Seidel Ch 21 Anus, Rectum, & Prostate

Mr. Tucker is a 56-year-old patient who presents to your office with a complaint of rectal pain. On examination you are palpating the lateral and posterior rectal walls. What should you expect to feel? A. A smooth, even, and uninterrupted surface B. Small nodules from internal hemorrhoids C. Tissue folds from the valves of Houston D. Bulging from the bladder wall

A. A smooth, even, and uninterrupted surface The walls should feel smooth, even, and uninterrupted.

"Boggy, enlarged, and tender" on rectal examination is descriptive of which condition? A. Prostatitis B. Anorectal abscess C. Prostatic carcinoma D. Rectal polyp

A. Prostatitis Seminal vesicles are often involved in prostatitis and may be dilated and tender on palpation; however, the prostate may feel boggy, enlarged, and tender or have palpable areas of fibrosis that simulate neoplasm.

A patient tells the examiner that she has liquid stools containing small flecks of blood stained mucous. Stools of this type result from: A. amebiasis. B. excessive fiber intake. C. excessive dietary beef. D. insufficient fluid intake.

A. amebiasis. Small flecks of blood-stained mucus in liquid feces are indicative of amebiasis.

The adult internal rectal sphincter is controlled by the: A. autonomic nervous system. B. central nervous system. C. lumbar spinal reflexes. D. sacral spinal reflexes.

A. autonomic nervous system. The internal ring of smooth muscle is under involuntary autonomic control.

Mr. Santos is a 67-year-old patient who presents to your office. On examination, you palpate his prostate, noting that it is hard and irregular. The median sulcus is not palpable. These findings are consistent with: A. prostate cancer. B. benign prostate hypertrophy. C. prostatitis. D. a rectal mass.

A. prostate cancer. With cancer of the prostate, a hard, irregular nodule may be palpable on prostate examination.

When examining the prostate, you feel fluctuant softness. This finding indicates: A. prostatic abscess. B. posterior rectal wall neoplasm. C. prostatic hypertrophy. D. rectal prolapse.

A. prostatic abscess. A prostatic abscess is felt as a fluctuant mass in the prostate.

Enlargement of the prostate may cause: A. urinary retention. B. a forceful urinary stream. C. infertility. D. prostate cancer.

A. urinary retention Symptoms of an enlarged prostate relate to urinary obstruction: hesitancy, decreased force and caliber of stream, dribbling, incomplete emptying of the bladder, frequency, urgency, nocturia, and dysuria.

Mr. Allen is a 56-year-old patient who presents for a routine physical examination. Before palpating his prostate, you should tell him, "You may feel an urge to _______." A. urinate B. defecate C. vomit D. faint

A. urinate In men, you can palpate the posterior surface of the prostate gland on the anterior wall. Tell the patient that he may feel the urge to urinate but that he will not.

Which examination finding in the child is a clue to the diagnosis of Hirschsprung disease? A. Passing of frequent, loose stools in the absence of other symptoms B. A consistently empty rectum with a history of constipation C. Itching and irritation around the anus D. Rectal prolapse

B. A consistently empty rectum with a history of constipation A consistently empty rectum in the presence of constipation is a clue to the diagnosis of Hirschsprung disease.

Mr. Mills, a 38-year-old patient, presents with severe rectal pain and fever. Which condition might be the cause of the symptoms? A. An imperforate anus B. A perianal abscess C. Benign prostatic hypertrophy D. An anorectal fistula

B. A perianal abscess Perianal abscess is an infection of the soft tissues surrounding the anal canal, with formation of a discrete abscess cavity. Symptoms include tenderness, fever, and pain on defecation or with sitting or walking.

A newborn does not pass meconium in the first 24 hours after birth. Which problem must be suspected? A. Biliary atresia B. Cystic fibrosis C. Meckel diverticulum D. Spinal bifida

B. Cystic fibrosis If there is no passage of stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis.

Mr. Bower is a 78-year-old patient who is unable to assume a standing position for a routine rectal examination. Which is the best alternative position? A. Lithotomy position B. Left lateral position with the knees flexed C. Knee-chest position D. Prone position

B. Left lateral position with the knees flexed The rectal examination can be performed with the patient in any of these positions: knee-chest; left lateral with hips and knees flexed; lithotomy, or standing with the hips flexed and the upper body supported by the examining table.

During a rectal examination, you find shelf lesions when you palpate the anterior rectal wall. What is the significance of this finding? A. A sexually transmitted infection exists. B. Peritoneal metastases are present. C. Houston valves have fibrosed. D. Fecal matter has been retained.

B. Peritoneal metastases are present. Because the anterior rectal wall is in contact with the peritoneum, you may be able to detect the tenderness of peritoneal inflammation and the nodularity of peritoneal metastases. The nodules, called shelf lesions, are palpable just above the prostate in men and in the cul-de-sac of women.

Mr. Yates is a 62-year-old patient who presents with a chief complaint of rectal pain. The examiner will focus the history and examination on which known fact? A. Rectal pain is almost always accompanied by an infection. B. Rectal pain is almost always an indication of local disease. C. A complaint of rectal pain is usually associated with a serious systemic process. D. One of the most common causes of rectal pain is prostatic enlargement.

B. Rectal pain is almost always an indication of local disease. Rectal pain is almost always indicative of a local disease.

What information do you give the parents of an infant on whom you have done a rectal examination? A. Large amounts of mucus may appear in the stool for a day or two. B. Some bleeding and rectal prolapse may be seen right after the examination. C. Stool is likely to be black for 48 hours. D. Crankiness and lack of interest in sucking may occur for 12 to 24 hours.

B. Some bleeding and rectal prolapse may be seen right after the examination. Some health care providers are reluctant to use the index finger because of its size, choosing instead the fifth finger; however, even with the smallest of adult fingers, some bleeding and transient prolapse of the rectum often occur right after examination.

You are teaching a parent how to check for pinworms. When is the best time to have the parent assess the child? A. Right after the child wakes up B. While the child is sleeping C. Early afternoon D. Right before the child goes to bed

B. While the child is sleeping The best time to visualize pinworms in children is after they fall asleep.

A toddler requires a rectal examination. How do you position the child? A. Prone B. supine C. On the left side D. On the right side

B. supine Perform the rectal examination in infants and young children with the child lying on his or her back.

Hemorrhoids are: A. ulcerations of the anal ring. B. varicose veins in the anal region. C. inflammatory lesions of the anal region. D. precursors to rectal polyps.

B. varicose veins in the anal region. External hemorrhoids are varicose veins that originate below the anorectal line and are covered by anal skin. Internal hemorrhoids are varicose veins that originate above the anorectal junction and are covered by rectal mucosa.

Mrs. Black brings her infant son to your office. She tells you that his stools are thin, slimy, and brown to green. You explain that this is a normal finding for a: A. newborn infant. B. breastfed infant. C. 3- to 6-day-old infant. D. formula-fed infant.

C. 3- to 6-day-old infant. Stools of infants 3 to 6 days old are transitional: thin, slimy, and brown to green.

In which situation would the examiner perform a rectal examination on an infant or child? A. A newborn infant passes a greenish-black viscous stool 12 hours after birth. B. The mother of a 3-month-old baby describes the baby's stools as "loose and golden yellow." C. A stool of a 6-year-old child is guaiac positive. D. A mother tells the examiner that her 3-year-old child was sent home from daycare after two episodes of diarrhea.

C. A stool of a 6-year-old child is guaiac positive. Rectal examination is not always performed on infants and children unless there is a particular problem. An examination is required whenever there is any symptom that suggests an intraabdominal or pelvic problem, a mass or tenderness, bladder distention, bleeding, or rectal or bowel abnormalities.

Mr. Custer is a 56-year-old patient who presents to your office. On examination, you note a smooth and firm protrusion into the rectum. Which condition can present as as a smooth, firm 4-cm protrusion into the rectum? A. Anorectal fistula B. Imperforate anus C. Benign prostatic hypertrophy D. Prostatitis

C. Benign prostatic hypertrophy With benign prostatic hypertrophy, the prostate feels smooth, rubbery, symmetric, and enlarged.

What is the best method of verifying anal patency in a newborn? A. Inserting a lubricated thermometer through the anus and into the rectum B. Inserting the fifth digit through the anus and into the rectum C. Checking for the passage of meconium in the first 24 to 48 hours after birth D. Inspecting the anus for an anal opening

C. Checking for the passage of meconium in the first 24 to 48 hours after birth If there is no passage of stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis.

A patient presents to your clinic with rectal pain. On examination, you note a tender, swollen mass in the superficial subcutaneous tissue just adjacent to the anus. Of what is this an indication? A. Pilonidal cyst B. Enlarged prostate C. Perianal abcess D. Hemorrhoids

C. Perianal abcess Perianal abscess presents as a tender, swollen, fluctuant mass in the superficial subcutaneous tissue just adjacent to the anus. Pilonidal cyst is a cyst or sinus near the cleft of the buttocks and may contain a tuff of hair. Located in the midline, superficial to the coccyx and lower sacrum.

A pregnant woman presents to the emergency department with the complaint of dark stools. She tells the examiner, "I read in a magazine that this is a sign of bleeding." Which question by the examiner is most applicable for this situation? A. "Where did you read that information?" B. "Have you been giving yourself enemas?" C. "How much fruit and vegetable intake have you had in the last few days?" D. "Are you taking prenatal vitamins?"

D. "Are you taking prenatal vitamins?" During pregnancy, the stool color may be dark green or black if the woman is taking iron supplements.

Which is a possible explanation for an examination finding of "absence of the anal wink"? A. Upper motor neuron disorder B. Chrinic constipation C. Pilonidal cyst D. Chronic abuse

D. Chronic abuse Lack of contraction may indicate a lower spinal cord lesion or chronic abuse.

Which factor increases a man's risk for developing prostate cancer? A. High-fiber diet B. Hispanic ethnicity C. Congestive heart failure D. Family history

D. Family history A person with one first-degree relative with a history of prostate cancer has twice the risk of developing prostate cancer himself; the risk increases with more than one first-degree relative.

Which example best describes how firm you expect a healthy prostate gland to feel? A. It feels like a soft olive or grape. B. It feels like the topside of a plastic LEGO piece. C. It feels like a small baseball. D. It feels like a pencil eraser.

D. It feels like a pencil eraser. The gland should feel like a pencil eraser—firm, smooth, and slightly movable—and it should be nontender

On rectal examination, you note a lax anal sphincter. This is an indication of which problem? A. Meckel diverticulum B. Volvulus C. Polyps D. Neurologic deficit

D. Neurologic deficit A lax sphincter may indicate neurologic deficit or sexual abuse.

How is the anal ring assessed? A. Inspection of the anus B. External palpation of the anus C. Use of a sigmoidoscope D. Rotation of a finger within the anal sphincter

D. Rotation of a finger within the anal sphincter Rotate your finger to examine the muscular anal ring.

Which statement applies to screening for sexually transmitted infections (STIs) in men who have sex with men? A. Screening for common STIs should be done every 6 months if the man is sexually active. B. Regular screening should be done for human papillomavirus (HPV) infection. C. HIV screening should be done if HIV serologic testing is positive or if the patient has not been tested within past year. D. Screening for gonorrheal pharyngeal infection should be done if the man has had receptive oral intercourse with a condom.

D. Screening for gonorrheal pharyngeal infection should be done if the man has had receptive oral intercourse with a condom. Test for the following infection in men who have had receptive oral intercourse during the preceding year regardless of history of condom use during exposure: urethral infection and rectal infection with Neiserria gonorrhoeae and Chlamydia trachomatis; pharyngeal infection with N. gonorrhoeae.

Digital rectal examinations (DRE) are used to detect: A. prostatitis (inflammation or infection of the prostate). B. prostate enlargement (BPH). C. prostate cancer. D. all of the above.

D. all of the above. On digital rectal examination the posterior surface of the prostate gland can be felt through the anterior wall of the rectum. Normally the gland feels firm, smooth, and slightly movable and is nontender, with a diameter of about 4 cm, with less than 1 cm protrusion into the rectum. With prostatitis the gland is enlarged, acutely tender, and often asymmetric. A symmetric, enlarged, smooth, gland with a rubbery or boggy consistency is indicative of benign hypertrophy, whereas stony hard nodularity may indicate prostate cancer.

Rectal bleeding may be an indication of: A. hemorrhoids. B. ulcerative colitis. C. polyps. D. all of the above.

D. all of the above. There are numerous reasons that blood can appear in the feces, ranging from benign, self-limiting events to serious, life-threatening disease.

The absence of meconium stool passage in an infant may be indicative of: A. a pilonidal cyst. B. a perianal abscess. C. benign prostatic hypertrophy. D. an imperforate anus.

D. an imperforate anus. Imperforate anus is a condition that is usually diagnosed on rectal examination of the newborn and is confirmed by lack of passage of stool within the first 48 hours of life. Radiographic confirmation may be necessary.

Mrs. Jackman brings her 6-year-old daughter in for an office visit. While examining the perineum, you observe hemorrhoids. This finding suggests: A. sexual abuse. B. chronic constipation. C. a diet high in fibrous foods. D. an underlying problem such as portal hypertension.

D. an underlying problem such as portal hypertension. Hemorrhoids are rare in children, and their presence suggests a serious underlying problem such as portal hypertension.

Prostate enlargement is determined by the: A. diameter of the rectum near the bladder. B. circumference of the prostate. C. estimation of the depth of the sulcus. D. protrusion of the prostate into the rectum.

D. protrusion of the prostate into the rectum. Prostate enlargement is classified by the amount of protrusion into the rectum.

The primary function of the rectum is: A. formation of feces. B. absorption of water. C. the absorption of nutrients. D. storage of feces.

D. storage of feces. Above the anorectal junction, the rectum dilates and turns posteriorly into the hollow of the coccyx and sacrum, forming the rectal ampulla, which stores flatus and feces.

An expected anal or rectal finding late in pregnancy is the presence of: Rectal prolapse Skin tags Polyps Hemorrhoids

Hemorrhoids

In males, which surface of the prostate gland is accessible by digital examination? Median lobe Posterior Superior Anterior

Posterior

During the digital rectal examination, have the patient bear down to: Spread the buttocks Examine the prolapse of hemorrhoids Relax the internal sphincter Relax the external sphincter

Relax the external sphincter