Rectal

Question 1

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

Answer 1

voluntary, involuntary

Question 2

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

Answer 2

somatic and visceral nerve supplies.
NOT

Question 3

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

Answer 3

5-fold

Question 4

Which lobes are palpable on the prostate

Answer 4

two lateral, median sulcus

Question 5

Median lobe is _____ palpable in prostate

Answer 5

NOT

Question 6

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

Answer 6

anterior

Question 7

GI red flags

Answer 7

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

Question 8

GU red flags

Answer 8

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

Question 9

pencil thin stool is a potential sign of

Answer 9

colon CA

Question 10

Melena

Answer 10

Black tarry

Question 11

Hematochezia

Answer 11

bloody stool

Question 12

External hemorrhoids

Answer 12

not painful unless theyre thrombosed

Question 13

Internal hemorrhoids

Answer 13

originate from vessels and those are painful ones

Question 14

Proctitis (a type of anal fissure)

Answer 14

acute inflammatory process of the rectum

Question 15

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

Answer 15

benign prosthetic Hyperplasia

Question 16

Painless hematuria is common for _____

Answer 16

bladder cancer

Question 17

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

Answer 17

prostatitis.

Question 18

Prostate CA risk fx

Answer 18

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)

Question 19

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

Answer 19

True

Question 20

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

Answer 20

5- alpha reductase inhibitors (finasteride and dutasteride)

Question 21

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

Answer 21

50-55

Question 22

What is the age to stop screening for prostate ca?

Answer 22

69 vs Life expectancy < 10 years

Question 23

A positive hem-occult test is indicative of

Answer 23

blood in stool

Question 24

Common abnormalities:

Answer 24

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

Question 25

Pruitius

Answer 25

Swollen, thickened, fissured, perianal skin with excoriation

Question 26

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

Answer 26

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

Question 27

Sphincter tone

Answer 27

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

Question 28

Induration

Answer 28

May be caused by inflammation, scarring or malignancy

Question 29

Normal prostate will feel

Answer 29

rubbery and nontender

Question 30

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

Answer 30

prostitits

Question 31

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

Answer 31

Rectal Surface

Question 32

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

Answer 32

posterior surface of the prostate gland

Question 33

Sphincter is spastic- exam is painful and may need_____

Answer 33

May need EUA(anasthesia)

Question 34

What is the most common type of anal fissure?

Answer 34

midline posterior

Question 35

Anorectal fistula

Answer 35

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

Question 36

Polyp of Rectum

Answer 36

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

Question 37

Cancer of rectum

Answer 37

Firm, often nodular

Question 38

Rectal Shelf

Answer 38

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

Question 39

Acute Bacterial prostatitis

Answer 39

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

Question 40

BPH

Answer 40

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

Question 41

Prostate Cancer

Answer 41

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

Question 42

genital warts

Answer 42

HPV or condylomata lata (syphilis)

Question 43

Anal fissures

Answer 43

proctitis, Crohn’s, straining

Question 44

Who needs rectal/prostate exam

Answer 44

Lower GI bleeding, pain/discomfort in rectum

Question 45

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

Answer 45

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

Question 46

slide 18

Question 47

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

Answer 47

skin tag, sphincter