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self assessment CME questions
Terms in this set (49)
Best treatment for bleeding around ileostomy created for UC with blue skin tinge
How does a harmonic scalpel work
Disrupts hydrogen bonds using vibrations
best treatment for diverticular abscess less than 4cm
ABX only - no IR drainage needed
how to proceed with depressed man who refuses treatment for obstructing sigmoid colon CA?
In an elderly man with multiple medical comorbidities and a psychiatric illness, it is appropriate to obtain a psychiatric evaluation to assess the effect of depression on decision-making, especially if the decision is life-threatening
what is a type 2 statistical error?
When the sample size is small, randomized trials are subject to beta errors (type-II errors)--that is, the probability of concluding that no difference between treatment groups exists when, in fact, there is a difference.
what is type 1 error?
A type I error occurs when the null hypothesis is false but it is not rejected, ie, a false-positive result or asserting something that is actually absent.
what is the most common reason for postoperative delirium in an elderly patient?
a history of cognitive dysfunction (cognitive impairment and dementia) was the strongest predisposing risk factor for the development of postoperative delirium
how does a surrogate help with end of life decisions
they need to adhere to a living will which will enable care consistent with the patients wishes and increase the chance that the patient will not die in a hospital
what is the Chi squared statistical test?
it compares observed versus expected cases of something in a given population
why are vessels with atheromas at higher risk of bleeding after being divided with a Ligasure?
the atheroma prevents proper coaptation of the tissue
what is the legal standard for decision making capacity
1- patients' ability to communicate a choice; 2- understand the relevant information; 3 - appreciate the medical consequences of the situation; 4 - reason about treatment choices.
what is the newest and best way to prevent retained sponges?
radiofrequency sponge detection and identification to supplement manual counts at the end of the operative procedure is very effective
describe phase 1, 2, and 3 trials
Phase I trials are designed to gather data on safety, pharmacokinetics, tolerability, and pharmacodynamics of a drug. Typically these studies use small groups of healthy volunteers. They also usually include dose-ranging/dose escalation to determine what safe dosing of a drug may be.
Phase II trials evaluate the biological activity or effect of a drug. Larger groups are used and the trials look to assess dosing requirements and efficacy. Many phase II trials are randomized controlled trials.
Phase III trials are designed to assess effectiveness, essentially value in clinical practice. These tend to be randomized multicenter controlled trials of very large groups of patients.
what does a positive sitz marker study look like?
in slow transit constipation, more than 20% of the markers are present and scattered throughout the colon.
what is best initial move in new patient with fecal incontinence and sphincter defect?
an initial trial of fiber optimization and low-dose antimotility drug use are warranted. This will be successful in a number of individuals.
what did the landmark Wexner study show about SNS?
At 12 months, 83% of patients had therapeutic success, with reduction in the number of incontinence episodes per week by 50%, and 100% continence in 41% of patients - also FI decreased from a mean of 9.1 episodes at baseline to 1.7 at 5 years, and 89% of patients had more than 50% improvement in FI
When is a disk excision appropriate is treatment for an endometrial implant
When the lesion is less than 3 cm
What is the best treatment for a large or very deep endometrial implant that is symptomatic.
Bowel resection with anastomosis
when to use surgical treatment for endometriosis
endometrial lesions that have invaded into the bowel wall with resultant motility dysfunction, bleeding, fibrosis, stricture, and obstruction
what is the initial RX for endometriosis
combination oral contraceptives (estrogen and progestin), progestational agents (medroxyprogesterone), gonadotropin inhibitors (danazol), gonadotropin-releasing hormone agonist (leuprolide, goserelin, nafarelin), and aromatase inhibitors (anastrozole, letrozole).
definition of IBS
recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with two or more of the following criteria: symptoms related to defecation, change in stool frequency, or change in stool form
what does the ganglion impair innervate
the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. A ganglion impar block can be used to treat chronic perineal pain.
most common postop complication of STARR procedure
Fecal urgency was the most common postoperative complication in a large registry of patients (20% of patients). Chronic pain has been reported in another 7% of patients. Bleeding and rectovaginal fistula have been reported after the STARR procedure, but are much less
what is RX for colonic pseudo-obstruction
1 - conservative, 70% successful; 2 - neostigmine 2mg IV over 2-5 min in monitored setting; 91% successful - If no initial response is seen in the first 3 hours, neostigmine 2 mg IV may be repeated every 3 hours for up to three total doses.
what is the right management of a large sigmoid stricture caused by endometriosis
a bowel resection; hormones are not very effective for bowel-affected endometriosis
which type of rectocele repair has a higher recurrence rate but a lower dyspareunia rate
trans-anal repair for rectocele
what is the definition of chronic coccygodynia
Pain arising in or around the coccyx is termed coccygodynia. It is considered chronic when pain lasts more than 2 months
what will a biopsy in a baby with Hirschsprungs show?
Hypertrophic nerve trunks; absence of ganglion cells in both the myenteric (intermuscular) and submucosal plexuses
should sacral nerve stimulation be offered to people with an 80 degree sphincter defect?
SNM for fecal incontinence in patients with a sphincter defect up to 120 degrees was shown to improve symptoms (Wexner score) from 15.7 at baseline to 1.0 at the 12-month follow-up.
what are symptoms of mesh erosion after anterior mesh recto-pexy
It presents with pelvic pain and can be associated with rectal bleeding and discharge. The mesh can also erode into the vagina, causing similar vaginal symptoms
what is the treatment for short segment Hirschsprung's
posterior anorectal myomectomy has been used for short-segment disease in adults as an alternative to colo-anal pullthrough
what is the classic histologic finding from solitary rectal ulcer syndrome
Fibromuscular obliteration of the lamina propria
which is the best operation for an adult presenting with long segment Hirschsprung's disease
Duhamel and modified Duhamel operations are superior for preventing postoperative impotence and anastomotic dehiscence, and creating a reservoir to minimize soiling in adults
after C diff is treated and resolves should you do any further testing
If the clinical symptoms of Clostridium difficile colitis resolve after treatment, no further testing is indicated.
GI bleed patient is stable and has had negative scope and negative angiography - what is next test?
CT angiography - turns out this is very sensitive and specific and picks up many bleeds and localizes them - nuc med study is sensitive but gives no localization
what's the best initial RX for radiation proctitis?
what is the best repair for a distal ureteral transection during LAR
Most injuries occur in the lower one-third of the ureter. These can generally be repaired via ureteroneocystostomy, provided there is no tension on the anastomosis
which organism that causes colitis will respond to a fluoroquinolone
what is next step for 54 year old with UC who has a polyp that is completely removed and it shows HGD?
NOT colectomy - can do scope in 6 mo - point is when these patients have MULTIFOCAL dysplasia on random bx then colectomy may be needed - DEFINED dysplasia that can be resected just means follow closely
Variants of which gene are most linked to the risk of developing chronic pouchitis after ileal pouch anal anastomosis for ulcerative colitis
what does the NOD2 gene do
play a role in ileal Crohn disease; also reduce the host response to gut microbes; also have been shown to increase the risk for chronic pouchitis in patients with ulcerative colitis after IPAA
which repair has the best results for parastomal hernia repair
laparoscopic sugar baker - 12% recurrence
does the presence of primary sclerosing cholangitis increase or decrease the risk of colon CA in a person with ulcerative colitis
it increases the risk of colon CA
what is the best treatment for a patient with a painful anal fissure who has Crohns disease
fissurectomy and removal of any HAP, allow secondary healing (LIS has up to 30% incontinence rates)
best treatment for pouchitis secondary to cytomegalovirus infection
30 year old man has been DX with diarrhea due to cryptosporidium - what is the first step
Highly active antiretroviral therapy
what is more likely to cause a stricture-plasty during a crohns operation to fail: steroids or malnutrition
what is Heyde syndrome
In patients with severe aortic stenosis, platelet dysfunction has been observed secondary to a shearing force on the platelets themselves. The theory is that this results in an acquired dysfunction of von Willebrand factor.
what is usually the etiology of a peri-stomal ulcer in someone with Crohns disease - how do you treat it?
pyoderma gangrenosum - First-line therapy is with systemic steroids and in the case of Crohn disease, infliximab. There is no evidence that wound care contributes significantly to healing. The main goal of wound care is to prevent secondary infection
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