WBR0918

Author	Vendhan Ramanujam
Exam Type	USMLE Step 3
Main Category	Primary Care Office, Inpatient Facilities
Sub Category	Gastrointestinal, 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	Repeat colonoscopy after 1 year
Answer A Explanation	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	Repeat colonoscopy after 3 years
Answer B Explanation	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	Repeat colonoscopy after 5 years
Answer C Explanation	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	Repeat colonoscopy after 10 years
Answer D Explanation	Incorrect-Hyperplastic polyps should be followed up with a repeat colonoscopy after 10 years.
Answer E	Repeat colonoscopy after 15 years
Answer E Explanation	Incorrect-Repeat colonoscopy after 15 years is not the correct approach to any of above scenario.
Right Answer	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 Educational Objective: References: ]]
Approved	Yes
Keyword	Colonic polyp, Adenomatous polyp, Villous polyp, Tubular polyp, Hyperplastic polyp
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