Assessment - Exam 2 - Practice Questions - Anus, Rectum & Prostate WITH CORRECT ANSWERS 2024
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A 49‐year‐old male nurse experiences fecal incontinence after a motor vehicle accident that left him paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a person without his injuries. Which of the following is true regarding the muscle control o...
A 49‐year‐old male nurse experiences fecal incontinence after a motor vehicle accident
that left him paralyzed below the waist. He asks his rehabilitation physician about the
control of this function in a person without his injuries. Which of the following is true
regarding the muscle control of the anal sphincter?
a) Both internal and external anal sphincter are under voluntary control.
b) The internal anal sphincter is under involuntary control, whereas the external anal
sphincter is under voluntary control.
c) Both internal and external anal sphincter are under involuntary control.
d) The internal anal sphincter is under voluntary control, whereas the external anal
sphincter is under involuntary control.
e) Control of the anal sphincters is variable between individuals. correct answers b)
The internal anal sphincter is under involuntary control, whereas the external anal
sphincter is under voluntary control
Together, these two muscles hold the anal sphincter closed until the individual is ready
to defecate. The internal anal sphincter is under voluntary control, whereas the external
anal sphincter is under involuntary control; both internal and external anal sphincter are
under voluntary control; and both internal and external anal sphincter are under
involuntary control are incorrect because, as above, the internal anal sphincter is under
involuntary control, whereas the external anal sphincter is under voluntary control.
Control of the anal sphincters is variable between individuals is incorrect because this
anatomic and neurological arrangement is not typically variable between individuals,
although these pathways may be interrupted by derangements of normal physiology
such as spinal cord injuries.
A 62‐year‐old male who is undergoing evaluation for possible prostate cancer strongly
declines a rectal examination, stating that, "Some trainee once did that and it hurt
badly." Which of the following is true about the innervation of the anus and rectum that
may explain this patient's experience of discomfort?
a) The rectum contains primarily somatic nerves, whereas the anal canal contains
primarily visceral nerves, making the anus the most likely source of this patient's
discomfort.
b) The anal canal has a rich somatosensory innervation, making poorly directed
examinations painful in this area.
c) The rectum contains primarily somatic nerves, whereas the anal canal contains
primarily visceral nerves, making the rectum the most likely source of this patient's
discomfort.
d) The dentate or pectinate line does not differentiate any neurological input, making the
area either proximal or distal to the line equally re correct answers b) The anal canal
, has a rich somatosensory innervation, making poorly directed examinations painful in
this area.
The anal canal is characterized by somatosensory innervation, whereas the rectum has
little such nerve supply. Thus, the patient's discomfort likely occurred due to the stretch
of the anal canal rather than disruption of the more proximal rectal mucosa. The rectum
contains primarily somatic nerves, whereas the anal canal contains primarily visceral
nerves, making the rectum the most likely source of this patient's discomfort is incorrect
because the anal canal is more richly innervated with somatosensory nerves than the
rectum. The rectum contains primarily somatic nerves, whereas the anal canal contains
primarily visceral nerves, making the anus the most likely source of this patient's
discomfort is incorrect because, although the anal canal is the most likely site of the
patient's discomfort, the anal canal (not the rectum) contains a greater concentration of
somatosensory nerves. Proximal to the dentate line, the lower gastrointestinal tract is
innervated primarily by somatosensory nerves, making the proximal reach of the
examination the most likely site of this patient's pain is incorrect because the reverse is
true: somatosensory innervation is greater in the anal canal than the rectum. The
dentate or pectinate line does not differentiate any neurological input, making the area
either proximal or distal to the line equally responsible for this patient's discomfort is
incorrect because the dentate or pectinate line forms the anorectal junction. Little
somatosensory innervation occurs proximal to this line, making the rectal area a less
likely source of a patient's discomfort during anorectal examinations.
A 54‐year‐old male with a strong family history of breast and prostate cancer presents to
his primary care provider to discuss prostate screening. His father died at age 73 years
from prostate cancer that was not detected on routine digital rectal examinations
(DREs), and he would like to minimize his chance of a similar occurrence. Which of the
following is true regarding the anatomy and screening of the prostate by DRE?
a) The median lobe of the prostate is located anterior to the urethra and is not palpable
on DRE.
b) All three lobes of the prostate are palpable on DRE.
c) A prostate of 5 cm diameter without palpable nodes or masses represents a normal
prostate examination.
d) The median sulcus divides the lateral lobes from the median lobe and is palpable on
DRE.
e) The seminal vesicles are palpable distal to the prostate on DRE. correct answers a)
The median lobe of the prostate is located anterior to the urethra and is not palpable on
DRE.
Due to its location at the anterior aspect of the urethra, the median lobe of the prostate
is not palpable on DRE, nor are small tumors in this area. All three lobes of the prostate
are palpable on DRE is incorrect because the median lobe of the prostate is not
palpable on DRE, although the two lateral lobes are palpable. The seminal vesicles are
palpable distal to the prostate on DRE is incorrect because the seminal vesicles are
proximal (not distal) to the prostate. They are generally not palpable on DRE. The
median sulcus divides the lateral lobes from the median lobe and is palpable on DRE is
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