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Q1: Anal fissure (2 min)
"Describe the clinical features and management of an anal fissure."
- Severe pain on defecation + bright blood on toilet paper + constipation
- 90% POSTERIOR MIDLINE. Sentinel tag = chronic
- Atypical/multiple = Crohn, HIV, STI
- Acute: conservative (fibre, sitz bath, GTN/diltiazem topical)
- Chronic: lateral internal sphincterotomy (lower 1/3, lateral position)
Q2: Fistula-in-ano (2 min)
"State Goodsall's rule and describe fistula management."
- Anterior openings = straight (radial) track
- Posterior openings = curved to posterior midline
- Low fistula: fistulotomy (lay open — safe, sphincter below track)
- High fistula: seton (preserve sphincter), LIFT, advancement flap
Q3: Pilonidal sinus (2 min)
"Describe the presentation and treatment."
- Young hirsute males, natal cleft, sedentary occupation
- Hair penetrates skin → foreign body → sinus/abscess
- Acute: incision and drainage
- Chronic: excision ± primary closure
- Recurrence 10-50%
Q4: Rectal prolapse (2 min)
"How do you manage rectal prolapse?"
- Elderly women, full-thickness rectal protrusion
- Conservative: pelvic floor exercises
- Surgical fit: abdominal rectopexy (fix rectum to sacrum)
- Surgical frail: Delorme (mucosal sleeve, perineal)
- Recurrence 5-15%