Colon And Rectum: Diverticulosis- Hemorrhoids

66 Questions | Total Attempts: 241

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Colon And Rectum: Diverticulosis- Hemorrhoids - 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


Questions and Answers
  • 1. 
    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)
    • A. 

      Toxic megacolon

    • B. 

      Acute diverticulitis

    • C. 

      Diverticulosis

    • D. 

      Definite IBD

    • E. 

      Hemorrhoids

  • 2. 
    What is the result of low-fiber, high-fat diet, colonic motility disorder, chronic constipation, and  increased age on the colon?
    • A. 

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

    • B. 

      Obstruction due to hypertrophy of circular muscle or from inflammation, edema and spasms causing acute diverticulitis

    • C. 

      Autoimmunity and impaired immune regulation leading to IBD

    • D. 

      Infections leading to IBD

    • E. 

      Complications of sever acute colitis leading to toxic megacolon

  • 3. 
    What is the treatment for diverticulosis? Click all that apply
    • A. 

      High fiber diet/ fiber supplements to increased stool bulk and decreased colonic transit times. Only done in non acute phase

    • B. 

      Stool softeners (Colace)

    • C. 

      Non chronic laxatives

    • D. 

      Avoid constipation

    • E. 

      Bowel rest

  • 4. 
    What tests do you perform to diagnose diverticulosis? (click all that apply)
    • A. 

      Barium Enema

    • B. 

      Digital dis impaction

    • C. 

      Abdominal x ray

    • D. 

      CBC

    • E. 

      Colonoscopy

  • 5. 
    What are the complications of diverticulosis? (Click all that apply)
    • A. 

      Diverticulitis

    • B. 

      Severe impaction

    • C. 

      Toxic megacolon

    • D. 

      Hemorrhage

    • E. 

      Vagal response

  • 6. 
    What diagnostic test is used as a standard approach for most colonic mucosal disease?
    • A. 

      Flexible sigmoidoscopy

    • B. 

      Colonoscopy

    • C. 

      Barium enema

    • D. 

      CT Colonography

  • 7. 
    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.
    • A. 

      Colonoscopy

    • B. 

      Flexible sigmoidoscopy

    • C. 

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

    • D. 

      CT Colonography

  • 8. 
    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
    • A. 

      Barium enema

    • B. 

      Colonoscopy

    • C. 

      Flexible sigmoidoscopy

    • D. 

      CT scan

    • E. 

      CT colonography

  • 9. 
    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.
    • A. 

      Flexible sigmoidoscopy

    • B. 

      Barium enema

    • C. 

      CT Colonography

    • D. 

      Anoscopy

    • E. 

      Colonoscopy

  • 10. 
    What are the complications of a colonoscopy and a flexible sigmoidoscopy? Click all that apply
    • A. 

      Perforation

    • B. 

      Toxic megacolon

    • C. 

      Reaction to medication

    • D. 

      Vagal response

    • E. 

      Hemorrhage

  • 11. 
    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. 

      Colonoscopy

    • B. 

      Barium enema

    • C. 

      Flexible sigmoidoscopy

    • D. 

      Ultrasound

    • E. 

      CT Colonography

  • 12. 
    The difference between diverticulosis and diverticulitis is that in diverticulitis
    • A. 

      The greater pressures within the segments of the colon causes hypertrophy, thickening, and out pouching of the mucosa through the muscularis

    • B. 

      The pouches always lead to abscess formation

    • C. 

      The accumulation of gas causes marked dilation and necrosis of the colon

    • D. 

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

    • E. 

      Bowel becomes inflamed

  • 13. 
    The following are characteristics of complicated diverticulitis: (click all that apply)
    • A. 

      Abscess formation

    • B. 

      Fistula formation

    • C. 

      Constipation

    • D. 

      Obstruction

    • E. 

      Macroperforations

  • 14. 
    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?
    • A. 

      Toxic Megacolon

    • B. 

      Adenocarcinoma

    • C. 

      Acute Diverticulitis

    • D. 

      Diverticulosis

    • E. 

      Ulcerative Colitis

  • 15. 
    What is the test of choice to diagnose acute diverticulitis. (remember that an endoscopy is contraindicated because it may lead to bowel perforation)
    • A. 

      Abdominal x ray

    • B. 

      Barium enema with water soluble contrast

    • C. 

      CT scan

    • D. 

      Flexible sigmoidoscopy

    • E. 

      Colonoscopy

  • 16. 
    Treatment for acute diverticulitis includes: (click all that apply)
    • A. 

      Bowel rest (clear liquids only)

    • B. 

      High fiber diet

    • C. 

      Antibiotics

    • D. 

      Ciprofloxacin and metronidazole for gram negative rods and anaerobes

    • E. 

      Ciprofloxacin and metronidazole for gram positive rods and anerobes

  • 17. 
    How can a complicated diverticulitis such as a perforated diverticulum lead to death?
    • A. 

      Perforation of diverticulum leads to hemorrhage when mucosal perforation penetrates into a submucosal artery

    • B. 

      Perforation of ulcerated diverticulum can lead to bloody stool

    • C. 

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

    • D. 

      Pneumaturia leading to death

  • 18. 
    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. 

      Diverticular hemorrhage due to mucosal ulceration of a diverticulum that penetrated into a submucosal artery

    • B. 

      Colonic obstruction due to the hypertrophy of circular muscle or inflammation, edema, and spasms that accompany diverticulitis

    • C. 

      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.

    • D. 

      Perforated diverticulum that allowed air and feces into the peritoneal cavity

    • E. 

      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.

  • 19. 
    What are the two chronic idiopathic diseases characterized by inflammation of the bowel?
    • A. 

      Ulcerative Colitis and Crohn's disease

    • B. 

      Toxic Megacolon and Ulcerative Colitis

    • C. 

      Toxic Megacolon and Crohn's disease

    • D. 

      Diverticulosis and Diverticulitis

  • 20. 
    Which of the following is associated with and is a possible cause genetic predisposition of IBD? (Click all that apply)
    • A. 

      Caucasian and European Jewish heritage

    • B. 

      Impaired immune regulation and autoimmunity

    • C. 

      Genetic Markers/ mutations

    • D. 

      Turner's syndrome, Glycogen Storage Dz type I, Hermansky-Pulak syndrome

    • E. 

      Familial aggregation

  • 21. 
    List the categories for IBD associations and possible causes
  • 22. 
    T/F. Smoking causes a two fold increased risk for Crohn's disease?
    • A. 

      True

    • B. 

      False

  • 23. 
    The onset of Ulcerative Colitis is usually between the ages of ________ and a second peak at ________ years old
    • A. 

      30-50, 60

    • B. 

      20-40, 60

    • C. 

      18-25, 50

    • D. 

      25-55, 70

    • E. 

      22-28, 50

  • 24. 
    Ulcerative colitis is limited to the _______ to ___________. Inflammation is confined to the ____________ and is noted for the formation of _______________.  The _________ is almost always involved
    • A. 

      Ileum to cecum, all layers of the intestinal wall, cobblestone appearance, ileocecal region

    • B. 

      Ileum to cecum, all layers of the intestinal wall, skip lesions, cecum

    • C. 

      Rectum to cecum, mucosa, crypt abscesses, rectum

    • D. 

      Rectum to cecum, mucosa, skip lesions, rectum

  • 25. 
    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
    • A. 

      True

    • B. 

      False

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