View Answer

E

20. The patient returns to the office 3 years later complaining of abdominal pain, abdominal distention, bloating after meals, and intermittent constipation interspersed with diarrhea. He has lost 20 pounds during the last 3 months, which he ascribes to the aforementioned abdominal symptoms. An upper gastrointestinal series with a small bowel follow-through reveals one area of tight stricture in the distal small bowel. The stricture appears to be 10 cm in length. Which of the following is true?

A All strictures require resection; bypass of the involved segment is not an option.

B Postoperatively, this patient's chance of another recurrence requiring surgery is 50%.

C Because this patient requires surgery for the second time, his risk of cancer is extremely high, and he should have an extensive small bowel resection.

D Postoperative anastomotic strictures typically cause symptoms years later.

E Because of the patient's prior surgery, folate replacement is essential.

View Answer

B

Questions 21–23

A 32-year-old male executive with long-standing Crohn's disease presents with a complete obstruction of the small bowel. At laparotomy, scarring of the distal ileum and cecum cause an obstruction. A 10-cm segment of mid small bowel shows moderate nonobstructive Crohn's disease.

21. Which operative procedure should be performed at this time?

A Radical resection of the involved segment of mid small bowel, all of the ileum, the cecum, and the right colon

B Resection of the distal ileum and right colon with the involved mesentery and lymph nodes

C Bypass of the obstructing segment with a side-to-side anastomosis between the ileum and the right colon and no resection

D Stricturoplasty of the obstruction plus resection of the short involved segment of mid small bowel

E Resection of the distal ileum and cecum

View Answer

E

22. Postoperatively, the patient requires an indwelling bladder catheter for 5 days to treat urinary retention. He does well until the tenth postoperative day, at which point he develops a fever of 103°F, right lower quadrant pain, and an ileus. The midline wound is not inflamed. Which of the following is most likely to have developed?

A Blind loop syndrome

B Pyelonephritis

C Recurrent Crohn's disease

D Intra-abdominal abscess

E Pseudomembranous enterocolitis

View Answer

D

23. After successful surgery and discharge from the hospital, which of the following is true?

A If the diseased bowel is removed, therapy with prednisone and metronidazole can best prevent a recurrence.

B The chance of a cure is greater than 60%.

C The recurrence rate is higher than 50% during the next 5–10 years.

D If the terminal ileum is removed, the risk of a recurrence is less.

E If the terminal ileum is removed, the patient will require long-term therapy with oral iron to prevent anemia.

View Answer

C

Questions 24–25

A 63-year-old man presents with a 3-day history of increasing cramping abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. No localized tenderness and no rectal masses are present. The stool is heme positive.

24. Diagnostically, the first step should be to perform which of the following?

A Total colonoscopy

B Mesenteric angiography

C Flat plate and erect abdominal radiographs

D Upper gastrointestinal radiographs with small bowel follow-through

E Barium enema