GOGETA
I'm Dr. GOGETA
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A 35 y/o woman requests a routine health assessment. She has no specific medical complaints or past medical hstory. Her father developed colon cancer at age 54 but is still living. His brother died of colon cancer at aae 41. Their father (the patient's grandfather) died in his sixties of colon cancer. His sister died of gastric cancer. The patent's sister was recently diagnosed with endometrial cancer at age 43.
The patient has a good appetite and has no nausea, vomiting, or weight loss. She has had no change in her bowel habits or hematochezia, and her menstrual periods are normal. Physical examination is normal. Digital rectal examination is negative for fecal occult blood. A screening complete blood count and biochemical profile are normal.
Which of the following actions is most appropriate?
a. Perform annual occult blood tests of three stool specimens. Initiate screening with flexible sigmoidoscopy at age 50.
b. Perform colonoscopy at least every 2 years.
c. Barium enema now; if normal no further evaluation.
d. Perform colonoscopy now; if no polyps are seen, no further investigation is necessary.
e. Perform fecal occult blood testing and flexible sigmoidoscopy now. If no polyps are seen now, the patient should be followed routinely with fecal occult blood testing and flexible sigmoidoscopy beginning at age 50.
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| Vietnamese
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d-
Screening 10 years earlier for their 1st-relative with colon cancer, 41-10=31. She is 35 years old.
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| paheli
It'sAllAboutGoodKarma
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Yes, D.
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| guangyu
Forum Elite
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B
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| goldencreeper
Forum Newbie
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i think, this person requires early investigation with family history, but a follow up every 10 yrs with colonoscopy is also essential.........
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| paheli
It'sAllAboutGoodKarma
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Wow, I did not read the second part at all! I should shoot myself now!
It's BBBBBBBB.
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows.
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| GOGETA
I'm Dr. GOGETA
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Answer is b.
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As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
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| peter90036
Forum Elite
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wait waht?
my notes iz:
Family history of CC in < 60 years of age.
Colonoscopy every 5 years. Starting age 40, or 10 yrs before family member was dx.
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| hero
Forum Guru
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none of the above 
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| freud
Forum Newbie
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the answer is colonoscopy now and every 2 yrs considering his strong family history.
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| peter90036
Forum Elite
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make me look it up again...
this question is one of those written by an ass.
the (USA)(as i check them now in 2008, but their origins are older) guidelines state:
Consortium of gastroenterology societies:<60 years, or two first-degree relatives diagnosed at any age should be advised to have screening colonoscopy starting at age 40 years, or 10 years younger than the earliest diagnosis in their family, whichever comes first, and repeated every 5 years.
US Preventive Services Task Force: first-degree relative diagnosed with colorectal cancer before 60 years of age, and suggest that initiating screening before 50 years of age is reasonable, but do not specify a particular age or screening modality.
American College of Gastroenterology: use colonoscopy, If the first-degree relative was diagnosed before 60 years or multiple first-degree relatives have had colorectal cancer, begin screening at age 40 or 10 years before the youngest relative's diagnosis and repeat every three to five years.
American Society of Colon and Rectal Surgeons: colonoscopy, first-degree relative with onset age <55 years, or in two first degree relatives, begin at age 40 or 10 years earlier than the age of the relative when the cancer was diagnosed and repeat every five years.
as you see 3/4 have repeat at >= 3 years which = NOT <3 years.... so unless the question creator can bring up some other guidelines (which are not included in uptodate-a publication that covers many many sources).
so the answer repeat every 2 is correct only because its the only one available BY EXCLUSION. ...
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