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A 52 y/o male, (+) fecal occult blood test, What is the next step


A 52 y/o male, (+) fecal occult blood test, What is the next step


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بلشنا:

CASE #1
A 52 year old man comes for a routine physical examinatioin. He feels well, has no significant medical history, takes no medications , and has no family history of colorectal cancer. Physcial examination and complete blood count are normal. He returns three fecal occult blood test cards ( six windows), and one window tests positive for occult.
Which of the following should be done next?
A) Colonoscopy
B) Flexible sigmoidoscopy
C) Barium enema examination
D) Digital rectal examination
E) Repeat fecal occult blood test

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Hot sauce's picture
by
طبيب مقيم


this is really confusing
but I would go for A
any +ve FOBT should be followed with a clonoscopy

however u may try a B+C coambination (flex sig +BE)

anyway u better tell me the source of the q cuz the answer will vary depending on ur source

Dr_Ayyad
بعد التخرج


I'll go for A
he is 52 and he should have cancer screening anyway

dado's picture
dado
بعد التخرج


if he had a digital rectal exam then the answer should be a, but if he didn't have it before, then the answer should be d.

anyway if i have such question in an examination i will go for a.

dr.tabban's picture
dr.tabban

Quote:
his is really confusing
but I would go for A
any +ve FOBT should be followed with a clonoscopy

A

Quote:
however u may try a B+C coambination (flex sig +B

I think this is recommended for screening isn't it ?

DAM's picture
DAM


A
نظرا" لعمر المريض Rolling Eyes بظن وممكن نعيد التحليل كمان
يعني بمشي مع A+D

drhanadi's picture
drhanadi
طبيب مقيم


Dr Ayyad you are right

any +ve FOBT should be followed with a colonoscopy

This is a golden GI rule. Simply because FOBT is a test ment for screening for colon cancer. And anything short of full colonic examination would not be enough to rule out colonic neoplasia. BE is not as sensitive and if it showes anything then you still have to do colonoscopy to take biopsies. So this test does not negate the need for colonoscopy beside it is really painful compared to colonscopy since no sedation is given with the test.

To show you how the role of barium enema is fading away I don't remember how many years ago I last ordered this test.

ABIM's picture
ABIM

Quote:
A 52 year old man comes for a routine physical examinatioin. He feels well, has no significant medical history, takes no medications , and has no family history of colorectal cancer. Physcial examination and complete blood count are normal. He returns three fecal occult blood test cards ( six windows), and one window tests positive for occult.
Which of the following should be done next?
A) Colonoscopy
B) Flexible sigmoidoscopy
C) Barium enema examination
D) Digital rectal examination
E) Repeat fecal occult blood test

The right answer is A
Colonoscopy is the most appropriate test for pts with a positive fecal occult blood test. Annual fecal occult blood testing, followed by colonoscopy if the test is positive, reduces colorectal cancer mortality by as much as 33%. Colonoscopy can detect sublte mucosal abnormalities such as telangiectasias, areas of inflammation or ulceration, and neoplasms. In addition, most polyps and some early-stage cancers can be removed during the procedure.
Flexible sigmoidoscopy evaluates only the distal colon and rectum. A barium enema examination misses approximately 50% of small polyps that can be seen on colonoscopy and is therefore not recommended unless the pt is unable to undergo colonscopy> Digital rectal examination detects very few colorectal neoplasms. Becasue even one psoitve window on a fecal occult blood test constitutes a positive study, there is no reason to repeat this test.

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Hot sauce's picture
Hot sauce
طبيب مقيم

What if he is a young man with a + FOBT?I think the next step will be UGI endoscopy,wont it?

and I want to ask a question Dr.ABIM:
if a pt present with UGI bleeding and he is in shock(BP 80\50) what is the first thing to do? IV fluid replacment or control the bleeding?

dado's picture
dado
بعد التخرج

What if he is a young man with a + FOBT?I think the next step will be UGI endoscopy,wont it?

and I want to ask a question Dr.ABIM:
if a pt present with UGI bleeding and he is in shock(BP 80\50) what is the first thing to do? IV fluid replacment or control the bleeding?

dado's picture
dado
بعد التخرج
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