Which physical exam finding is most consistent with a patient presenting symptoms of dysuria, fever, and rectal pain?

The presence of an extremely tender prostate in a patient with dysuria, fever, and rectal pain is highly indicative of acute prostatitis, which is an inflammation of the prostate gland often caused by a bacterial infection. Symptoms such as dysuria (painful urination), fever, and rectal pain suggest an active infection or inflammation in the lower urinary tract and/or prostate.

In acute prostatitis, the prostate tends to be markedly tender upon examination, which reflects the acute inflammatory process occurring in the gland. The tenderness can result in significant discomfort when pressure is applied, and it is also accompanied by systemic symptoms like fever. This clinical presentation differentiates acute prostatitis from other conditions, such as chronic prostatitis or benign prostatic hyperplasia, where tenderness may not be a significant finding.

Other options do not match the expected signs associated with this clinical picture. For example, a normal prostate examination would not align with the symptoms of acute infection. Similarly, a firm, non-tender prostate or a non-tender abdomen does not suggest the acute inflammation typically seen in prostatitis, nor does it explain the acute onset of fever and rectal pain effectively.