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Author: Laurence Scott Bailen, M.D.

1. Question 1

A 75 year-old woman has had regular daily bowel movements throughout her entire life. She comes to your office because she has noted a marked change in her bowel habits. She now will only have a bowel movement every third day and the stool is hard and difficult to pass. She has recently been taking a morphine derivative due to back pain. She has no known neurologic disorder and leads a very active life style. A colonoscopy is normal.

Which of the following most likely has caused her symptoms of constipation?

  1. Irritable bowel syndrome

  2. Colonic pseudoobstruction

  3. Inadequate fiber intake

  4. Narcotic use

  5. Large rectocele

2. Question 2

An 85 year-old man complains of bright red blood per rectum. He has been constipated recently. He denies any rectal pain with defecation or fever. He notes that blood will drip out after a bowel movement. A perianal exam is normal.

The most likely cause of this patient's symptoms is which of the following?

  1. Anal fissure

  2. Internal hemorrhoid

  3. Anal fistula

  4. Perianal abscess

  5. External hemorrhoid

3. Question 3

A 50 year-old woman comes in for a colonoscopy to screen for colorectal cancer. She is asymptomatic. Multiple diverticula are seen in the colon.

Which of the following best describes the location of diverticula in the colon?

  1. They are most commonly located in the ascending colon

  2. They are most commonly located in the transverse colon

  3. They develop where the vasa rectae penetrate the colonic circular muscle

  4. They develop where the vasa rectae penetrate the anti-mesenteric taenia

  5. They are most commonly located in the cecum