question archive A 50 year old female visits your office with a 2 week history of extreme pain upon defecation

A 50 year old female visits your office with a 2 week history of extreme pain upon defecation

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A 50 year old female visits your office with a 2 week history of extreme pain upon defecation. The patient denies any associated abdominal pain, nausea, vomiting, fever, or chills. The patient reports a long history of constipation which has been severe lately, she has also noticed slight spotting of blood on tissue paper, but denies any anal drainage, bright red blood per rectum, or melena. Upon examination, the most likely physical finding is?

A. Disruption of anoderm in the posterior midline.

B. Protrusion of an internal hemorrhoid

C. Fistula in ano

D. Perirectal abscess

E. Anal condyloma

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