ROSH Gastrointestinal Practice Exam

What is the most appropriate pharmacotherapy for a patient with mildly tender, external, non-thrombosed hemorrhoid?

1. Oral docusate

2. Topical hydrocortisone

3. Topical lidocaine

4. Topical nifedipine

The correct answer is: Topical hydrocortisone

The most appropriate pharmacotherapy for a patient with a mildly tender, external, non-thrombosed hemorrhoid is topical hydrocortisone. This choice is correct because hydrocortisone is a corticosteroid that reduces inflammation and itching associated with hemorrhoids. Its anti-inflammatory properties can alleviate the discomfort experienced by the patient, providing symptomatic relief. Topical hydrocortisone is particularly suitable for use in mild cases where there is some tenderness but no complications such as thrombosis. It can effectively reduce inflammation and can be used as part of a broader management plan that includes dietary modifications and good hygiene practices. Other options have their roles, but may not be as appropriate in this specific scenario. For instance, oral docusate is a stool softener that primarily helps prevent straining during bowel movements but does not directly address the current symptoms of inflammation or pain associated with the hemorrhoid. Topical lidocaine is a local anesthetic that can provide immediate pain relief but might not tackle underlying inflammation effectively. Topical nifedipine, which is generally used for its vasodilatory effects, has been associated with treating chronic anal fissures rather than external hemorrhoids, making it less applicable for mild external hemorrhoids without thrombosis. Thus, topical hyd