Chapter 21: Anus, Rectum, and Prostate

Question 1

1. Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. Which sign would indicate to the healthcare provider that she has a closed anal passageway?
   a. Development of a scaphoid abdomen
   b. Vomiting after her first feeding
   c. Bleeding from the rectum
   d. Failure to pass meconium stool

Answer 1

d. Failure to pass meconium stool

Question 2

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

Answer 2

b. Posterior

Question 3

3. The prostatic sulcus
   a. divides the right and left lateral lobes.
   b. is the site of the seminal vesicle emergence.
   c. refers to the anterior aspect of the prostate.
   d. secretes clear viscous mucus.

Answer 3

a. divides the right and left lateral lobes.

Question 4

4. The rectal past medical history of all patients should include inquiry about
   a. bowel habits.
   b. dietary habits.
   c. hemorrhoid surgery.
   d. laxative use.

Answer 4

c. hemorrhoid surgery.

Question 5

5. The effects of aging on the gastrointestinal system leads to more frequent experiences of
   a. constipation.
   b. prolonged satiety.
   c. diarrhea.
   d. prostate glandular atrophy.

Answer 5

a. constipation.

Question 6

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

Answer 6

a. African descent.

Question 7

7. The caliber of the urinary stream is routine information in the history of
   a. adolescents.
   b. infants.
   c. older adults.
   d. sexually active young men.

Answer 7

c. older adults.

Question 8

8. Equipment for examination of the anus, rectum, and prostate routinely includes gloves and
   a. a hand mirror and gauze.
   b. a lubricant and penlight.
   c. slides and normal saline.
   d. swabs and culture medium.

Answer 8

b. a lubricant and penlight.

Question 9

9. Which is a risk factor for colorectal cancer?
   a. High-fiber diet
   b. Diet low in animal fats and proteins
   c. Irish descent
   d. Inherited BRAC2 mutation

Answer 9

d. Inherited BRAC2 mutation

Question 10

10. Nodules found in the peritoneum through the anterior rectal wall
    a. are found with bi-digital palpation.
    b. are called shelf lesions.
    c. are chronic fibrosis.
    d. are found by having the patient bear down.

Answer 10

b. are called shelf lesions.

Question 11

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

Answer 11

d. tenderness and inflammation.

Question 12

12. Palpation of the anal ring is done by
    a. Bi-digital palpation with the thumbs.
    b. inserting the smallest finger into the anus.
    c. pressing a gauze pad over the anus.
    d. rotation of the forefinger inside the anus.

Answer 12

d. rotation of the forefinger inside the anus.

Question 13

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

Answer 13

b. anterior wall of the rectum.

Question 14

14. The cervix may be palpated through the
    a. anterior rectal wall.
    b. internal umbilical wall.
    c. lateral urethral meatus.
    d. posterior uterine surface.

Answer 14

a. anterior rectal wall.

Question 15

15. Your patient’s chief complaint is repeated, pencil-like stools. Further examination should include
    a. a stool culture.
    b. parasite testing.
    c. a digital rectal examination (DRE).
    d. a prostate examination.

Answer 15

c. a digital rectal examination (DRE).

Question 16

16. Very light tan or gray stools may indicate
    a. upper gastrointestinal bleeding.
    b. obstructive jaundice.
    c. lower gastrointestinal bleeding.
    d. polyposis.

Answer 16

b. obstructive jaundice.

Question 17

17. Tarry black stools should increase suspicion for
    a. internal hemorrhoids.
    b. rectal fistula.
    c. upper intestinal tract bleeding.
    d. prostatic cancer.

Answer 17

c. upper intestinal tract bleeding.

Question 18

18. Prostate-specific antigen (PSA) screening is controversial because
    a. there are many false-negative results.
    b. PSA is produced by many other tissues.
    c. it is less sensitive than digital rectal examination.
    d. no data have proved that it decreases mortality.

Answer 18

d. no data have proved that it decreases mortality.

Question 19

19. Which finding in an infant may indicate lower spinal deformities?
    a. Perirectal redness
    b. Shrunken buttocks
    c. Rectal prolapse
    d. Dimpling in the pilonidal area

Answer 19

d. Dimpling in the pilonidal area

Question 20

20. A lower spinal cord lesion may be indicated by which finding?
    a. Lack of an anal wink
    b. Rectal prolapse
    c. Anal fistula
    d. Small flaps of anal skin

Answer 20

a. Lack of an anal wink

Question 21

21. Pinworms and Candida may both cause
    a. constipation.
    b. hemorrhoids.
    c. perirectal irritation.
    d. perirectal protrusion.

Answer 21

c. perirectal irritation.

Question 22

22. Thrombosed hemorrhoids are
    a. flabby skin sacs.
    b. red, inflamed, and painful.
    c. fluctuant soft papules.
    d. blue, shiny, painful masses.

Answer 22

d. blue, shiny, painful masses.

Question 23

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

Answer 23

d. rubbery

Question 24

24. Mr. Dunn is a 62-year-old man who has presented for a routine annual examination. On examination of the prostate you note a hard, irregular, painless nodule and obliteration of the median sulcus. These are signs of
    a. benign prostatic hypertrophy.
    b. cancer of the prostate.
    c. long-standing prostatitis.
    d. swelling as a result of aging.

Answer 24

b. cancer of the prostate.

Question 25

25. The mother brings her 4-year-old to the clinic because the child complains of perianal itching. As part of your examination you complete a cellulose tape test. The cellulose tape test is used for the detection of
    a. enterobiasis.
    b. carcinoma.
    c. amebiasis.
    d. steatorrhea.

Answer 25

a. enterobiasis.

Question 26

1. Mr. Sweeney is a 58-year-old man who has presented for a routine annual prostate examination. On examination, you note a normal prostate gland. Which of the following characteristics should describe the normal prostate? (Select all that apply.)
   a. Rubbery consistency
   b. About 4 cm in diameter
   c. Fluctuant softness
   d. Gland protruding 1 cm into the rectum
   e. Firm, smooth, and slightly movable

Answer 26

ANS: B, D, E

b. About 4 cm in diameter
d. Gland protruding 1 cm into the rectum
e. Firm, smooth, and slightly movable