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NBME Form 16 Practice Test

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A 28-year-old woman presents with a red perianal area, itching, pain during defecation, constipation, and bright red blood on wiping. Most likely diagnosis?
Correct Answer:
External hemorrhoids
Explanation:
External hemorrhoids arise from dilation of the veins around the anus, producing a visible red, itchy perianal area that can be painful with defecation. Straining from constipation increases venous pressure and promotes these dilated veins, so bleeding often appears as bright red on wiping. Internal hemorrhoids, while they can bleed, are typically painless because they are above the dentate line and lack somatic pain fibers. Anal fissures cause sharp pain during stool passage and usually present with a tear in the anoderm and blood on the stool rather than a tender, visible perianal lump. A perianal abscess would present with a tender, swollen area and often fever. Therefore, the presentation most closely matches external hemorrhoids.

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