Chapter 21: Anus, Rectum, and Prostate

Question 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

ANS: D
Failure to pass meconium stool indicates that a newborn has an imperforate anus.

Question 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

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.

Question 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

ANS: A
The prostatic sulcus divides the two lateral lobes and is palpated as a shallow groove.

Question 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

ANS: C
Past medical history should include inquiry about hemorrhoids, spinal cord injury, benign
prostatic hypertrophy (BPH), prostate, colorectal, breast, ovarian, or endometrial cancers, and
episiotomies of fourth-degree lacerations during delivery. Habits are part of the personal and
social history; the use of laxatives is part of the history of the present illness.

Question 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

ANS: A
Older adults experience an elevated pressure threshold for the sensation of rectal distention
and are therefore susceptible to constipation. They also experience early satiety, fecal
incontinence, and prostate glandular hypertrophy.

Question 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

ANS: A
The incidence rate of prostate cancer is 50% higher for African American men compared with
white American men. African American men also have a higher mortality rate.

Question 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

ANS: C
Routine questions about the caliber of the urinary stream and dribbling are directed toward
older men because hypertrophy of the prostate gradually impedes urine flow.

Question 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

ANS: B
Equipment for the examination includes a penlight, lubricating jelly, gloves, and fecal occult
blood testing materials.

Question 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

ANS: D
History of intestinal polyps is considered a risk factor for colorectal cancer, as are diets low in
fiber and high in animal fats and an ethnic background of Ashkenazi Jewish descent.

Question 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

ANS: B
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 metastasis. The
nodules called shelf lesions are palpable just above the prostate in males and in the cul-de-sac
of females.

Question 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

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

Question 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

ANS: D
The anal muscular ring is palpated by rotating the examination finger.

Question 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

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

Question 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

ANS: A
In women, the cervix can be palpated through the anterior rectal wall. It feels like a small,
round mass.

Question 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

ANS: C
Persistent pencil-shaped stools are indicative of stenosis from scarring or pressure from a
mass. DRE should be performed to assess for a mass.

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 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

ANS: D
There are no data confirming that PSA screening decreases mortality from prostate cancer.

Question 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

ANS: D
Sinuses, tufts of hair, and dimpling in the pilonidal area may indicate lower spinal deformities
such as a pilonidal cyst.

Question 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

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

ANS: D
Thrombosed hemorrhoids appear as blue shiny masses at the anus; they contain clotted blood
and are edematous and painful.

Question 23

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

Answer 23

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

Question 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

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

Question 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

ANS: A
Enterobiasis (pinworm infestation) is detected by the cellulose tape test. Pinworms are
collected by applying tape to the perianal folds and then pressing the tape on a glass slide.

Question 26

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
The gland should feel like a pencil eraser, firm, smooth, and slightly movable and should be
nontender. It has a diameter of 4 cm, with a 1-cm protrusion into the rectum.