Anal fissure Quiz: Ace Your Exams

A 26-year-old man presents to a primary care clinic with a 3-week history of severe peri-rectal pain with defecation. He reports a “small bump" by his anus that is tender to touch. The patient has had bright red blood on the toilet paper after wiping. He has not had abdominal pain, diarrhea, or weight loss. He has no significant past medical history, takes no medications, and denies tobacco or alcohol use. The patient is sexually active with multiple partners and uses condoms inconsistently. Vitals are within normal limits. Physical examination demonstrates the findings seen below. Which of the following is the most likely diagnosis?
 
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