WBR0918

Author

PageAuthor::Vendhan Ramanujam

Exam Type

ExamType::USMLE Step 3

Main Category

MainCategory::Primary Care Office, MainCategory::Inpatient Facilities

Sub Category

SubCategory::Gastrointestinal, SubCategory::Surgery

Prompt

[[Prompt::A 48 year old Caucasian male presented to his primary care physician with the complaint of an episode of passing blood along with his stool. He had no prior history of a similar illness or a colonoscopy. He had no family history of colon cancer. He denied smoking and taking alcohol. His vital signs were heart rate 92 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 37.2 C. Physical examination was unremarkable. Laboratory examination showed a normal complete blood count and a normal metabolic panel. The patient was referred for a colonoscopy, which revealed a solitary polyp as shown below

It was removed by snare electrocoagulation and a histopathological examination revealed a non-infiltrating adenocarcinoma. The further line of management in this patient will be]]

Answer A

AnswerA::Repeat colonoscopy after 1 year

Answer A Explanation

AnswerAExp::'''Correct'''-Polyps with non-infiltrating carcinoma should be followed up with a repeat colonoscopy after 1 year because of the increased risk of relapse.

Answer B

AnswerB::Repeat colonoscopy after 3 years

Answer B Explanation

[[AnswerBExp::Incorrect-Adenomatous polyps >1 cm in size or multiple (>2) polyps in number or villous type or with a high grade dysplasia should be followed up with a repeat colonoscopy after 3 years. If it is negative, another repeat colonoscopy should follow after 5 years.]]

Answer C

AnswerC::Repeat colonoscopy after 5 years

Answer C Explanation

[[AnswerCExp::Incorrect-Adenomatous polyp <1 cm in size or ≤2 polyps in number or tubular type or without a high grade dysplasia carriers a low risk of neoplastic conversion and it should be followed up with a repeat colonoscopy after 5 years.]]

Answer D

AnswerD::Repeat colonoscopy after 10 years

Answer D Explanation

AnswerDExp::'''Incorrect'''-Hyperplastic polyps should be followed up with a repeat colonoscopy after 10 years.

Answer E

AnswerE::Repeat colonoscopy after 15 years

Answer E Explanation

AnswerEExp::'''Incorrect'''-Repeat colonoscopy after 15 years is not the correct approach to any of above scenario.

Right Answer

RightAnswer::A

Explanation

[[Explanation::Polyps with non-infiltrating carcinoma should be followed up with a repeat colonoscopy after 1 year to look for a relapse.

Educational Objective: Colonoscopic surveillance of colonic polyps is as follows

Type of polyp	Repeat colonoscopy
Polyp with non infiltrating carcinoma	After 1 year
Adenomatous polyps >1 cm in size or multiple (>2) polyps in number or villous type or with a high grade dysplasia	After 3 years, if negative follow up again after 5 years
Adenomatous polyp <1 cm in size or ≤2 polyps in number or tubular type or without a high grade dysplasia	After 5 years
Hyperplastic polyps	After 10 years