cirus
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37 old pt with her 56yrs father just had a sigmoidoscopy that found a Single POLYP that was found to benign, no family history of colon cancer, what is the screening recommendation?
1. Start Fecal occult blood annually at 40 years
2. Colonscopy at 40 years & every 10 years
Kaplan simulated exam qs....
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| dr.wad
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colonscopy every 3_5 years
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| Justice
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I am confused: who had the colonoscopy - father or daughter?
To Dr.wad: your reply isn't from the given options...
I would go with 2. Colonscopy at 40 years & every 10 years
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| cirus
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Well that was my ans, but according to Kap sim, its Fecal occult blood...
Looking then on the version, i found it to be 1999, so i guess thats the problem,but then came another strange qs, although its psychiatry ill post it here for ur opinion..
Pts father died 4 ms ago, he is diagnosed with Major depression, whats the next step in the managment?
1. Antidepressant
2. Support from family & friends.
thnx Justice
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| dr.wad
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justice......my answer is from NMS.
also i checked CURRENT which says ( for patients with adenomatous polyps who had low risk feature on initial colonoscopy and polypectomy ( i.e one or two polyps less than 10 mm in size without villous features or high risk grade dysplasia ) or for higher risk patients whose follow up surveillance colonoscopy is negative for further polyps after 3 years , repeat colonoscopy to check for metachronous adenomas should be done in 5 years. ( CURRENT 2005 p 616 )
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| cirus
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dr.wad wrote:
justice......my answer is from NMS.
also i checked CURRENT which says ( for patients with adenomatous polyps who had low risk feature on initial colonoscopy and polypectomy ( i.e one or two polyps less than 10 mm in size without villous features or high risk grade dysplasia ) or for higher risk patients whose follow up surveillance colonoscopy is negative for further polyps after 3 years , repeat colonoscopy to check for metachronous adenomas should be done in 5 years. ( CURRENT 2005 p 616 )
the qs is about the daughter, not the father, & since the father only had one polyp, which was found to be benign, I don't think this is adenomatous polyposis which would then be a hereditory disease putting the daughter as a high risk..
the stem of my Q is, which is preffered, Colonoscopy every 10 years or annual fecal occult blood?
from what i know is that both r recommended together, but colonoscopy is much more specific & sensetive, so if u have to choose between them, which one would u go for
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| dr.wad
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sorry  . i thought the q talking about the father.
my comment is what to do for postpolypectomy surveillance ( i.e for the patient himself).
for the daughter i will do colonoscpy every 10 years.
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| gr8doc
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Screning test for a person who is not categorised as the high risk, as in this particular case would be Stool for Occult blood. If the father's polyp would have turned out to be a malignancy, in that case the answer would be Colonoscopy.
I hope this helps.
& What's the answer to the second one? Start anti depressants?
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| cirus
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Thats the funny part---> Support from family & friends
since when does a pt already diagnosed with MAJOR DEPRESSION gets treatment with SUPPORT, even if grief was the initial cause?????
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| gr8doc
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Thats' really funny....
Is this again a Kaplan Product?
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| cirus
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No the next one even more, i just wish i could copy these qs for u to see them..
15 yr old pt with a holosystolic murmur at the apex, the murmur SOFTENS with valsalva, what is the most likely diagnosis?
1. Hypertrophic obstructive cardiomyopathy.
2. VSD
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| gr8doc
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VSD. in valsalva there is decreased blood to the LV so there is decreased blood going thru the VSD, so murmur has to soften or decrease.
Don't tell me the answer is HOCM.
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| cirus
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Well the answer is HOCM
those 3 qs where in one block (4) kaplan simulated exam..At this point i decided not to continue solving it
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| gr8doc
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Oops !!! That's a little shocking !!!! 
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| cirus
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elitoki wrote:I'm little confuse~ with the Qs and comments~ 1. the daugther who is low risk of colon cancer because father has benig polyps, should follow the same recomendation of colon cancer screening. And that is after 40 yr annual fecal occult blood, then after 50 yr can begin with colonoscopy each 10 yr. So, the answer(Start Fecal occult blood annually at 40 years) was correct. 2. pt who has the mayor depression as basic diagnosis had suffered grief status due to death of his/her father 4 mo ago. So the pt now is going through his grief period, so "support" will be right answer. 3. heart murmur usually increase with increasing blood return to the hearth except HOCM. HOCM= less blood, more murmur. AS, MS= more blood, more murmur. ??? What was wrong with the Qs? All seems ok to me. pls tell me if I'm wrong.... Thanks.
for the 2nd qs--> the pt was diagnosed with Maj Dep after his fathers death by 4 ms, its not greif, its depression,so ttt can't be just support
3rd qs-->Valsalva(increase in intrathoracic pr) decreases preload, so can't be HOCM as the murmur is softer, it should be higher to be HOCM.
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| elitoki
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3rd qs-->Valsalva(increase in intrathoracic pr) decreases preload, so can't be HOCM as the murmur is softer, it should be higher to be HOCM.
U r right !
I don't know what I was thinking.
Valsalva cause less blood to the chamber and increase murmur.
... less blood more murmur. I got it~
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| doyoudig
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I think the deal w/ MDD is that both will have to be implemented (Rx and Support) but if u have to choose btw then in termes of what is easiest, less expensive
I also also would have choosen Support, even though Pt will need Medical Rxment
As to Kaplna Simulated, its so Old and Outdated, don't bother with it...
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| gr8doc
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doyoudig wrote:
I think the deal w/ MDD is that both will have to be implemented (Rx and Support) but if u have to choose btw then in termes of what is easiest, less expensive
I also also would have choosen Support, even though Pt will need Medical Rxment
As to Kaplna Simulated, its so Old and Outdated, don't bother with it...
That means everytime there is a case of MDD with one of the treatment options as support, you would choose it? I don't think that's the right answer.
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| doyoudig
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ok, are u going to give him drugs 1st or are u going to establish his support system/suicide risks 1st, that's all I am saying
pls gudie me to a site for the initial steps of Mx
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| cirus
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Come on guys, we've been over this q for many times, if a pt was in greif for way to long (>2ms) & developed sympts of M Dep, the first thing to do is give antidep (ofcourse after excluding hypothyroidism if its in the ans, esp if the pt gained weight in that period), u can also suggest family support beside the meds as for one reason u can not relly on his family supporting him, & another is that u need to ttt his symp.
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