Family Medicine EOR: Gastrointestinal and Nutritional (Smarty PANCE) Exam Questions and Answers 100% Pass | Verified and Updated 2024

Family Medicine EOR: Gastrointestinal and Nutritional (Smarty PANCE) Exam Questions and Answers 100% Pass | Verified and Updated 2024 What is an anal fissure? Tear or fissure in the anal epithelium What is the most common site? Posterior midline (comparatively low blood flow) What is the cause? Hard stool passage (constipation), hyperactive sphincter, disease process (e.g., Crohn's disease) What are the signs/symptoms? Pain in the anus, painful (can be excruciating) bowel movement, rectal bleeding, blood on toilet tissue after bowel movement, sentinel tag, tear in the anal skin, extremely painful rectal exam, sentinel pile, hypertrophic papilla What is a sentinel pile? Thickened mucosa/skin at the distal end of an anal fissure that is often confused with a small hemorrhoid What is the anal fissure triad for a chronic fissure? 1. Fissure 2. Sentinel pile 3. Hypertrophied anal papilla What is the conservative treatment? Sitz baths, stool softeners, high fiber diet, excellent anal hygiene, topical nifedipine, Botox® What disease processes must be considered with a chronic anal fissure? Crohn's disease, anal cancer, sexually transmitted disease, ulcerative colitis, AIDS What are the indications for surgery? Chronic fissure refractory to conservative treatment What is one surgical option? Lateral internal sphincterotomy (LIS)—cut the internal sphincter to release it from spasm What is the "rule of 90%" for anal fissures? 90% occur posteriorly 90% heal with medical treatment alone 90% of patients who undergo an LIS heal successfully What is the most common cause of acute abdomen? Acute appendicitis is the most common cause of acute abdomen. How does acute appendicitis classically present? Acute appendicitis classically presents with nausea/vomiting, fever, and diffuse periumbilical pain migrating to the McBurney point. What is McBurney's point? The McBurney point is an anatomical landmark located one-third of the distance from the right anterior superior iliac spine to the umbilicus. What is a positive Rovsing sign? A positive Rovsing sign is indicative of acute appendicitis, and occurs when a patient experiences severe lower right quadrant abdominal pain upon palpation of the lower left quadrant of the abdomen. Pain on active hip flexion constitutes what? Pain on active hip flexion constitutes a positive psoas sign, which is indicative of acute appendicitis. What constitutes a positive obturator sign?