What study uses a computer to measure how long it takes the sphincter to contract after the nerve is stimulated?

T/F Crohn'd Disease is surgically curable

Hypoalbuminema, hypocholesterolemia, hypocalcemia, hypomagnesemia, and hypoprothombinemia are all a result of ______________ in Chron's disease?

The difference between diverticulosis and diverticulitis is that in diverticulitis

Which test looks at the entire colon including the cecum (and sometimes the terminal ileum for evaluation and bx)? This test also requires conscious sedation (demerol and versed) and Golytely and visicol to evacuate colon completely.

What disease is characterized by transmural inflammation of the bowel wall that can involve any segment of the GI tract from mouth to anus, but the Ileocecal region is the most common?

What type of hemorrhoid is characterized as painless/insensitive, above the dentate line, and may bleed or prolapse through the anal canal? What type of epithelium is above the dentate line?

What test uses a low density substance to coat the mucosa of the rectum then instills air into the rectum? This test also requires a preparatory enema or laxative and a clear liquid diet.

What test is used to look at the distal third of the colon (sigmoid and rectum) and requires no sedation? This test also requires an enema and a clear liquid diet

What is the result of low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and increased age on the colon?

A 25 year old female presents with an insidious onset of RLQ abdominal pain and cramping, prolonged diarrhea that floats and is foul smelling, anorexia, fatigue, and weight loss. Her labs indicate the presence of inflammatory activity and nutritional deficiencies. What is the most likely diagnosis?

T/F Peripheral arthritis is an extraintestinal manifestation of both Crohn's disease and Ulcerative Colitis?

What treatment option would be indicated if a patient had an unresolving toxic megacolon?

What study measures the pressure of the anal sphincter and sensations of fullness?

How can a complicated diverticulitis such as a perforated diverticulum lead to death?

A patient's barium enema reveals outpouchings of mucosa/submucosa through the muscularis propria layer of the colon. The patient has mild symptoms of fluctuating bowel habits and abdominal pain. What is your likely diagnosis? (Image from Current not ppt- FYI- double contrast barium enema)

Which test will give you a 3-D image of the colon/bowel that uses air and liquid contrast, requires no sedation, and preparation incudes golytely and visicol?

A patient presents with painless pneumaturia (air in urine) and or feces mixed in with their urine. What complication of acute diverticulitis should you consider?

A patient presents with perianal itching and BRB on toilet paper, underclothes, and coating the surface of their stool. What diagnostic tests and treatments would you order and prescribe?

What is the treatment for pilonidal cysts and sinus

What test requires the patient to ingest a caspule that contains radioopaque markers and sit for a series of abdominal x rays that are taken over 7 days (noting the location of the radiopaque markers)

What dianosis is characterized by sudden swelling or severe continuous pain folloing spontaneous submucosal hemorrhage? What kind of epithelium is associated with this dx?

A patient comes in with a cc of annoying itching of the anus and perianal region. What is the most likely diagnosis?

What is the treatment for pruritus ani?

A patient presents with abdominal distension, pain, fever (39C), tachycardia (120bpm), diarrhea and dehydration. The result of the abdominal x ray is the following: What is your diagnosis?

What disease is characterized by a diffuse infestation of bacterial enterotoxins in the muscle layers that results from severe acute colitis and leads to a paralytic ileus? Eventually, the inflammation and accumulation of gas cause atony, marked dilatation and necrosis of involved segment of colon

The etiology of what disorder involves dead hair pushed into tiny abrasions in the skin forming a one ended tunnel that becomes a sinus and becomes infected? (Hint: this often developes in places where the presence of hair and poor hygeine may exist)

Which test is initiated by inserting a barium paste into rectum, examining the patient with fluroscopy while sitting on the commode and defecating, and used to reveal rectoceles, and delayed or incomplete emptying?

Identify the disease that causes this appearance of the colon

Ulcerative colitis is limited to the _______ to ___________. Inflammation is confined to the ____________ and is noted for the formation of _______________. The _________ is almost always involved

What are the various diagnostic tests to determine if a patient has a rectal prolapse?

Pruritus ani is caused by what organism?

What three things will you include in your treatment of Ulcerative Colitis?

When is surgery indicated for rectal prolapse?

The onset of Ulcerative Colitis is usually between the ages of ________ and a second peak at ________ years old

The onset of crohn's disease is usually between the ages of ____ -____, with a second peak between ____ to _____. Most cases begin before age ____.

Surveillance colonoscopy is highly recommended for pts with UC. Screening _____ years after onset of pancolitis, or ___-____ years of onset of left-sided colitis. Surveillance than every __-___ years after initial colonoscopy.

What is the test of choice to diagnose acute diverticulitis. (remember that an endoscopy is contraindicated because it may lead to bowel perforation)

List the categories for IBD associations and possible causes

What diagnostic test is used as a standard approach for most colonic mucosal disease?

Why do patients suffering from Crohn's disease have anemia? (click all that apply)

Ulcerative colitis is limited to the _ to _. Inflammation is confined to the and is noted for the formation of _. The ___ is almost always involved

The onset of Ulcerative Colitis is usually between the ages of and a second peak at years old

The onset of crohn's disease is usually between the ages of __ -, with a second peak between to _. Most cases begin before age __.

Surveillance colonoscopy is highly recommended for pts with UC. Screening ___ years after onset of pancolitis, or _- years of onset of left-sided colitis. Surveillance than every -_ years after initial colonoscopy.