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Worksheetslower gi lesion
Total questions: 18
Worksheet time: 9mins
A 49-year-old woman is diagnosed with a malignancy of the upper rectum. She subsequently undergoes laparoscopic anterior resection with a covering defunctioning loop ileostomy. From which artery is the lesion’s blood supply most likely to be derived?
Inferior mesenteric artery
External pudendal artery
Left external iliac artery
Obturator artery
Superior mesenteric artery
A patient is being prepared for treatment of a fistula-in-ano in the operating theatre. He is placed in lithotomy position. The external opening is at 8 o’clock position. Using Goodsalls rule, in which of the following positions is the internal opening likely to be?
12 o’clock
8 o’clock
6 o’clock
It is not possible to predict
You see a 55-year-old woman in the emergency department, who was admitted with central colicky abdominal pain and multiple episodes of vomiting. She last opened her bowels 4 hours ago. On examination she appears dehydrated and is in pain. The abdomen is generally tender and slightly distended. Bowel sounds are increased. You suspect bowel obstruction and decide to order some investigations. What is the most valuable initial investigation that will support your suspected diagnosis?
Upper gastrointestinal endoscopy
Colonoscopy
Computed tomography scan of the abdomen
Plain film radiograph of the abdomen
A 36-year-old male with past history of appendectomy presents with distension of abdomen, vomiting and colicky pain in the lower abdomen. On examination the abdomen is tympanic and generalized tenderness is present. Bowel sounds are absent. Plain erect x-ray of abdomen is taken as shown in the picture. What is the MOST likely diagnosis?
Acute pancreatitis
Adhesive obstruction
Diverticulitis
Sigmoid volvulus
37 years-old man presented to you at surgical outpatient clinic with the symptoms of chronic diarrhoea. He claims he had lost more than 5kg in 2 months. He denied any history of early satiety or vomiting. On examination noted to have uncontrolled diabetes. What is the MOST possible diagnosis of this patient?
Hepatic Flexure tumor
Chronic pancreatitis
Hepatocelular carcinoma
Chronic cholecystitis
A 55 year old woman presents with intermittent bright red PR bleeding. On examination she is stable, and PR shows small external haemorrhoid. What is appropriate treatment for this lady?
Reassure, prescribe treatment for haemorrhoids
Refer to surgeons for elective haemorrhoidectomy
Prescribe treatment for haemorrhoids, and arrange outpatient colonoscopy with surgical follow-up.
No further treatment necessary.
Admit to hospital for colonoscopy or double contrast barium enema
Which of the following is the least common cause of large bowel obstruction?
Neoplasm
Diverticulitis
Volvulus
Adhesions
Faecal impaction
Which of the following features suggests a complete large bowel obstruction?
Presence of multiple loops of bowel with plicae circularis on AXR
Bilious vomiting
Distended abdomen, with high pitched bowel sounds with normal flatus.
Empty rectum on PR exam
Dilated loops of bowel with haustra visible
What is the upper limit of normal for large bowel?
3cm
4cm
5cm
6cm
10cm
Which is INCORRECT regarding Ulcerative Colitis?
Affects men more than woman
Mild disease affects 60% of patients and consists of less than 4 bowel motions per day, with the disease limited to rectum in 80%.
In severe disease there is usually hypoalbuminemia and mildly deranged LFT’s.
Loperamide and other antidiarrhoeal agents should be avoided as they increase the risk of toxic megacolon.
Toxic megacolon is usually treated conservatively unless the bowel is wider than 6 cm or the patient severely ill.
•You see a 55-year-old woman in the emergency department, who was admitted with central colicky abdominal pain and multiple episodes of vomiting. She last opened her bowels 4 hours ago. On examination she appears dehydrated and is in pain. The abdomen is generally tender and slightly distended. Bowel sounds are increased. You suspect bowel obstruction and decide to order some investigations. What is the most urgent investigation that will support your suspected diagnosis?
Erect CXR PA view
Contrasted enhanced Ct scan of abdomen and pelvis
Supine Plain AXR AP view
USG abdomen and pelvis
•You see a 55-year-old woman in the emergency department, who was admitted with central colicky abdominal pain and multiple episodes of vomiting. She last opened her bowels 4 hours ago. On examination she appears dehydrated and is in pain. The abdomen is generally tender and slightly distended. Bowel sounds are increased. You suspect bowel obstruction and decide to order some investigations. What is the most important initial investigation that will support your suspected diagnosis?
Urgent sigmoidoscopy
Barium enema
AXR
CT Abdomen and pelvis
A 52-year-old female, known case of ischaemic heart disease, presented to Emergency Department with the symptoms of cramping abdominal pain, abdominal distension and vomiting for the past one week. She also had history of a bleeding diarrhoea three days ago. On examination she was noted to have profuse sweating, tachycardia and hypotension. A colonoscopy was performed shows that ulcerative lesion from the anus till terminal ileum with multiple area of skip lesion. What is the MOST IMPORTANT steps to confirm the diagnosis?
contrasted enhanced ct scan of abd and pelvis
Push enteroscopy
Random colon biopsy
Stool for ova and cyst
A 3-month-old baby, presents with abdominal distension for two weeks. However no vomiting or fever. The mother claims that the child was irregularly passing stool. Abdominal examination shows an indentable non-tender mass at the left iliac fossa region.
What is the BEST APPROPRIATE investigation to confirm the diagnosis?
ultrasound of abdomen and pelvis
Contrasted enhance ct abd and pelvis
Double contrast barium enema
Erect PA view abd xray
A 46-years-old woman on aspirin for IHD, presents to you for fresh pr bleeding since two weeks ago. She also complaininhg of recurrent abd pain esp at left side. On further questioning , she had history of constipation for the three years on regular stool softener. What is the BEST APPROPRIATE management for her
Stop aspirin as soon as possible .
Arrange for haemorrhoidectomy
Increase dose for stools softener
arrange for early colonoscopy
What is the BEST imaging tools to assest the staging of rectal cancer ?
Contrast enhanced CT scan of pelvis
Endoanal ultrasound
MRI pelvis
PET Scan of pelvis
What is the BEST appropriate treatment for Grade III internal haemorrhoid?
proctoscopy-stool softener-daflon-banding of haemorrhoid
colonoscopy and banding haemorrhoid
colonoscopy-stapler haemorrhoidepexy
Proctoscopy-daflon-open haemorrhoidectomy
A 57-years-old women presented to you with perianal pain and blood in the stool since three days. She complaining of
constipation for one week. On examination noted to multiple anal fissure at anal region.
What is the BEST TREATMENT for her ?
Stools softener, apply lignocaine gel and arrange for early colonoscopy
Proctoscopy and apply lignocaine gel
stools softener, lignocaine gel and lateral sphinterectomy
reassurance and advice for high fiber diet
