Behind the knife, the Surgery Podcast, where we take a behind the scenes intimate look at surgery

from leaders in the Knife. We are continuing our mock oral series with the focus on colorectal today.

Dr. Sean Langenfeld, assistant professor of surgery and associate program

director for the general surgery residency program at the University of Nebraska Medical Center,

will lead our two guest residents through some common board scenarios.

Joining us are Jonathan Abelson, a fifth year resident from the New York Hospital

while Cornell Medicine program and Paul Johnson another fifth year from the

Rutgers New Jersey Medical School Program. Both are pursuing colorectal fellowships. Thank you for volunteering and good luck.

Just a couple of things to remind you about as we get started. I don't think anybody's trying to trick

you or intimidate you.

It's actually counterproductive to intimidate people during this process because it keeps from you from being able to extract whether you know what you're doing or not.

But your first patient is a 52 year old male.

He was into your office complaining of a three month history of rectal bleeding.

Upon further questioning, he states that there's no pain associated with it.

The blood is mixed with the stool.

And his tools are otherwise normal.

He doesn't have any past medical or surgical history. He doesn't take any medications and he's adopted so he doesn't know his

family history. Okay great so that's all the history that I need so I proceed to a

physical exam focusing on abdomen and doing an inore rectal exam.

Okay, you do a head-to-to-toe physical exam, which is the abdominal exam portion is normal.

On digital exam you can palpate a

circumferential mass about 4 centimeters above the anal verge. It appears

...