Perianal abscess and fistula Quiz: Ace Your Exams
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A 54-year-old man presents to the office with a severely painful anal mass that he noticed 3 days ago. He has anal pain that is constant and is made worse with defecation. He has a history of hypertension, for which he takes hydrochlorothiazide. He smokes ½ pack of cigarettes daily and drinks 6 beers on the weekends. Temperature is 38.4 °C (100.4 °F), pulse is 95/min, blood pressure is 155/92 mmHg, and respirations are 16/min. He is lying on his side and appears uncomfortable. Cardiopulmonary examination is normal. Abdominal examination is normal. Anal examination reveals a focal area of fluctuance with erythema and induration overlying the perianal skin. Which of the following additional physical examination findings would support the most likely diagnosis?
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