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CCFP Review 2024/2025 Update- Questions and Answers
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CCFP Review 2024/2025 Update- Questions and Answers
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CCFP Review 2024/2025 Update- Questions andAnswers
local trauma (hard stool), Crohn's, TB, leukemia, anal canal spasm (pain, anxiety, etc)
Correct Ans-Anal Fissure RF
Most common is posterior midline, then anterior midline Correct Ans-Anal Fissure Phys Exam
1. Fibre (bulking agent eg psyllium or polycarbophils)
2. Sitz baths, avoid straining
3. Topical NG
4. Topical CCB
5. Botulinum toxin
6. Surgery if persistent (lateral spincterotomy)
7. Endoscopy if recurrent (r/o Crohn's) Correct Ans-Anal Fissure Mgmt
1. I&D, if fistula, can milk into anal canal
2. Antibiotics if: cellulitis, immunocompromise, diabetes, valvular heart disease
3. Surgical tx if chronic suppuraitive fistula Correct Ans-Rectal Abscess - Tx
Mc Burney - RLQ
Rosving - LLQ = RLQ pain --> interior appendix
,CCFP Review 2024/2025 Updte- Questions and Answers
Psoas - R hip extension --> rectocecal appendix
Obturator - R of flexed hip --> pelvic appendix
Atypical presentation in children, elderly Correct Ans-Appendicitis Physical Exam
1. NPO
2. Fluids
3. Analgesia
4. Antiobitoics - Cefoxitin or cefotetan one dose pre-op, or combination cefazolin and
metronidazole. If pen allergic clindamycin + cipro/levo/gent Correct Ans-Appendicitis Tx
1. Site: Rectum alway, and only colon (UC) vs any GI, rectum often spared (Cr)
2. Pattern: continuous (UC) vs skip lesions (Cr)
3. Diarrhea: bloody (UC) vs non bloody (Cr)
4. Abdo pain: rare (UC) vs frequent (Cr)
5. Perianadal: none (UC) vs in 30% (Cr)
6. Fisutla: none (UC) vs yes (Cr)
7. Scope: eryhematous, friable, superficial ulcers (US) vs apthoid and deep ulcers, cobble
stoning (Cr)
8. Radiologic: tubular appearance resulting from loss of haustral folds (UC) vs string sign TI,
RLQ mass, fistulas, abscess (Cr)
, CCFP Review 2024/2025 Update- Questions and
Answers
9. Histology: both have crypt abscesses but Cr also has granulomatous disease (<30%) and is
transmural
10. Smoking: protective (UC) vs worsens (Cr)
11. Serology: p-ANCA more common (UC) vs ASCA more common (Cr) Correct Ans-Crohn's vs
UC. Site, pattern, diarrhea, abdo pain, perianal dz, fistula, endoscopy, radiologic findings,
histology, smoking, serology
fistula, abscess, stricture/stenosis, colon adenoca Correct Ans-Crohn's Complications
(intestinal)
All related to malabsorption
Anemia, gallstones, kidney stones, osteoperosis, Vit B12 def (if TI involved) Correct
AnsCrohn's Complication (extra-intestinal)
Eye: uveitis/iritis, episcleritis, sclera-conjunctivitis joint:
non-deforming arthritis, ank spond, sacroiliitis
Skin: erythema nodosum, pyoderma gangrenosum,
Other: PSC, VTE, cancer (lymphoma, cervical dysplasia, colon adenocarcinoma) Correct Ans-
IBD Extraintestinal Manifestations
Mild-mod: oral steroids, 5-ASA, antibiotics is perianal disease (metronidazole +/-
ciprofloxacin)
, CCFP Review 2024/2025 Updte- Questions and Answers
Mod-severe: oral steroids, azathioprine or 6-MP,anti-TNF (infiximab) or adalimumab
Correct Ans-Crohn's Treatment (acute)
Mild-mod: 5-ASA, no tx, loperamide
Mod-severe: azathioprine OR 6-MP, MTX, anti-TNF (infiximab, ), cholestyramine (4g) if
<100cm TI
Must get colonoscopy q8-10 yrs, 8yrs after dx
Surgery not curative, for complications only Correct Ans-Crohn's Treatment (chronic)
1. Sigmoidoscopy (UC) vs endoscopy/colonoscopy with biopsies
2. CBC, CRP, Liver enzymes, LFTs, electrolytes, urea and Cr
3. Stool culture, O&P, C diff. R/o infectious diarrhea.
4. Anti-TTG
5. Vitamin B12, Ferritin (later in life)
6. Colonoscopy q8-10 yrs 8-10 yrs post-dx Correct Ans-IBD Investigations
5-ASA, sulfasalazine, oral/IV steroids if severe Correct Ans-Ulcerative Colitis Treatment
(Acute)
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