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PCA > Rectal > Flashcards

Rectal Flashcards

1
Q

The anal canal is normally held in a closed position by the _________external anal sphincter and the __________internal sphincter

A

voluntary, involuntary

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2
Q

Anal canal is demarcated from the rectum superiorly by a serrated line marking the change from skin to mucous membranes (pectinate or dentate line) which also marks the boundary between ________ and _______nerve supplies. It is ________palpable

A

somatic and visceral nerve supplies.
NOT

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3
Q

The prostate is small during childhood, but between puberty and age 20, it increases roughly_______

A

5-fold

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4
Q

Which lobes are palpable on the prostate

A

two lateral, median sulcus

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5
Q

Median lobe is _____ palpable in prostate

A

NOT

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6
Q

In females the uterine cervix usually palpable through the _______ wall of the rectum

A

anterior

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7
Q

GI red flags

A

Any change in bowel habits?
Blood in the stool?
Pain with defecation?
External anal growths: Anal warts, fissures, hemorrhoids?

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8
Q

GU red flags

A
  1. Irritative urinary sx- pain or burning with urination, hesitancy, urgency
  2. Obstructive urinary sx- trouble starting stream, difficulty keeping stream going, feeling as though the bladder still full despite having urinated
    Hematuria- presence of blood in urine
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9
Q

pencil thin stool is a potential sign of

A

colon CA

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10
Q

Melena

A

Black tarry

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11
Q

Hematochezia

A

bloody stool

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12
Q

External hemorrhoids

A

not painful unless theyre thrombosed

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13
Q

Internal hemorrhoids

A

originate from vessels and those are painful ones

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14
Q

Proctitis (a type of anal fissure)

A

acute inflammatory process of the rectum

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15
Q

Weak urinary stream sx such as Difficulty starting or holding back stream, Flow weak, Intermittency, Frequent urination- nocturia, Hematuria are all suggestive of

A

benign prosthetic Hyperplasia

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16
Q

Painless hematuria is common for _____

A

bladder cancer

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17
Q

Sudden onnset of irritative sx combined with LBP, pelvic, fever and chills = ____________. Males are NOT prone to UTIs

A

prostatitis.

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18
Q

Prostate CA risk fx

A

Leading cancer dx. in men in US and 2nd leading cause of death after lung ca
Risk factors
70% cases in men over 65 years of age
Median age is 66.
AA men have the highest incidence esp. with advanced disease
1st degree relative; risk doubled (take home risk fx)

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19
Q

T/F No evidence of lifestyle modification including dietary changes, increased physical activity can prevent prostate CA

A

True

20
Q

What reduces prostate cancer risk to some degree although they are not shown to reduce mortality.

A

5- alpha reductase inhibitors (finasteride and dutasteride)

21
Q

Pt is ____ to _____ age range should start screenning for prostate CA

A

50-55

22
Q

What is the age to stop screening for prostate ca?

A

69 vs Life expectancy < 10 years

23
Q

A positive hem-occult test is indicative of

A

blood in stool

24
Q

Common abnormalities:

A

Hemorrhoids
Perianal abscess
Rashes
Skin tags
Anal fissures
Anal condylomas (warts)
** Pruitius Ani: Swollen, thickened, fissured, perianal skin with excoriation

25
Q

Pruitius

A

Swollen, thickened, fissured, perianal skin with excoriation

26
Q

What may be preventing finger from entering all the way in during the rectal exam?

A

a mass/lesion preventing finger from entering all the way in

27
Q

Sphincter tone

A

Tightness in anxiety, inflammation, or scarring Laxity in some neurologic diseases
Consider testing perianal sensation

28
Q

Induration

A

May be caused by inflammation, scarring or malignancy

29
Q

Normal prostate will feel

A

rubbery and nontender

30
Q

A patient who has ______ will not be able to tolerate any palpation

A

prostitits

31
Q

When performing the rectal exam, first you want to put your finger clockwise in which you will feel the

A

Rectal Surface

32
Q

When performing the rectal exam, you secondary want to put your finger in Counterclockwise in which you will feel

A

posterior surface of the prostate gland

33
Q

Sphincter is spastic- exam is painful and may need_____

A

May need EUA(anasthesia)

34
Q

What is the most common type of anal fissure?

A

midline posterior

35
Q

Anorectal fistula

A

abnormal connective tract that originates from anal glands to external opening on skin
Result after prior abscess/infection
Look for openings in skin anywhere around anus

36
Q

Polyp of Rectum

A

Variable in size
Stalk (pedunculated) vs flat (sessile)
May be soft and difficult to feel
Endoscopy/biopsy needed for dx

37
Q

Cancer of rectum

A

Firm, often nodular

38
Q

Rectal Shelf

A

Firm to hard nodular rectal “shelf” may be just palpable with fingertip
In women, this can occur behind uterus and cervix

39
Q

Acute Bacterial prostatitis

A

presents with fever and UTI sx
Tender, swollen, boggy, warm
Will be extremely tender

40
Q

BPH

A

Symptoms occur with smooth muscle contraction in prostate and bladder neck and compression of urethra
Irritative and Obstructive
Normal vs symmetrically enlarged, smooth, firm
Obliteration of median sulcus
Notable protrusion into rectal vault
Severity may not correlate with physical exam findings

41
Q

Prostate Cancer

A

Suggestive of area of hardness in gland
Distinct hard nodule or firmness
As it grows may feel irregular and extend beyond gland
Median sulcus may be obscured

42
Q

genital warts

A

HPV or condylomata lata (syphilis)

43
Q

Anal fissures

A

proctitis, Crohn’s, straining

44
Q

Who needs rectal/prostate exam

A

Lower GI bleeding, pain/discomfort in rectum

45
Q

When doing the rectal exam, if there is pain or tenderness, dont force it. What do you want to do instead?

A

place fingers on both sides of the anus and gently spread the orifice and bear down. look for a lesion

46
Q

slide 18

A
47
Q

Anal fissure is very painful. The most common is the midline posterior. They may have sentinel ____________ just below it. _________ is spastic which makes the exam painful, may need EUA

A

skin tag, sphincter

PCA (17 decks)

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