Question # 124 A 52-year-old woman comes to the emergency department for rectal pain that started 2 hours ago. The pain is described as severe, burning, and exacerbated while sitting. Medical history...

Extracted text: Question # 124 A 52-year-old woman comes to the emergency department for rectal pain that started 2 hours ago. The pain is described as severe, burning, and exacerbated while sitting. Medical history is significant for chronic idiopathic constipation, for which she takes a fiber supplement. The patient has 4 children, all of whom were vaginally delivered. Family history is unremarkable. She does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 (99 F), blood pressure is 138/84 mm Hg, and pulse is 90/min. On physical examination, the patient appears in moderate distress due to pain. The abdomen is soft, nondistended, and nontender. Bowel sounds are normoactive. Anal examination reveals a small, exquisitely tender, bluish lesion at the anal verge. Which of the following is the most likely diagnosis? A Condyloma acuminata B Crohn disease Perianal abscess Prolapsed internal hemorrhoid E Rectal prolapse F Thrombosed external hemorrhoid