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General Surgery · Anorectal: atypical fissure
Sample itemA patient has a painless, broad anal fissure situated laterally with undermined edges. Which underlying conditions should be considered?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Crohn disease, tuberculosis, HIV or malignancy
Typical fissures lie in the posterior midline and are painful. Fissures that are lateral, multiple, painless or indolent are atypical and suggest Crohn disease, tuberculosis, syphilis, HIV, leukaemia or carcinoma. Biopsy and evaluation are needed and sphincterotomy is avoided.
Option by option
A. Crohn disease, tuberculosis, HIV or malignancy (correct)
Correct. Atypical fissures indicate systemic or neoplastic disease.
B. Diabetes insipidus
Diabetes insipidus is unrelated.
C. Simple constipation only
Constipation produces typical midline fissures.
D. Pregnancy only
Pregnancy is not a cause of atypical fissures.
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.
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