PAEA Surgery End Of Rotation (EOR) Practice Exam

What is the characteristic of a Grade IV hemorrhoid?

1. Prolapse upon defecation but spontaneously reduces

2. No prolapse, bulge in anal canal lumen

3. Prolapsed and cannot be manually reduced

4. All the time reducible

The correct answer is: Prolapsed and cannot be manually reduced

A Grade IV hemorrhoid is distinguished by its inability to be manually reduced. This type of hemorrhoid is characterized by a constant prolapse; it remains outside the anal canal and cannot be pushed back in, which often leads to complications such as thrombosis or strangulation. The other classifications of hemorrhoids denote different levels of severity. For instance, a Grade I hemorrhoid does not prolapse but is present within the anal canal, while a Grade II involves prolapse during defecation that spontaneously reduces after. A Grade III hemorrhoid, while it does prolapse during defecation, can still be manually reduced. In summary, a Grade IV hemorrhoid is significant because it represents a more severe condition where the prolapsed tissue does not revert to its normal position, emphasizing the need for possible surgical intervention or other treatment to manage symptoms and complications.