JAAPA CME Post-Test May 2023

Diagnosing and Managing Adrenal Incidentalomas

Adrenal incidentalomas are commonly encountered because of the widespread use of high-resolution cross-sectional imaging. Adrenal incidentalomas may be benign or malignant, and also may demonstrate hormonal hypersecretion, so all patients with adrenal masses should undergo further assessment. Clinicians should have a basic understanding of adrenal incidentalomas, their workup, and when follow-up and referral are warranted.

Learning Objectives

  • Understand imaging characteristics that indicate the likelihood of malignancy or pheochromocytoma
  • Describe appropriate hormonal workup in patients with adrenal incidentalomas
  • Recognize when endocrine and/or surgical referral are warranted
  • Recognize which adrenal masses warrant follow-up imaging

Fecal Impaction in Adults

Fecal impaction is a common digestive disorder and is considered an acute complication of chronic and untreated constipation. Generally, the factors responsible for fecal impaction are similar to those associated with constipation. Early identification and treatment minimize complications and patient discomfort. Common treatment options to address fecal impaction of the rectum include manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes. In severe cases, surgical intervention is necessary. Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves. Following treatment, conduct an evaluation of causes and create a preventive therapy plan.

Learning Objectives

  • Recognize risk factors for fecal impaction in adults
  • Identify fecal impaction based on history of present illness, physical examination, and diagnostics
  • Create a medical plan to relieve acute fecal impaction
  • Describe measures to prevent fecal impaction

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