PAEA Surgery End Of Rotation (EOR) Practice Exam

What is the classification for a hemorrhoid that does not prolapse and only causes a bulge in the anal canal lumen?

1. Grade II

2. Grade III

3. Grade IV

4. Grade I

The correct answer is: Grade I

A hemorrhoid that does not prolapse and only causes a bulge in the anal canal lumen is classified as Grade I. In this grading system, Grade I hemorrhoids are characterized by internal hemorrhoids that are not visible outside the anal opening. They can cause symptoms such as bleeding or discomfort but do not protrude outside of the anal canal, which is a defining feature of more advanced grades. As the grading scale progresses, the distinctions become clearer. Grade II hemorrhoids do prolapse with straining but reduce spontaneously. Grade III hemorrhoids protrude during straining and need to be manually reduced. Grade IV hemorrhoids are permanently prolapsed and cannot be reduced back into the anal canal, requiring more invasive treatment approaches. This classification illustrates the severity and treatment needs, highlighting why only a bulge within the anal canal is indicative of a Grade I hemorrhoid.