Anorectal disorders: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Anorectal disorders

Sample item

A 30-year-old woman has severe pain during and after defecation with streaks of fresh red blood on the stool. A tear is seen in the posterior midline of the anal verge. What is the initial treatment?

AHaemorrhoidectomyBLateral internal sphincterotomyCConservative medical therapy with a topical vasodilatorDAnal dilatation under anaesthesia

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Conservative medical therapy with a topical vasodilator

This is an anal fissure, caused by trauma and spasm of the internal sphincter with poor perfusion. First-line care is conservative: stool bulking, sitz baths and a topical agent that relaxes the sphincter. Surgery is reserved for failure of medical treatment.

Option by option

A. Haemorrhoidectomy
Haemorrhoidectomy treats haemorrhoids, and a fissure is a different condition.
B. Lateral internal sphincterotomy
Sphincterotomy is a second-line option after medical treatment has failed.
C. Conservative medical therapy with a topical vasodilator (correct)
Correct. This reduces trauma and sphincter spasm and heals most fissures.
D. Anal dilatation under anaesthesia
Forceful dilatation can injure the sphincter and cause incontinence, so it is no longer favoured.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Conservative medical therapy with a topical vasodilator. This is an anal fissure, caused by trauma and spasm of the internal sphincter with poor perfusion.

Why is "Haemorrhoidectomy" not the answer?

Haemorrhoidectomy treats haemorrhoids, and a fissure is a different condition.

Why is "Lateral internal sphincterotomy" not the answer?

Sphincterotomy is a second-line option after medical treatment has failed.

Why is "Anal dilatation under anaesthesia" not the answer?

Forceful dilatation can injure the sphincter and cause incontinence, so it is no longer favoured.

What concept does this question test?

It tests Anorectal disorders in General Surgery. First-line care is conservative: stool bulking, sitz baths and a topical agent that relaxes the sphincter. Surgery is reserved for failure of medical treatment.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anorectal disorders?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.