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colonoscopy

Practice targeted AMC-style multiple-choice questions on colonoscopy.

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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

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.
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 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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Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Following successful management of this acute episode, what is the most appropriate next step regarding long-term assessment of the colon?

A. Repeat CT scan in 3 months to assess resolution.
B. Refer for surgical consultation for elective colectomy.
C. Schedule a colonoscopy within 6-8 weeks.
D. Perform a barium enema to assess the extent of diverticular disease.
E. Advise a high-fibre diet and no further investigation unless symptoms recur.
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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 70-year-old man presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unexplained fatigue. His GP notes mild pallor. Full blood count reveals a haemoglobin of 105 g/L and low ferritin. A colonoscopy is performed, and the image provided is a representative view of a finding in the sigmoid colon. Biopsies were taken. Considering the clinical context and the endoscopic appearance, which of the following is the most appropriate next step in the management pathway to determine the extent of disease?

A. Referral for immediate surgical resection
B. Repeat colonoscopy in 6 months to assess response to medical therapy
C. CT scan of chest, abdomen, and pelvis for staging
D. PET scan for metabolic activity assessment
E. Commencement of iron supplementation and review in 4 weeks
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 58-year-old male presents with fatigue and microcytic anemia. He denies overt bleeding but reports occasional dark stools. Colonoscopy reveals the image shown. Biopsies confirm adenocarcinoma. What is the MOST appropriate next investigation to stage the cancer?

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

A 58-year-old male presents with iron deficiency anemia and a change in bowel habits. A colonoscopy was performed, and the image is shown. Biopsies were taken. Assuming the biopsies confirm malignancy, what is the next step?

A. Repeat colonoscopy in 6 months
B. Referral to a gastroenterologist for endoscopic mucosal resection
C. Fecal immunochemical test (FIT)
D. Initiate chemotherapy
E. CT scan of the 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 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

A 72-year-old patient presents with a 4-month history of tenesmus and occasional bright red rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies confirm adenocarcinoma. Considering the likely stage suggested by the endoscopic appearance, which investigation is MOST crucial for pre-operative staging?

A. PET scan
B. Endorectal ultrasound
C. Repeat colonoscopy to assess proximal colon
D. CT scan of the chest, abdomen, and pelvis
E. Bone scan
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Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical presentation and the findings on the provided image, which of the following investigations is most appropriate to recommend for this patient *after* resolution of the acute episode?

A. Colonoscopy in 6-8 weeks
B. Repeat CT scan of the abdomen and pelvis
C. Urgent colonoscopy within 48 hours
D. Faecal occult blood test
E. Barium enema
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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 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy reveals the lesion shown. Biopsy confirms adenocarcinoma. What is the MOST appropriate next investigation to determine disease stage?

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

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy findings are shown. What is the MOST appropriate next step in management?

A. Start empiric antibiotics
B. Administer corticosteroids
C. Initiate iron supplementation
D. Repeat colonoscopy in 1 year
E. Surgical resection
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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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Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical context and the findings demonstrated in the provided image, what is the most appropriate recommendation regarding subsequent investigation of the colon following resolution of the acute symptoms?

A. Barium enema within 3 months.
B. Flexible sigmoidoscopy within 1 week.
C. Urgent colonoscopy within 24 hours.
D. No further colonic investigation is necessary.
E. Colonoscopy within 6-8 weeks.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 58-year-old male presents with fatigue and iron deficiency anemia. Colonoscopy reveals the image shown. Biopsies are taken. Assuming pathology confirms malignancy, what is the MOST appropriate next investigation to determine disease stage?

A. CT scan of the abdomen and pelvis
B. PET-CT scan
C. Endoscopic ultrasound
D. MRI of the abdomen and pelvis
E. Carcinoembryonic antigen (CEA) level
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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 with a 4-month history of increasing constipation and occasional streaks of blood on stool. He denies significant weight loss. Physical exam is unremarkable. A colonoscopy was performed, and the image is shown. Biopsies are taken from the lesion. Assuming the biopsy confirms adenocarcinoma, what is the MOST appropriate initial investigation to guide further management?

A. Referral for neoadjuvant chemotherapy
B. CT scan of chest, abdomen, and pelvis
C. Repeat colonoscopy in 3 months
D. PET scan for distant metastases
E. Endoscopic ultrasound for local staging
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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 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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