NBME Step 2 CK Form 7 Colonoscopy (NBME Answers)

Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#26 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Colonoscopy 🔍 / 📺 / 🌳 / 📖
tags: GI inc

+5 upvote downvote
submitted by ∗carolebaskin(109)

get full access to all content ⋅ pick a username

Tricky! Yes, fecal occult blood test would pick up hemorrhoid blood and this is a male <50yo, so case closed right?

Wrong! Hematocrit = 35% --> hgb = 35/3 = 11.7 < 13.5 (normal)

Why is he anemic? Do a colonoscopy.

get full access to all content ⋅ pick a username

+2 upvote downvote
submitted by ∗lindasmith462(73)

get full access to all content ⋅ pick a username

workup for minimal BRBPR

50+ -> colonoscopy
40-49 -> sigmoidoscopy
<40 -> no workup for low risk*

colonoscopy for any age if red flags present:

anemia
constitutional sx (fatigue, weight loss, etc)
change in bowel habits (frequency, caliber, constitution of stool)

*Of note (according to uptodate) anoscopy/proctoscopy should be considered part of the physical exam and be performed in office and would therefore technically be the correct answer here. That being said if this was a patient <40 years old w/o red flags anoscopy would be the right answer.

get full access to all content ⋅ pick a username

azibird I was also thinking why not do anoscopy to look for internal hemorrhoids? However, even if they are present, this will not explain the anemia and colonoscopy is still needed. I've started viewing these stupid management questions as "you can only do one of these options" and it's starting to work. As in yes NEXT should be anoscopy but if I can only pick one option I'm picking colonoscopy. Another tricky angle is that it says next step in DIAGNOSIS so technically anoscopy won't ever diagnose his bleeding problem since hemorrhoids aren't the problem. +1

+1 upvote downvote
submitted by ∗seagull(1933)

get full access to all content ⋅ pick a username

My understanding is that occult blood is commonly due to an upper GI bleed. Wouldn't the colon produce gross blood? I'm hopelessly lost in these matters.

get full access to all content ⋅ pick a username

krewfoo99 Yeah I am lost in this one too. Maybe colonoscopy is the right answer to rule out other serious causes of GI Bleeding (Ex: Cancer). +1

happyyoyo So, hemorroidal bleeding would cause blood coating the stool. Bleeding ANYWHERE in the GI tract that eventually makes its way down to the rectum would cause OCCULT bleeding. +1

+0 upvote downvote
submitted by ∗step_prep5(246)

get full access to all content ⋅ pick a username

Key idea: Patients get their first screening colonoscopy at 50 years old, so in this patient with bowel changes (constipation) and anemia (which cannot be fully explained by hemorrhoids), the next best step would be a colonoscopy

https://step-prep.org/tutoring/

get full access to all content ⋅ pick a username

Must-See Comments from step2ck_form7

seagull on Analgesic therapy
athleticmedic on Uterine atony
seagull on Haemophilus influenzae
jlbae on Lorazepam therapy
seagull on Spondylolisthesis
carolebaskin on B lymphocyte
yotsubato on Indomethacin
yotsubato on Uterine atony
study_dude_guy on Bone marrow aspiration
chris07 on Heat stroke
osler_weber_rendu on Compression fracture
buttercup on Repeat blood pressure measurement in 4 weeks
step_prep5 on CT scan of the head
thajoker on Brisk rotatory nystagmus on left lateral gaze