A 46-Year-Old Man Comes to the Emergency Department Due to Severe

question 24

Multiple Choice

A 46-year-old man comes to the emergency department due to severe anal pain.  He has a history of chronic constipation and on several occasions has noticed streaks of blood on the tissue paper after wiping.  He has no abdominal pain, nausea, vomiting, or weight loss and has no family history of malignancy.  His temperature is 36.7 C (98 F) .  On examination, there are several large, purplish-blue sacs bulging into the anal canal, one of which originates below the dentate line and is extremely tender.  Excision of the tender lesion under local anesthesia is planned.  The anesthetic agent most likely blocks sensory impulses carried by which of the following structures?

• A)Ilioinguinal nerve
• B)Inferior gluteal nerve
• C)Inferior hypogastric plexus
• D)Pelvic splanchnic nerves
• E)Pudendal nerve