NSG 555 Quiz 2 module 3 GI/GU 2025
Questions and Answers
cranial nerve function - --CORRECT ANSWER--Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s - --CORRECT ANSWER--external: usually
asymptomatic unless a small thrombus , then acutely painful and itchy and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition - --CORRECT ANSWER--increased pressure-->vascular
engorgement-->trauma to vessels-->pain and prolaps of tissue
4 degrees of internal hemorrhoids - --CORRECT ANSWER--1. painless bleeding,
bulge but no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
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,diagnostics of hemorrhoids - --CORRECT ANSWER--clinical one. further testing
not needed but if pt over 50 or concern re cancer should get colonoscopy.
management of hemorrhoids - --CORRECT ANSWER--high fiber diet, increased
fluid. fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids - --CORRECT ANSWER--4th degree can be at risk
for strangulation and can become gangrenous and need surgery. use rubber band
ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure - --CORRECT ANSWER--painful linear cracks common in kids and
middle age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,caused by trauma from constipationor diarrhea which causes a chemical burn or
anal stenosis
anal fissure that is NOT posterior midline - --CORRECT ANSWER--suspect STI,
TB, HIV, infection, UC, crohns, malignant neoplasm, etc REFER THESE PTS
s/s and PE of anal fissure - --CORRECT ANSWER--tearing with passing stool,
pain, small amounts of blood on TP.
differential dx anal fissure - --CORRECT ANSWER--anal cancer, perianal abscess,
thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody
diarrhea, wt loss
management of anal fissures - --CORRECT ANSWER--usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure - --CORRECT ANSWER--
lateral internal sphincerotomy: reduces internal sphincter tone allowing fissure to
heal
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, Pruritis ani - --CORRECT ANSWER--RED FLAG IF wieght loss or refractory
s/s to rule on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out
STI, may need biopsy if no relief, assess if food alergy or detergent allergy, pin
worms, yest, etc.
management of pruritis ani - --CORRECT ANSWER--hygien. increase fiber if
there are loos stools. Use a hair dryer on cool setting to dry anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula - --CORRECT ANSWER--common in crohns patients.
pus from internal opening of fistual tract, purulent drainage or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
Questions and Answers
cranial nerve function - --CORRECT ANSWER--Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s - --CORRECT ANSWER--external: usually
asymptomatic unless a small thrombus , then acutely painful and itchy and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition - --CORRECT ANSWER--increased pressure-->vascular
engorgement-->trauma to vessels-->pain and prolaps of tissue
4 degrees of internal hemorrhoids - --CORRECT ANSWER--1. painless bleeding,
bulge but no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,diagnostics of hemorrhoids - --CORRECT ANSWER--clinical one. further testing
not needed but if pt over 50 or concern re cancer should get colonoscopy.
management of hemorrhoids - --CORRECT ANSWER--high fiber diet, increased
fluid. fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids - --CORRECT ANSWER--4th degree can be at risk
for strangulation and can become gangrenous and need surgery. use rubber band
ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure - --CORRECT ANSWER--painful linear cracks common in kids and
middle age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,caused by trauma from constipationor diarrhea which causes a chemical burn or
anal stenosis
anal fissure that is NOT posterior midline - --CORRECT ANSWER--suspect STI,
TB, HIV, infection, UC, crohns, malignant neoplasm, etc REFER THESE PTS
s/s and PE of anal fissure - --CORRECT ANSWER--tearing with passing stool,
pain, small amounts of blood on TP.
differential dx anal fissure - --CORRECT ANSWER--anal cancer, perianal abscess,
thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody
diarrhea, wt loss
management of anal fissures - --CORRECT ANSWER--usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure - --CORRECT ANSWER--
lateral internal sphincerotomy: reduces internal sphincter tone allowing fissure to
heal
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, Pruritis ani - --CORRECT ANSWER--RED FLAG IF wieght loss or refractory
s/s to rule on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out
STI, may need biopsy if no relief, assess if food alergy or detergent allergy, pin
worms, yest, etc.
management of pruritis ani - --CORRECT ANSWER--hygien. increase fiber if
there are loos stools. Use a hair dryer on cool setting to dry anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula - --CORRECT ANSWER--common in crohns patients.
pus from internal opening of fistual tract, purulent drainage or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
