PHYSICAL EXAMINATION OF THE ANUS, RECTUM AND PROSTATE

Question 1

Rectal examination can be performed with the patient in what positions?

Answer 1

knee-chest
left lateral with hips and knees flexed
standing with the hips flexed
upper body supported by the examining table

Question 2

When inspecting the anus what are you looking for?

Answer 2

erythema or edema
drainage
bleeding
skin lesions
skin tags
or warts
external hemorrhoids
fissures, and fistulas

Question 3

When inspecting, what will make fistulas, fissures, rectal prolapse, polyps, and internal hemorrhoids more readily apparent?

Answer 3

Having the patient bear down

Question 4

Palpation
Having the patient do ____ will help relax the external sphincter?

Answer 4

bear down

Question 5

Palpation
While the patient is bearing down, insert the tip of the finger into the anal canal at a __ degree angle to the anal orifice.

Answer 5

90

Question 6

True/False
Palpate anal ring.
Have the patient briefly tighten their external sphincter around your finger, noting its tone. Rotate your finger to examine the
muscular anal ring.

Answer 6

True

Question 7

A lax sphincter could be indicative of what?

Answer 7

neurological injury or
deficit

Question 8

Palpate the rectal wall. Insert your finger farther and palpate in sequence the……..

Answer 8

posterior,
lateral
anterior rectal walls

Question 9

True/false
The rectal walls should feel smooth, even and uninterrupted.

Answer 9

True

Question 10

What should you take note of when palpating the rectal wall?

Answer 10

Note any nodules, masses, polyps, tenderness or other irregularities

Question 11

Palpating prostate gland in males,
posterior surface of the gland will be palpable through what rectal wall?

Answer 11

Anterior rectal wall

Question 12

A healthy prostate has a diameter of approximately ___cm with less than ___ cm protrusion into the rectum

Answer 12

4 cm with less than 1 cm protrusion

Question 13

When palpating the prostate what is noted?

Answer 13

Size
Contour
Characteristics

Question 14

The ______ of the prostate should be palpable but may be obliterated if hypertrophy or neoplasm is suspected.

Answer 14

median sulcus

Question 15

Palpating the prostate
1) A rubbery or boggy consistency is indicative to _______ but can also be normal in older adults
2) stony hard nodules are indicative of _________

Answer 15

1) benign hypertrophy or infection
2) carcinomas.

Question 16

In females, a _____ or _____ uterus may be palpable during rectal examination. The cervix may be palpable through the ______ rectal wall

Answer 16

retroflexed or retroverted
anterior

Question 17

What will require a DRE?

Answer 17

1) Persistent pencil like stool
2) Light tan/gray stools
3) Tarry black stool
4) Bright red blood in stool

Question 18

Persistent pencil like stool may indicate what?

Answer 18

permanent stenosis from scaring or presence of a malignancy

Question 19

Light tan/gray stools =

Answer 19

obstructive jaundice

Question 20

Tarry black stool =

Answer 20

upper GI bleed

Question 21

Bright red blood in stool =

Answer 21

Lower GI bleed

Question 22

Questions should center on bowel habits and characteristics such as _1__
travel history to determine ___2___
dietary patterns such as _____3___
risk factors for colorectal or prostatic cancer, and use of _____4____

Answer 22

1. timing, frequency, and stool color
2. risk of parasitic infestations
3. inclusion of fiber foods or intolerance of certain foods
4. alcohol intake, smoking and dietary habits

Question 23

Prostate enlargement is classified by what?

Answer 23

the amount protruding into rectum