anus, rectum, prostate

Question 1

Concerning symptoms of the anus and rectum

Answer 1

• change in bowel habits
• melena/hematochezia
• pain with defecations
• rectal bleeding
• tenderness
• history of anal warts/fissures

Question 2

anal pain, itching, tenesmus or discharge, bleeding is

Answer 2

proctitis

Question 3

what are the causes of proctitis

Answer 3

• IBD
• STI
• Radiation induced
• bacterial infection
• trauma

Question 4

what is the main cause of rectal itching in younger patients?

Answer 4

pinworms

Question 5

how do kids get pinworms?

Answer 5

through ingestion (they are in soil and can transfer through the hands)

Question 6

when is the scotch tape test conducted?

Answer 6

for pinworms
* put scotch tape on the anus

Question 7

what causes accumulate, cauliflower like warts? what causes it?

Answer 7

Condyloma acuminata
HPV

Question 8

what is a flat top wart seen secondary in syphilis?

Answer 8

Condyloma lata

Question 9

where are anal fissure found?

Answer 9

midline is most common

Question 10

what can cause anal fissures?

Answer 10

• constipation
• straining
• crohn’s
• trauma (anal sex)
• infection
• STI/STD
• anal cancer

Question 11

what are some obstructive symptoms

Answer 11

• difficulty starting stream
• weak stream
• incomplete bladder emptying

Question 12

what are some irritative symptoms?

Answer 12

• dysuria
• urinary frequency
• urgency

Question 13

what position do you have th pt in for a DRE

Answer 13

on the side or standing over a table

Question 14

what 2 things are you assessing for during a DRE

Answer 14

1. anal sphincter tone
2. anal canal and rectal surgace for abnromalities

Question 15

what do you palpate the prostate for?

Answer 15

the lateral lobes and median sulcus

note the size, shape, texture, mobility, nodules

Question 16

what does the prostate normally feel like?

Answer 16

• rubbery and nontender
• round, heart shaped
• only the posterior side

Question 17

how long is the normal prostate

Answer 17

2.5cm

Question 18

what are some indications for a DRE

Answer 18

1. abdominal or pelvic pain
2. prostate exam
3. change in bowel habits
4. rectral bleeding, pain, itching
5. melena/hematochezia
6. urinary or fecal incontinence

Question 19

where is a pilonidal cyst found

Answer 19

midline natal cleft superficial to the coccyx

Question 20

what pathology may you possibly see the opening of a sinu tract with a small tuft of hair surrounded by erythema

Answer 20

pilonidal cyst

Question 21

pilonidal cysts are normally _________ until an abscess forms

Answer 21

asymptomatic

Question 22

what hemorrhoid causes pain

Answer 22

external hemorrhoids that are thrombosed

Question 23

what hemorrhoid originates below the denate line and are covered with skin?

Answer 23

external hemorrhoids

Question 24

what does thormbosis of an external hemorrhoid cause?

Answer 24

acute pain with a tender, swollen, bluish mass at the anal margin

Question 25

where are internal hemorrhoids found?

Answer 25

above the denate line that can cause bleeding with defecation

Question 26

which hemorrhoid causes bleeding with defecation?

Answer 26

internal hemorrhoids

Question 27

what can happen to internal hemorrhoids?

Answer 27

they can prolapse

Question 28

what pathology appears as a rosette from the anus with radiating folds?

Answer 28

Partial thickness rectal prolapse (rectal mucosa only)

Question 29

what pathology appears as larger mass from the anus and is covered by circular folds?

Answer 29

full thickness rectal prolapse (entire bowel wall prolapse)

Question 29

what is a very painful tear of the anoderm?

Answer 29

anal fissure

Question 30

where do anal fissures most commonly occur ?

Answer 30

the midline posteriorly

Question 31

what is associated with a sentinel skin tag

Answer 31

anal fissure

Question 32

what does the anus sphincter feel like for a DRE with anal fissures

Answer 32

anal sphincter is spastic exam is painful

Question 33

what is a fissure that gos from the anal glands to an external opening of the skin

Answer 33

anorectal fissure

Question 34

what is anorectal fistulas a result of

Answer 34

previous anorectal abscess/infection

Question 35

what are the two types of polyps of the rectum

Answer 35

1. peduncalated (stalk) 2. sessile (flat)

Question 36

are polyps easy to feel?

Answer 36

No they are soft and difficult to feel

Question 37

how do you differentiate polyps from malignancy

Answer 37

sigmoidoscopy or colonoscopy and biopsy

Question 38

what is a rectal shelf from?

Answer 38

peritoneal metastases | usually on the anterior

Question 39

pts have a "boggy" or swollen prostate

Answer 39

acute bacterial prostatitis

Question 40

what do pts present with for acute bacterial prostatitis

Answer 40

* fever * uti symptoms * perineal/suprapubic/rectal pain

Question 41

in males <35 experiencing acute bacterial prostatitis, consider

Answer 41

* n. gonorrhea * C. trachomatis

Question 42

in males >35 experiencing acute bacterial prostatitis, consider

Answer 42

e. coli enterococcus proteus

Question 43

how does chronic bacterial prostatitis prostate feel?

Answer 43

* normal * without swelling or tenderness

Question 44

what is associated with recurrent UTIs and the same organism

Answer 44

chronic bacterial prostatitis

Question 45

what symptoms are associated with chronic bacterial prostatitis

Answer 45

* asymptomatic * dysuria * mild pelvic pain

Question 46

what does the prostate feel like for BPH pts

Answer 46

* symmetrically enlarged * smooth * firm * +/- median sulcus palpable

Question 47

what symptoms are associated with BPH

Answer 47

irritative or obstructive or both

Question 48

what is suggested by an area of hardness in the gland?

Answer 48

prostate cancer

Question 49

what is the normal "finger print" of a prostate

Answer 49

2 fingerprints 20g weight

Question 50

what is the most frequently diagnosed non-skin cancer in the US?

Answer 50

Prostate cancer

Question 51

what age is at higher risk for prostate cancer

Answer 51

> 50 yo

Question 52

what ethnicity is associated with higher risk of prostate cancer

Answer 52

African american | higher chance before 50yo and advance stage

Question 53

what family history is associated with increased risk of prostate cancer?

Answer 53

* first degree relative (2x the risk) * 2+ relatives with prostate cancer (5-11x risk) * BRCA mutations

Question 54

smoking, agent orange, high fat diety, and obesity are assoicated with higher risk of

Answer 54

prostate cancer

Question 54

what can elevate PSA

Answer 54

1. prostate cancer also: * BPH * prostatitis * perianal trauma * prostate infection * ejaculation * dre

Question 55

what does PSA stand for

Answer 55

prostate specific antigen

Question 55

what is considered a normal level of PSA

Answer 55

<4ng/ml

Question 57

what % of men will have a PSA elevated and what % will have cancer

Answer 57

12% of men with elvated PSA 30% with prostate cancer

Question 58

what percent of men with abnormal DRE will have prostate cancer on biopsy

Answer 58

28% of men

Question 59

what types of cancer metastasize to the bone?

Answer 59

* breast * lung * tomato * kidney * prostate