Surgery EOR Exam Review Questions with
100% Verified Correct Answers
51yo M, anal pain and bleeding, feels "knife-like" and worse with BM, small laceration
in posterior midline of anus
anal fissure
30yo M, hx constipation, severe tearing pain on defecation, bright red blood streaks on
stool, elliptical lesion noted on posterior midline of anus
anal fissure
where anatomically does anal fissure most often appear
posterior midline
and distal to the dentate line
if an anal fissure is in this placement, concern for other causes such as Crohn disease,
HIV, leukemia, etc.
lateral
treatment for anal fissure
1. start with fiber supplements or increase fiber in diet, and stool softener meds to prevent
constipation; also warm sitz baths
2. can try topical meds to relax sphincter (nitroglycerin, hydrocortisone, diltiazem) or botox
injections, or for pain can do topical lidocaine
,3. last resort is surgery (lateral internal sphincterotomy) done only if symptoms > 8 weeks
and failed all else - surgery carries a risk of irreversible fecal incontinence
44yo M, pain in anal area, no rectal bleeding or itching, but bowel movement was
extremely painful, exam shows tender fluctuant erythematous mass to the right of the
anus and involves anal verge
perianal abscess
treatment of perianal abscess
I&D first (make incision close to anal verge as possible
then give abx
describe perianal abscess
severe throbbing continuous perianal pain, redness and swelling in region, induration and
fluctuance
can lead to sepsis or fistula if not treated
treat with I&D and abx
more in men age 40, mass will be close to the anal verge
describe anal fistula
abnormal communication between the anus and the perirectal skin, most commonly resulting
from drainage of a perirectal/perianal abscess
,anal irritation and itching, drainage from the anus that is bloody or pus filled, or urinary
symptoms if the fistula involves the bladder
anal fistulas are associated with Crohn disease
treatment for anal fistula
IV abx and urgent surgical consult to correct the fistula --> seton or fistulotomy
but note that recurrence rates are high
bloody or pus filled drainage out of anus, rectal pruritus, intermittent pain with
defecation or sitting
anal fistula
describe pilonidal disease
chronic glandular inflammation due to blocked hair follicles along superior and inferior
gluteal cleft
more in men
may have abscesses or chronically draining pits along gluteal cleft that extend CEPHALAD
(up) - different from anorectal abscesses and fistulas which extend down to the RECTUM
treatment of pilonidal disease
I&D for acute
definitive is surgery - removal of pilonidal tracts
, also can consider abx if acutely infected
29yo M, buttock pain and fluid drainage that started 1 week ago, has tender, red,
fluctuant mass in sacrococcygeal region 6cm cephalad to rectum
pilonidal disease
achalasia describe
disorder of the distal 2/3 of the esophagus --> loss of peristalsis and impaired relaxation of
the LES (increased tone in this sphincter)
leads to dysphagia to both solids and liquids, along with regurgitation
associated with Chagas disease
unlike esophageal stricture, achalasia presents with equal dysphagia to both solids and
liquids; rather than progressive dysphagia for solids
disorder of the distal 2/3 of the esophagus --> loss of peristalsis and impaired relaxation
of the LES (increased tone in this sphincter)
achalasia
44yo male presents with difficulty swallowing solids and liquids, sometimes has to
reposition his neck to pass food bolus and occasionally regurgitation of swallowed food
accompanied by chest pain, unintentional 8lbs weight loss
achalasia
most common cause of dysphagia
100% Verified Correct Answers
51yo M, anal pain and bleeding, feels "knife-like" and worse with BM, small laceration
in posterior midline of anus
anal fissure
30yo M, hx constipation, severe tearing pain on defecation, bright red blood streaks on
stool, elliptical lesion noted on posterior midline of anus
anal fissure
where anatomically does anal fissure most often appear
posterior midline
and distal to the dentate line
if an anal fissure is in this placement, concern for other causes such as Crohn disease,
HIV, leukemia, etc.
lateral
treatment for anal fissure
1. start with fiber supplements or increase fiber in diet, and stool softener meds to prevent
constipation; also warm sitz baths
2. can try topical meds to relax sphincter (nitroglycerin, hydrocortisone, diltiazem) or botox
injections, or for pain can do topical lidocaine
,3. last resort is surgery (lateral internal sphincterotomy) done only if symptoms > 8 weeks
and failed all else - surgery carries a risk of irreversible fecal incontinence
44yo M, pain in anal area, no rectal bleeding or itching, but bowel movement was
extremely painful, exam shows tender fluctuant erythematous mass to the right of the
anus and involves anal verge
perianal abscess
treatment of perianal abscess
I&D first (make incision close to anal verge as possible
then give abx
describe perianal abscess
severe throbbing continuous perianal pain, redness and swelling in region, induration and
fluctuance
can lead to sepsis or fistula if not treated
treat with I&D and abx
more in men age 40, mass will be close to the anal verge
describe anal fistula
abnormal communication between the anus and the perirectal skin, most commonly resulting
from drainage of a perirectal/perianal abscess
,anal irritation and itching, drainage from the anus that is bloody or pus filled, or urinary
symptoms if the fistula involves the bladder
anal fistulas are associated with Crohn disease
treatment for anal fistula
IV abx and urgent surgical consult to correct the fistula --> seton or fistulotomy
but note that recurrence rates are high
bloody or pus filled drainage out of anus, rectal pruritus, intermittent pain with
defecation or sitting
anal fistula
describe pilonidal disease
chronic glandular inflammation due to blocked hair follicles along superior and inferior
gluteal cleft
more in men
may have abscesses or chronically draining pits along gluteal cleft that extend CEPHALAD
(up) - different from anorectal abscesses and fistulas which extend down to the RECTUM
treatment of pilonidal disease
I&D for acute
definitive is surgery - removal of pilonidal tracts
, also can consider abx if acutely infected
29yo M, buttock pain and fluid drainage that started 1 week ago, has tender, red,
fluctuant mass in sacrococcygeal region 6cm cephalad to rectum
pilonidal disease
achalasia describe
disorder of the distal 2/3 of the esophagus --> loss of peristalsis and impaired relaxation of
the LES (increased tone in this sphincter)
leads to dysphagia to both solids and liquids, along with regurgitation
associated with Chagas disease
unlike esophageal stricture, achalasia presents with equal dysphagia to both solids and
liquids; rather than progressive dysphagia for solids
disorder of the distal 2/3 of the esophagus --> loss of peristalsis and impaired relaxation
of the LES (increased tone in this sphincter)
achalasia
44yo male presents with difficulty swallowing solids and liquids, sometimes has to
reposition his neck to pass food bolus and occasionally regurgitation of swallowed food
accompanied by chest pain, unintentional 8lbs weight loss
achalasia
most common cause of dysphagia
