A 42-Year-Old Man Comes to the Emergency Department Due to Worsening

question 25

Multiple Choice

A 42-year-old man comes to the emergency department due to worsening anal pain for the past 2 days.  The patient initially had pain only during defecation, but now the pain is constant and severe.  He also has anal pruritus but has not had any drainage.  The patient reports a history of constipation with hard stools every 3-4 days requiring the frequent use of laxatives.  He has had sexual intercourse with men and women and has had anoreceptive intercourse in the past.  Temperature is 38 C (100.4 F) , blood pressure is 120/80 mm Hg, and pulse is 85/min.  Physical examination shows an erythematous and tender 1-cm fluctuant mass near the anal orifice with induration of the overlaying skin.  Which of the following is the most likely cause of this patient's current condition?

• A)Human papillomavirus infection of the anal canal
• B)Infection of an occluded anal crypt gland
• C)Overstretching and tearing of the anal mucosa
• D)Prolapse of an internal hemorrhoid
• E)Thrombosis of an external hemorrhoid

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