10Which statement is false concerning this patient? nothing1HideAnsExcision is likely to be of benefitConservative measures should be initiatedFiber supplementation is associated with improvementTopical analgesics are indicated1924[Default][MC Any][MC All]1
11What is “conservative” therapy? Your Treatment PlanWhat is “conservative” therapy?
12Conservative Therapy Sitz Baths Stool softeners Fiber supplementation Topical therapy
15Which statement is false concerning this diagnosis? nothing1noHemorrhoidectomy benefit drops after 72 hoursConservative management is unlikely to be of benefitMalignancy may be comorbid1267[Default][MC Any][MC All]
1762 year old male referred for colonoscopy for persistent bleeding despite conservative treatment.
18Which statement is false concerning this diagnosis? nothing1HideAnsThis diagnosis is the most common cause of rectal bleedingRubber band ligation is the most effective treatmentSurgical excision has better remission rates for grade 3 and higherExcision is associated with decreased pain and complications214[Default][MC Any][MC All]17
19Case #2A 38 year old female presents to your clinic complaining of over one year of anal itching. She has worked to self-manage without success.
20Which statement is false concerning pruritus ani? nothing1noIt has a broad differential diagnosisIt may be radicular in natureTopical steroids should be avoidedAntibacterial soap is effective58[Default][MC Any][MC All]11
21Case #3A 26 year old male presents complaining of anal pain. He notes constipation, with recent BM’s including a feeling of passing “shards of glass.” He notes small bright red blood after BM’s.
32Which is a true statement for this diagnosis? nothing1HideAnsAntibiotics are necessaryConservative therapy will lead to resolutionThis diagnosis requires referralAcute onset with minimal exam findings is concerning131[Default][MC Any][MC All]18
3323 year old male with a painless anal mass. Case #523 year old male with a painless anal mass.
34Which is false concerning this diagnosis? nothing1noNo topical treatment has been shown to have superior efficacyAnoscopy should be performedBiopsy for persistenceHome treatment is not recommended662[Default][MC Any][MC All]9
35Case #6A 26 year old male presents complaining of anal pain, occasional discharge, and a sensation of swelling.
38Which is true regarding treatment? nothing1noAll fistulas should be referred for surgical evaluationMRI or ultrasound may help define the lesionPosterior position is concerningAbscess formation is uncommon[Default][MC Any][MC All]
4062 year old female with a complaint of recent constipation, straining, and an anal mass.
4128 year old male with nocturnal diarrhea and chronic weight loss.
42What is the most important piece of advice for this patient?
4327 year old male with recent rectal pain, intermittent bloody stools, urgency, tenesmus, and lower abdominal pain.
44Exam is unremarkable except for increased anal sphincter tone. A 52 year old male presents with sudden onset anal pain which lasts for several seconds up to minutes. It often occurs at night. He is unable to identify a trigger.Exam is unremarkable except for increased anal sphincter tone.
45Take-home points Consider malignancy Know, use, love conservative measures