Answer and Explanation 20

20.   The correct answer is D.  This is an thrombosed external hemorrhoid.  The patients pain will be dramatically with an incision and drainage of this lesion.  Anusol cream would help the inflammation but not the pain very much.  Bactrim and Keflex would be helpful if this was a peri-rectal abscess.  Referral for a biopsy would appropriate if malignancy was suspected or if you were uncertain about the etiology of the lesion.