Anus, Rectum, Prostate

Question 1

Current recommendations for prostate cancer screening

Answer 1

PSA testing is recommended q 1 to 2 years
DRE optional
Screening should stop at age 70 or when life expectancy drops below 10 years

Question 2

What is a normal PSA level?

Answer 2

< 4ng/mL

Question 3

History and exam findings with a normal prostate gland

Answer 3

right and left lateral lobes lies against the anterior rectal wall - lobes are palpable as a rounded, heart-shaped structure approximately 2.5cm long - are separated by a shallow median sulcus or groove, also palpable

Question 4

History and exam findings with benign prostatic hyperplasia

Answer 4

enlargement of the prostate gland -incidence increases with age - symptoms may be irritative (urgency, frequency, nocturia) , obstructive (decreased stream, incomplete emptying, straining), or both - prostate may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic - may be oblideration of median sulcus and more notable protrusion into the rectal lumen

Question 5

History and exam findings with acute prostatitis

Answer 5

presents with fever and UTI symptoms (frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain) - gland feels tender and swollen, “boggy” and warm -

Question 6

History and exam findings with chronic prostatitis

Answer 6

associated with recurrent UTIs - usually from the same organism - may be asymptomatic or have symptoms of dysuria or mild pelvic pain - prostate gland may feel normal, without tenderness or swelling

Question 7

History and exam finding with prostate cancer

Answer 7

a distinct hard nodule that alters the contour of the gland may or may no be palpable - as CA enlarges, it feels irregular and may extend beyond the confines of the gland

Question 8

Current colorectal screening guidelines

Answer 8

Adults age 50-75: 
-high sensitivity FOBT annually
-sigmoidoscopy q 5yrs and FOBT q 3 yrs
-colonoscopy q 10 yrs
Adults age 76-85 - do not screen routinely
Adults > 85 years - do not screen

Question 9

History and exam findings with internal hemorrhoids

Answer 9

enlargements of the normal vascular cushions located above the pectinate line - usually not palpable - may cause bright-red bleeding, esp. during defecation - may prolapse through the anal canal & appear as reddish, moist, protruding masses

Question 10

History and exam findings with external hemorrhoids

Answer 10

• dilated hemorrhoidal veins that originate below the pectinate line that are covered with skin
• seldom produce symptoms unless thrombosis occurs - causes acute local pain that increases with defecation and sitting
• a tender, swollen, bluish, ovoid mass is visible at the anal margin

Question 11

History & exam findings with a prolapsed rectum

Answer 11

• the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red tissue - occurs on straining for a bowel movement

Question 12

Risk factors for prostate CA

Answer 12

age - risk increases after age 50

ethnicity - African American men have the highest incidence