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altered bowel habits

Practice targeted AMC-style multiple-choice questions on altered bowel habits.

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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 58-year-old male presents with iron deficiency anemia and a change in bowel habits. Colonoscopy findings are shown. What is the MOST appropriate next step?

A. Fecal occult blood test
B. Administer IV antibiotics
C. Start iron supplementation and repeat colonoscopy in 3 months
D. Surgical resection
E. High-fiber diet and stool softeners
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 62-year-old male presents with a three-month history of intermittent rectal bleeding and altered bowel habits. His past medical history is unremarkable. A colonoscopy was performed, and a still image is shown. What is the MOST appropriate next step in management?

A. Recommend a high-fiber diet and monitor symptoms
B. Administer high-dose corticosteroids
C. Prescribe a course of broad-spectrum antibiotics
D. Surgical resection
E. Initiate iron supplementation and repeat colonoscopy in 6 months
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with a three-month history of intermittent rectal bleeding and altered bowel habits. His past medical history is unremarkable. A colonoscopy was performed, and an image from the procedure is shown. What is the MOST appropriate next step in management?

A. Surgical resection
B. Administer intravenous antibiotics
C. Initiate a course of high-dose corticosteroids
D. Repeat colonoscopy in 1 year
E. Prescribe a high-fiber diet and monitor symptoms
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old male presents to his general practitioner with a 3-month history of progressively worsening constipation alternating with episodes of loose stools, associated with occasional bright red blood per rectum and an unintentional weight loss of 4 kilograms over the same period. He denies any significant past medical history or family history of bowel disease. His vital signs are stable, and physical examination, including abdominal palpation and digital rectal examination, is unremarkable. Routine blood investigations reveal a haemoglobin of 105 g/L with a mean corpuscular volume of 78 fL, and normal inflammatory markers. Given the clinical presentation, a colonoscopy is performed. The image provided is a representative view obtained during this procedure. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A. Refer for urgent surgical resection without further investigation.
B. Obtain biopsies from the lesion and arrange for CT staging of the chest, abdomen, and pelvis.
C. Initiate a course of broad-spectrum antibiotics for presumed infectious colitis.
D. Schedule a repeat colonoscopy in 6 months to monitor the lesion's progression.
E. Prescribe a high-fibre diet and laxatives to manage the constipation.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

Mr. Arthur Jenkins, a 72-year-old retired accountant, presents to his GP complaining of a change in bowel habit over the past 4 months, now experiencing increased frequency and occasional loose stools mixed with some mucus. He also reports intermittent small amounts of bright red blood on the toilet paper, which he initially attributed to haemorrhoids. He denies significant weight loss or abdominal pain. His past medical history includes hypertension well-controlled on medication and osteoarthritis. On examination, his abdomen is soft and non-tender, and digital rectal examination is unremarkable. Routine blood tests, including FBE and LFTs, are within normal limits. A faecal occult blood test is positive. Given these findings, a colonoscopy is arranged. The image provided was captured during the procedure. Considering the patient's presentation and the findings observed during the colonoscopy as depicted in the image, what is the most appropriate immediate next step in the management plan?

A. Attempt endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of the lesion.
B. Advise the patient on dietary modifications to increase fibre intake and schedule a follow-up appointment in 3 months.
C. Prescribe a course of antibiotics for presumed infectious colitis and repeat colonoscopy in 6 weeks.
D. Refer the patient directly for urgent surgical consultation for a potential sigmoid colectomy.
E. Obtain multiple biopsies from the lesion for histological examination and arrange for CT staging of the chest, abdomen, and pelvis.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a representative image is shown. What is the MOST appropriate next step in management?

A. Prescribe topical corticosteroids
B. Schedule a repeat colonoscopy in 1 year
C. Order a barium enema
D. Initiate a course of broad-spectrum antibiotics
E. Biopsy of the lesion
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a representative image is shown. What is the MOST appropriate next step in management?

A. Surgical resection
B. Initiate high-dose corticosteroids
C. Repeat colonoscopy in 1 year
D. Prescribe a high-fiber diet
E. Administer intravenous antibiotics
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 68-year-old male presents to his GP complaining of a change in bowel habit over the past 6 months. He reports increasing constipation alternating with episodes of diarrhea. He also mentions unintentional weight loss of approximately 5 kg during this period. He denies any family history of bowel cancer. A colonoscopy was performed, and a representative image is shown. Assuming the lesion is confirmed as malignant, what is the MOST appropriate next step in the management of this patient?

A. Referral for palliative care
B. Repeat colonoscopy in 3 years
C. CT scan of the chest, abdomen, and pelvis
D. Initiate adjuvant chemotherapy with FOLFOX
E. Administer a course of broad-spectrum antibiotics
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with a three-month history of intermittent rectal bleeding and a change in bowel habits. He reports increased constipation alternating with episodes of diarrhea. His family history is significant for a father who had colon cancer at age 70. A colonoscopy was performed, and an image from the procedure is shown. What is the MOST appropriate next step in management?

A. Order a CT scan of the abdomen and pelvis
B. Administer stool softeners and schedule a follow-up appointment in 6 months
C. Biopsy the lesion
D. Initiate a high-fiber diet and repeat colonoscopy in 5 years
E. Prescribe anti-inflammatory medication
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with rectal bleeding and altered bowel habits. Colonoscopy findings are shown. What is the MOST appropriate next step?

A. Repeat colonoscopy in 1 year
B. Prescribe high-fiber diet
C. Surgical resection
D. Initiate chemotherapy
E. Administer antibiotics
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old presents with recent onset tenesmus and passage of mucus. He has lost 4kg over 2 months. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but the appearance is highly suspicious for malignancy. What is the MOST appropriate initial investigation to assess for metastatic disease?

A. PET scan
B. Tumour markers (e.g., CEA)
C. MRI of the pelvis
D. Endoscopic ultrasound
E. CT scan of chest, abdomen, and pelvis
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a concerning lesion was identified. What is the MOST appropriate next step in management?

A. Initiate a course of broad-spectrum antibiotics
B. Order a barium enema
C. Biopsy of the lesion
D. Prescribe topical corticosteroids
E. Schedule a repeat colonoscopy in 1 year
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 68-year-old man presents with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and fatigue. He denies significant weight loss. Physical examination is unremarkable. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy was performed, and the image provided is a representative view. Biopsies were taken from the observed lesion. Considering the clinical presentation and the endoscopic finding, what is the most appropriate next investigation to determine the extent of disease and inform definitive management planning?

A. PET scan
B. CT scan of chest, abdomen, and pelvis
C. Bone scan
D. Endoscopic ultrasound
E. MRI of the pelvis
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 68-year-old man presents to his GP with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and a feeling of incomplete evacuation. He reports fatigue but denies significant weight loss. His physical examination, including digital rectal examination, is normal. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy is performed, and the image provided is a representative view from the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, what is the most appropriate immediate next step in the management of this patient?

A. Obtain biopsies from the lesion for histological assessment and arrange for staging investigations.
B. Schedule a repeat colonoscopy in 6 months to assess for changes in the appearance of the lesion.
C. Prescribe a course of oral corticosteroids for presumed inflammatory bowel disease.
D. Recommend dietary modification and bulk-forming laxatives to manage the change in bowel habit.
E. Refer the patient directly for urgent surgical consultation and resection planning.
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