QUESTIONS FROM FITZGERALD 4TH EDITION
Anal Fissure
The most common anal fissure location is
o Posterior midline of the anus
Rectal bleeding associated with anal fissure is usually described by the patient as
o Drops of blood noticed when wiping
A 62 year old woman who reports frequent constipation is diagnosed with an anal
fissure. First line therapy includes all of the following except
o Intra-anal corticosteroids
o stool-bulking supplements
o high fiber diet
o periodic use of oral mineral oil
A 54 year old man with an anal fissure responds inadequately to dietary intervention and
standard therapy during the past 2 weeks. Additional treatment options include all of the
following except
o Rubber band ligation of the lesion
o Intra-anal nitroglycerine ointment
o botulinum toxicum injection to the internal anal sphincter
o surgical sphincterotomy
In a patient who presents with a history consistent with anal fissure but with notation of
an atypical anal lesion, alternative diagnoses to consider include all of the following
except
o C difficile colitis
o condyloma acuminate
o Crohn’s disease
o anal squamous cell carcinoma
Which of the following is the most likely patient report with anal fissure
o “I have anal pain for up to 1-2 hours after I have a bowel movement”
Long term, recurrent high-dose oral use of mineral oil may lead to a deficiency in
o Vitamin A
Hemorrhoids
Rectal bleeding associated with hemorrhoids is usually described as
o Streaks of bright red blood on the stool
Therapy for hemorrhoids include all of the following except
o Low fat diet
o weight control
o topical corticosteroids
o the use of stool softener
, The NP is advising a 58 year old woman about the benefits of a high fiber diet. Which of
the following foods provides the highest fiber content
o 1 cup of cooked oatmeal
A 62 year old man presents with a 2 month history of noting a "bit of dark blood mixed in
with my stool most days." PE reveals external hemorrhoids, no rectal mass, and a small
amount of dark brown stool on the examining digit. In office fecal occult blood test is
positive, and hemogram reveals a microcytic hypochromic anemia. The next best step in
his care is to
o Refer to gastroenterology practice for colonoscopy
Risk factors for the development of hemorrhoidal symptoms include all of the following
except
o Insertive partner in anal intercourse
o prolonged sitting
o chronic diarrhea
o excessive alcohol use
Which of the following best describes Grade III internal hemorrhoids
o The hemorrhoids prolapse upon defecation and must be reduced manually
Which of the following patients should be evaluated for possible surgical intervention for
hemorrhoids?
o A 44 year old woman who has internal and external hemorrhoids with
recurrent prolapse
Acute Appendicitis
All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except
o Marked febrile response
o epigastric pain
o positive obturator sign
o rebound tenderness
A 26 year old man presents with acute abdominal pain. As part of the evaluation for
acute appendicitis, you order a WBC with differential and anticipate the following
o Total WBC 16.5, Neutrophils 66%, Bands 8%, Lymphocytes 22%
You see a 72 year old woman who reports vomiting and abdominal cramping occurring
over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician
considers that
o The presentation can differ according to the anatomical location of the
appendix
The psoas sign can be best described as abdominal pain elicited by
o Passive extension of the hip
The obturator sign can be best described as abdominal pain elicited by
o Passive flexion and internal rotation of the hip
, An 18 year old man presents with periumbilical pain, vomiting, and abdominal cramping
over the past 48 hours. Physical exam reveals rebound tenderness, and laboratory
analysis shows the presence of bandemia and WBC 28. To support the diagnosis of acute
appendicitis with suspected appendiceal rupture, you consider obtaining the following
abdominal imaging study
o Computed tomography (CT) scan
Which of the following WBC forms is an ominous finding in the presence of severe
bacterial infection
o Metamyelocyte
Which of the following best represents the peak ages for occurrence of acute
appendicitis?
o 10 to 30 years
Clinical findings most consistent with appendiceal rupture include all of the following
except
o Abdominal discomfort less than 48 hours in duration
o fever greater than 102 F
o palpable abdominal mass
o marked leukocytosis with WBC > 20
Which of the following imaging studies potentially exposes the patient being evaluated
for abdominal pain to the lowest ionizing radiation burden?
o Ultrasound
Commonly encountered diagnoses other than acute appendicitis can include which of the
following in a 28 year old with a 2 day history of lower abdominal pain and with right
sided pain slightly worse than left? (More than one can apply)
o Constipation, pelvic inflammatory disease, ectopic pregnancy
Rebound tenderness is best described as abdominal pain that worsens with
o Release of deep palpation at the site of discomfort
Abdominal palpation that yields rebound tenderness is also known as a positive
___________ sign
o Blumberg’s
Which of the following findings would you expect to encounter in a 33 year old man with
appendiceal abscess?
o Dullness to percussion in the abdominal right lower quadrant
Colorectal Cancer
Which of the following is true concerning colorectal cancer?
o Later disease presentation often includes iron-deficiency anemia
According to the American Cancer Society recommendations, which of the following is
the preferred method for annual colorectal cancer screening in a 51 year old man?
o Fecal occult blood test
Which of the following is most likely to be noted in a person with colorectal cancer?
o Few symptoms
, Which of the following does not increase a patient’s risk of developing colorectal cancer?
o Long-term aspirin therapy
According to the American Cancer Society data, colorectal cancer is the number __
cause of cancer death in men and women
o 3
Colonic Diverticulosis
Colonic diverticulosis most commonly occurs in the walls of the
o Sigmoid colon
Approximately what percent of the population will develop diverticulosis by the time they
reach 50 years of age
o 33%
Which of the following is most consistent with the presentation of a patient with colonic
diverticulosis?
o Few or no symptoms
Which of the following is most consistent with the presentation of a patient with acute
colonic diverticulitis?
o Cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except
o Low-fiber diet
o family history
o older age
o select connective tissue disorders
To avoid the development of acute diverticulitis, treatment of diverticulosis can include
o The use of fiber supplements
The location of discomfort with acute diverticulitis is usually in which of the following
areas of the abdomen?
o Left lower quadrant
Which of the following best describes colonic diverticulosis
o Bulging pockets in the intestinal wall
You are seeing Mr. Lopez, a 68 year old man with suspected acute colonic diverticulitis.
In choosing an appropriate imaging study to support this diagnosis, which of the
following abdominal imaging studies is most appropriate?
o CT scan with contrast
In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule
out free air in the abdomen includes
o Plain abdominal film
A 56 year old woman is diagnosed with mild diverticulitis. In addition to counseling her
about increased fluid intake and adequate rest, you recommend antimicrobial treatment
with
o Ciprofloxacin with metronidazole
Lower GI hemorrhage associated with diverticular disease usually manifests as
Anal Fissure
The most common anal fissure location is
o Posterior midline of the anus
Rectal bleeding associated with anal fissure is usually described by the patient as
o Drops of blood noticed when wiping
A 62 year old woman who reports frequent constipation is diagnosed with an anal
fissure. First line therapy includes all of the following except
o Intra-anal corticosteroids
o stool-bulking supplements
o high fiber diet
o periodic use of oral mineral oil
A 54 year old man with an anal fissure responds inadequately to dietary intervention and
standard therapy during the past 2 weeks. Additional treatment options include all of the
following except
o Rubber band ligation of the lesion
o Intra-anal nitroglycerine ointment
o botulinum toxicum injection to the internal anal sphincter
o surgical sphincterotomy
In a patient who presents with a history consistent with anal fissure but with notation of
an atypical anal lesion, alternative diagnoses to consider include all of the following
except
o C difficile colitis
o condyloma acuminate
o Crohn’s disease
o anal squamous cell carcinoma
Which of the following is the most likely patient report with anal fissure
o “I have anal pain for up to 1-2 hours after I have a bowel movement”
Long term, recurrent high-dose oral use of mineral oil may lead to a deficiency in
o Vitamin A
Hemorrhoids
Rectal bleeding associated with hemorrhoids is usually described as
o Streaks of bright red blood on the stool
Therapy for hemorrhoids include all of the following except
o Low fat diet
o weight control
o topical corticosteroids
o the use of stool softener
, The NP is advising a 58 year old woman about the benefits of a high fiber diet. Which of
the following foods provides the highest fiber content
o 1 cup of cooked oatmeal
A 62 year old man presents with a 2 month history of noting a "bit of dark blood mixed in
with my stool most days." PE reveals external hemorrhoids, no rectal mass, and a small
amount of dark brown stool on the examining digit. In office fecal occult blood test is
positive, and hemogram reveals a microcytic hypochromic anemia. The next best step in
his care is to
o Refer to gastroenterology practice for colonoscopy
Risk factors for the development of hemorrhoidal symptoms include all of the following
except
o Insertive partner in anal intercourse
o prolonged sitting
o chronic diarrhea
o excessive alcohol use
Which of the following best describes Grade III internal hemorrhoids
o The hemorrhoids prolapse upon defecation and must be reduced manually
Which of the following patients should be evaluated for possible surgical intervention for
hemorrhoids?
o A 44 year old woman who has internal and external hemorrhoids with
recurrent prolapse
Acute Appendicitis
All of the following are typically noted in a young adult with the diagnosis of acute
appendicitis except
o Marked febrile response
o epigastric pain
o positive obturator sign
o rebound tenderness
A 26 year old man presents with acute abdominal pain. As part of the evaluation for
acute appendicitis, you order a WBC with differential and anticipate the following
o Total WBC 16.5, Neutrophils 66%, Bands 8%, Lymphocytes 22%
You see a 72 year old woman who reports vomiting and abdominal cramping occurring
over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician
considers that
o The presentation can differ according to the anatomical location of the
appendix
The psoas sign can be best described as abdominal pain elicited by
o Passive extension of the hip
The obturator sign can be best described as abdominal pain elicited by
o Passive flexion and internal rotation of the hip
, An 18 year old man presents with periumbilical pain, vomiting, and abdominal cramping
over the past 48 hours. Physical exam reveals rebound tenderness, and laboratory
analysis shows the presence of bandemia and WBC 28. To support the diagnosis of acute
appendicitis with suspected appendiceal rupture, you consider obtaining the following
abdominal imaging study
o Computed tomography (CT) scan
Which of the following WBC forms is an ominous finding in the presence of severe
bacterial infection
o Metamyelocyte
Which of the following best represents the peak ages for occurrence of acute
appendicitis?
o 10 to 30 years
Clinical findings most consistent with appendiceal rupture include all of the following
except
o Abdominal discomfort less than 48 hours in duration
o fever greater than 102 F
o palpable abdominal mass
o marked leukocytosis with WBC > 20
Which of the following imaging studies potentially exposes the patient being evaluated
for abdominal pain to the lowest ionizing radiation burden?
o Ultrasound
Commonly encountered diagnoses other than acute appendicitis can include which of the
following in a 28 year old with a 2 day history of lower abdominal pain and with right
sided pain slightly worse than left? (More than one can apply)
o Constipation, pelvic inflammatory disease, ectopic pregnancy
Rebound tenderness is best described as abdominal pain that worsens with
o Release of deep palpation at the site of discomfort
Abdominal palpation that yields rebound tenderness is also known as a positive
___________ sign
o Blumberg’s
Which of the following findings would you expect to encounter in a 33 year old man with
appendiceal abscess?
o Dullness to percussion in the abdominal right lower quadrant
Colorectal Cancer
Which of the following is true concerning colorectal cancer?
o Later disease presentation often includes iron-deficiency anemia
According to the American Cancer Society recommendations, which of the following is
the preferred method for annual colorectal cancer screening in a 51 year old man?
o Fecal occult blood test
Which of the following is most likely to be noted in a person with colorectal cancer?
o Few symptoms
, Which of the following does not increase a patient’s risk of developing colorectal cancer?
o Long-term aspirin therapy
According to the American Cancer Society data, colorectal cancer is the number __
cause of cancer death in men and women
o 3
Colonic Diverticulosis
Colonic diverticulosis most commonly occurs in the walls of the
o Sigmoid colon
Approximately what percent of the population will develop diverticulosis by the time they
reach 50 years of age
o 33%
Which of the following is most consistent with the presentation of a patient with colonic
diverticulosis?
o Few or no symptoms
Which of the following is most consistent with the presentation of a patient with acute
colonic diverticulitis?
o Cramping, diarrhea, and leukocytosis
Major risk factors for diverticulosis include all of the following except
o Low-fiber diet
o family history
o older age
o select connective tissue disorders
To avoid the development of acute diverticulitis, treatment of diverticulosis can include
o The use of fiber supplements
The location of discomfort with acute diverticulitis is usually in which of the following
areas of the abdomen?
o Left lower quadrant
Which of the following best describes colonic diverticulosis
o Bulging pockets in the intestinal wall
You are seeing Mr. Lopez, a 68 year old man with suspected acute colonic diverticulitis.
In choosing an appropriate imaging study to support this diagnosis, which of the
following abdominal imaging studies is most appropriate?
o CT scan with contrast
In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule
out free air in the abdomen includes
o Plain abdominal film
A 56 year old woman is diagnosed with mild diverticulitis. In addition to counseling her
about increased fluid intake and adequate rest, you recommend antimicrobial treatment
with
o Ciprofloxacin with metronidazole
Lower GI hemorrhage associated with diverticular disease usually manifests as
