Anus, Rectum, Prostate Online

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?

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

Mr. Mills, a 38-year-old patient, presents with severe rectal pain and fever. Which condition might be the cause of the symptoms?

A perianal abscess Perianal abscess: infection of the soft tissues surrounding the anal canal, with formation of a discrete abscess cavity. Painful and tender, fever, pain on defecation or with sitting or walking.

In which situation would the examiner perform a rectal examination on an infant or child?

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.

How is the anal ring assessed

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

__________ presents as an elevated red granular tissue opening on perianal skin with purulent drainage.

Anorectal fistula External opening of a fistula appears as a pink or red, elevated, elevated red granular tissue on the skin near the anus.

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?

Benign prostatic hypertrophy Prostate feels smooth, rubbery, symmetric, and enlarged.

What is the best method of verifying anal patency in a newborn?

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.

Which is a possible explanation for an examination finding of "absence of the anal wink"?

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

A newborn does not pass meconium in the first 24 hours after birth. Which is a problem that must be suspected?

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.

Which factor increases a man's risk for developing prostate cancer?

Family history Family history of prostate cancer: twice the risk with one first-degree relative; risk increases with more than one first-degree relative.

Which is a routine screening test performed in conjunction with a rectal examination?

Guaiac test of stool to rule out the presence of blood Stool recovered on the examining finger should be tested for occult blood.

Mr. Horstman is a 42-year-old patient who presents with a complaint of rectal pain. During the examination, you observe inflammation of the sacrococcygeal area. The patient complains of pain when it is palpated. Which problem is not consistent with such a finding?

Hemorrhoids External hemorrhoids: Internal: no discomfort unless they are thrombosed, prolapsed, or infected.

Which statement applies to screening for STIs in men who have sex with men?

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 N. gonorrhoeae and C. trachomatis; pharyngeal infection with N. gonorrhoeae.

What information do you give the parents of an infant on whom you have done a rectal examination?

Some bleeding and rectal prolapse may be seen right after the exam. Some healthcare 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.

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

Urinate In males, 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.

You are teaching a parent how to check for pinworms. When is the best time to have the parent assess the child?

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

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

Mrs. Jackman brings her 6-year-old daughter in for an office visit. While examining the perineum, you observe hemorrhoids. This finding suggests:

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

A patient tells the examiner that she has had small flecks of blood stained mucous in her stools. Stools of this type result from:

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

The absence of meconium stool passage in infant may be indicative of:

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

Early prostate cancer is:

asymptomatic Cancer of the prostate - early carcinoma asymptomatic.

The adult internal rectal sphincter is controlled by the:

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

Rectal bleeding may be an indication of:

hemorrhoids. B. ulcerative colitis. C. polyps. 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.

Which example best describes how firm you expect a healthy prostate gland to feel?

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

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?

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.

On rectal examination, you note a lax anal sphincter. This is an indication of which problem?

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

A client presents to your clinic with rectal pain. Upon examination, you note a tender, swollen mass in the superficial subcutaneous tissue just adjacent to the anus. Of what is this an indication?

Perianal abcess Perianal abscess: tender swollen fluctuant mass in the superficial subcutaneous tissue just adjacent to the anus.

During a rectal examination, you find shelf lesions when you palpate the anterior rectal wall. What is the significance of this finding?

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 males and in the cul-de-sac of females.

Which examination finding in the child is a clue to the diagnosis of Hirschsprung disease?

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.

Mrs. Black brings her infant son to your office. She tells you that his stools are thin, slimy, and brown to green. This is a normal finding for a _____________________

3- to 6-day-old infant Sequence and description of stools in infants 3 to 6 days old - Transitional: thin, slimy, brown to green

Hemorrhoids are:

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

"Boggy, enlarged, and tender" on rectal examination is descriptive of which condition?

Prostatitis Seminal vesicles are often involved 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

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?

Rectal pain is almost always an indication of local disease.

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:

prostate cancer. 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:

prostatic abscess Abscess may develop, felt as a fluctuant mass in the prostate.

Digital rectal examinations (DRE) are used to detect:

prostatitis (inflammation or infection of the prostate). B. prostate enlargement (BPH). C. prostate cancer. D. all of the above On digital rectal examination the posterior surface of the prostate gland through the anterior wall of the rectum. Normally the gland feels firm, smooth, slightly movable and is non-tender 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

Prostate enlargement is determined by the:

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:

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.

A toddler requires a rectal examination. How do you position the child?

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

Enlargement of the prostate may cause:

urinary retention Symptoms of urinary obstruction: hesitancy, decreased force and caliber of stream, dribbling, incomplete emptying of the bladder, frequency, urgency, nocturia, and dysuria.