WBR0824

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Gastrointestinal, SubCategory::Gastrointestinal, SubCategory::Preventive Medicine
Prompt	[[Prompt::A 52 year old woman has come to her primary care physician’s office for a routine annual examination. She has no complaints. She has no known family history of breast or cervical or colorectal cancer. She is a non-smoker. She drinks a glass of wine once in a month for the past 15 years and does not use illicit drugs. Her vital signs are heart rate 82 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 37.2 C. On physical examination she looks well nourished. A routine pelvic examination with Pap test and a mammography were done. As a part of the routine preventive care, the physician advices her regarding screening for colorectal cancer. Which will be the most effective method of screening for colorectal cancer in this patient?]]
Answer A	AnswerA::Colonoscopy every 10 years
Answer A Explanation	AnswerAExp::'''Correct'''-This patient has no family history of colorectal cancer and so routine screening for colorectal cancer should begin at the age of 50 years with repeat colonoscopy every 10 years.
Answer B	AnswerB::Flexible sigmoidoscopy every 3 to 5 years
Answer B Explanation	[[AnswerBExp::Incorrect-Since 40% of colon cancer occurs proximal to the rectum and sigmoid colon, flexible sigmoidoscopy is not nearly as sensitive in detecting lesions as colonoscopy.]]
Answer C	AnswerC::Fecal occult blood testing (FOBT) every year
Answer C Explanation	[[AnswerCExp::Incorrect-FOBT has more false positive and false negative results when compared to colonoscopy.]]
Answer D	AnswerD::Virtual colonoscopy with CT scanning
Answer D Explanation	[[AnswerDExp::Incorrect-Virtual colonoscopy lacks both sensitivity and specificity. It misses small lesions and does not allow for biopsies to be taken.]]
Answer E	AnswerE::Rectal examination every year
Answer E Explanation	AnswerEExp::'''Incorrect'''-Digital rectal examination is not a good test for detecting colorectal cancer because its reach is limited.
Right Answer	RightAnswer::A
Explanation	[[Explanation::In a patient with no family history of colorectal cancer, routine screening for colorectal cancer should begin at the age of 50 years with colonoscopy and it should be repeated every 10 years. Colonoscopy is the most accurate test for screening colorectal cancer because of its high sensitivity when compared to other screening tests. Educational Objective: In patients with no family history of colorectal cancer, routine screening for colorectal cancer should begin at the age of 50 years with colonoscopy and should be repeated once in every 10 years. Colonoscopy should never be attempted when FOBT is positive. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Colorectal cancer, WBRKeyword::Colonoscopy
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