Chapter 21: Anus, Rectum, and Prostate (questions from seidel book)

A lower spinal cord lesion may be indicated by which finding? a. Lack of an "anal wink" b. Anorectal fissure c. Anal fistula d. Passage of meconium e. Small flaps of anal skin

ANS: A Lightly touching the anal opening of an infant should produce a contraction referred to as the "anal wink." A negative wink may indicate a lower spinal cord lesion.

A common cause of dark green or black stool color during pregnancy is indicative of: a. consumption of iron preparations. b. consumption of vitamins. c. intestinal parasites. d. slow bleeding of hemorrhoids. e. slow intestinal bleeding.

ANS: A The daily use of iron replacement therapy, as expected during pregnancy, causes dark green or black stools

Factors associated with increased risk of prostate cancer include: a. African American descent. b. cigarette smoking. c. low-fat diet. d. alcoholism. e. obesity.

ANS: A The incidence rate of prostate cancer is more common in African Americans and in Caribbean patients of African ancestry; less common in Asian American and Hispanic/Latinos than in non-Hispanic whites.

The initial digital approach to the rectal examination should be: a. at a right angle to the anus. b. with direct horizontal pressure of fingertip. c. with the finger pad pressed against anal verge. d. during sphincter tightening. e. bidigital palpation with thumbs.

ANS: A The initial approach should be with the finger pad pressed against the perianal area at the anal junction. The sphincter will tighten and relax, and then the examination index finger should be flexed and inserted.

The adult internal rectal sphincter is controlled by the: a. autonomic nervous system. b. central nervous system. c. peripheral nervous system. d. lumbar spinal reflexes. e. sacral spinal reflexes.

ANS: A The internal ring of smooth muscle of the anal canal is under involuntary autonomic control

A healthy prostate protrudes into the rectal wall a distance of _____ cm. a. less than 1 b. 1 to 2 c. 2 to 3 d. 3 to 4 e. more than 4

ANS: A A healthy prostate should not protrude more than 1 cm into the rectum.

To make visualization of polyps in the anorectal area easier, you should: a. apply clear jelly around the anal orifice. b. ask the patient to bear down. c. ask the patient to relax the sphincter. d. rotate your finger inside the anal canal. e. have the patient contract the external sphincter.

ANS: B Asking the patient to perform a Valsalva maneuver will make fistulas, fissures, polyps, and hemorrhoids more visible.

Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of: a. benign prostatic hypertrophy. b. cancer of the prostate. c. longstanding prostatitis. d. swelling caused by aging. e. acute prostatitis.

ANS: B Obliteration of the median sulcus is consistent with organ enlargement; associated findings of a hard, irregular, and painless nodule are more likely a cancerous growth.

The posterior surface of the prostate can be located by palpation of the: a. posterior wall of the rectum. b. anterior wall of the rectum. c. lateral wall of the anus. d. lower abdomen and perineum. e. anal canal and perineum.

ANS: B Palpation of the rectal anterior wall facilitates posterior prostate location.

In males, which surface of the prostate gland is accessible by digital examination? a. Median lobe b. Posterior c. Superior d. Anterior e. Lateral

ANS: B The posterior surface of the prostate gland lies close to the anterior wall of the rectum and is palpable through digital rectal examination

Very light tan or gray stool may indicate: a. Hirschsprung disease. b. obstructive jaundice. c. lower gastrointestinal bleeding. d. polyposis. e. upper gastrointestinal bleeding.

ANS: B Very light tan or gray stools suggest obstructive jaundice.

Pinworms and Candida may both cause: a. shrunken buttocks. b. hemorrhoids. c. perirectal irritation. d. perirectal protrusion. e. constipation.

ANS: C Pinworms and Candida both cause perirectal irritation and itch.

Tarry black stool should make you suspect: a. internal hemorrhoids. b. rectal fistula. c. upper intestinal bleeding. d. prostatic cancer. e. lower intestinal bleeding.

ANS: C Upper intestinal tract bleeding results in tarry black stools.

Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. When is it likely that her closed anal passageway will be suspected by her healthcare providers? a. After she develops a scaphoid abdomen b. During her first feeding when she vomits c. When she bleeds from the rectum d. When she fails to pass meconium stool e. When the rectum prolapses

ANS: D Anal patency of the newborn is confirmed by passage of meconium stool.

Which of the following is a risk factor for anal cancer? a. White race b. Diet low in animal fats and proteins c. Physical inactivity d. Infection with high-risk type HPV e. Low body fat

ANS: D Infection with high-risk type human papillomavirus is considered a risk factor for anal cancer. The other answers are not.

When performing a rectal examination in a man, in which position is the patient generally placed? a. Lithotomy b. Prone c. Trendelenburg d. Left lateral e. Supine

ANS: D Male patients are usually positioned left lateral or standing with upper body flexed at the waist over the examination table, with the toes pointed together for increased exposure of the area.

Palpation of a normal prostate in an older adult is likely to feel: a. cool. b. grainy. c. polypoid. d. rubbery. e. hard.

ANS: D Older men are more likely to experience prostate hypertrophy, which, when palpated, feels smooth, rubbery, and symmetric.

Perianal abscesses, fissures, or pilonidal cysts will cause the patient to experience: a. bulging and wrinkling. b. constipation and pallor. c. urinary symptoms. d. tenderness and inflammation. e. diarrhea and redness.

ANS: D Pain, tenderness, and inflammation to the perianal area may be related to abscess, fistula or fissure, pilonidal cyst, or pruritus ani.

Which of the following conditions is most commonly seen in adults with diabetes? a. Pinworms b. Pilonidal cysts c. Perianal fistula d. Pruritus ani e. Anorectal fissure

ANS: D Pruritus ani refers to chronic itching of the skin around the anus, which can be caused by fungal infections and is more common in diabetic patients. Pinworms are more common in children; the other conditions do not cause pruritus.

Prostate-specific antigen (PSA) screening is controversial because: a. there are few false-negative results. b. PSA is produced by many other tissues. c. it is less sensitive than digital rectal examination. d. there are associated harms of false-positive test results. e. it detects prostate cancer only in its late stage.

ANS: D The persistent issue is whether the benefits of prostate cancer screening are large enough to outweigh the associated harms, which include false-positive screening test results, unnecessary biopsies, and overdiagnosis

An expected anal or rectal finding late in pregnancy is the presence of: a. cysts b. rectal prolapse. c. skin tags. d. polyps. e. hemorrhoids.

ANS: E Hemorrhoids are an expected variation late in pregnancy.