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 - ANS=A: CorrectThe walls should feel smooth, even,
and uninterrupted.
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. - ANS=B:
CorrectRectal pain is almost always indicative of a local disease.
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 - ANS=B: CorrectThe 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.
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?" - ANS=D: CorrectDuring pregnancy, the stool
color may be dark green or black if the woman is taking iron supplements.
,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 - ANS=A: CorrectIn 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.
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 - ANS=D: CorrectRotate your finger to
examine the muscular anal ring.
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 - ANS=D: . CorrectThe gland should feel like a pencil
eraser—firm, smooth, and slightly movable—and it should be nontender.
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 - ANS=C: CorrectIf there is no passage of
stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital
megacolon), or cystic fibrosis.
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. - ANS=A: CorrectWith cancer of the prostate, a hard, irregular nodule
may be palpable on prostate examination.
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 - ANS=B: CorrectPerianal 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.
"Boggy, enlarged, and tender" on rectal examination is descriptive of which condition?
A. Prostatitis
B. Anorectal abscess
C. Prostatic carcinoma
D. Rectal polyp - ANS=A: CorrectSeminal 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 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 - ANS=B: CorrectIf there is no passage of stool in 24 hours in a newborn,
suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis.
Enlargement of the prostate may cause:
A. urinary retention.
B. a forceful urinary stream.
C. infertility.
D. prostate cancer. - ANS=A: CorrectSymptoms 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.
The primary function of the rectum is:
A. formation of feces.
B. absorption of water.
C. the absorption of nutrients.
D. storage of feces. - ANS=D: CorrectAbove 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.
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. - ANS=B: CorrectExternal 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. 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. - ANS=D; CorrectHemorrhoids are
rare in children, and their presence suggests a serious underlying problem such as
portal hypertension.
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. - ANS=A: CorrectA prostatic abscess is felt as a fluctuant mass in the
prostate.
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. - ANS=A: CorrectSmall flecks of blood-stained mucus in liquid
feces are indicative of amebiasis.
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 - ANS=B: CorrectA consistently empty rectum in the presence of
constipation is a clue to the diagnosis of Hirschsprung disease.
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. - ANS=C: CorrectRectal examination is not always performed
on infants and children unless there is a particular problem. An examination is required
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 - ANS=A: CorrectThe walls should feel smooth, even,
and uninterrupted.
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. - ANS=B:
CorrectRectal pain is almost always indicative of a local disease.
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 - ANS=B: CorrectThe 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.
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?" - ANS=D: CorrectDuring pregnancy, the stool
color may be dark green or black if the woman is taking iron supplements.
,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 - ANS=A: CorrectIn 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.
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 - ANS=D: CorrectRotate your finger to
examine the muscular anal ring.
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 - ANS=D: . CorrectThe gland should feel like a pencil
eraser—firm, smooth, and slightly movable—and it should be nontender.
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 - ANS=C: CorrectIf there is no passage of
stool in 24 hours in a newborn, suspect rectal atresia, Hirschsprung disease (congenital
megacolon), or cystic fibrosis.
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. - ANS=A: CorrectWith cancer of the prostate, a hard, irregular nodule
may be palpable on prostate examination.
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 - ANS=B: CorrectPerianal 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.
"Boggy, enlarged, and tender" on rectal examination is descriptive of which condition?
A. Prostatitis
B. Anorectal abscess
C. Prostatic carcinoma
D. Rectal polyp - ANS=A: CorrectSeminal 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 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 - ANS=B: CorrectIf there is no passage of stool in 24 hours in a newborn,
suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis.
Enlargement of the prostate may cause:
A. urinary retention.
B. a forceful urinary stream.
C. infertility.
D. prostate cancer. - ANS=A: CorrectSymptoms 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.
The primary function of the rectum is:
A. formation of feces.
B. absorption of water.
C. the absorption of nutrients.
D. storage of feces. - ANS=D: CorrectAbove 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.
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. - ANS=B: CorrectExternal 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. 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. - ANS=D; CorrectHemorrhoids are
rare in children, and their presence suggests a serious underlying problem such as
portal hypertension.
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. - ANS=A: CorrectA prostatic abscess is felt as a fluctuant mass in the
prostate.
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. - ANS=A: CorrectSmall flecks of blood-stained mucus in liquid
feces are indicative of amebiasis.
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 - ANS=B: CorrectA consistently empty rectum in the presence of
constipation is a clue to the diagnosis of Hirschsprung disease.
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. - ANS=C: CorrectRectal examination is not always performed
on infants and children unless there is a particular problem. An examination is required
