USMLE® Step 1 style questions USMLE
A 36-year-old man comes to the outpatient clinic because of perianal pain. The pain has persisted for five weeks and is unbearable during defecation. The perianal pain is associated with dull throbbing pain and hematochezia. On examination, his temperature is 37°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 125/78 mm Hg. He denies any difficulty urinating or previous episodes similar to what he is experiencing now. Physical examination shows a superficial tear along the posterior midline of the anus. Which of the following is the most likely diagnosis?