WBR0825

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Gastrointestinal, SubCategory::Preventive Medicine
Prompt	[[Prompt::A 25 year old woman has come to her primary care physician’s office for a routine annual examination. She has no complaints. She has no known family history of breast or cervical cancer. But the physician is made aware of the patient's 40 year old elder sister who recently underwent surgery for colon cancer found as a result of routine colorectal cancer screening and surgeries for colon cancer in her mother and her aunt at the ages of 60 years and 70 years respectively. She is a non-smoker. She drinks a glass of wine once in a month for the past 2 years and does not use illicit drugs. She lives with her boyfriend and has no history of multiple sexual partners. Her vital signs are heart rate 82 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 37.2 C. On physical examination she looks well nourished. A routine pelvic examination with Pap test and a clinical breast examination were done. She is concerned about her family history of colon cancer. Which will be the most effective targeted method of preventive care in this patient?]]
Answer A	AnswerA::Start screening with colonoscopy at the age of 50 years and follow her up every 10 years.
Answer A Explanation	AnswerAExp::'''Incorrect'''-Starting screening with colonoscopy at the age of 50 years and following up every 10 years will be for the general population without any family history of colorectal cancer.
Answer B	AnswerB::Start screening at 40 years or 10 years earlier than the age at which the family member contracted cancer.
Answer B Explanation	AnswerBExp::'''Incorrect'''-Starting screening at 40 years or 10 years earlier than the age at which the family member contracted cancer will be for patients with a single-family member with colon cancer.
Answer C	AnswerC::Colonoscopy every 1 or 2 years starting at the age of 25 years.
Answer C Explanation	AnswerCExp::'''Correct'''-This patient's history is suggestive of Lynch syndrome or Hereditary nonpolyposis colorectal cancer and the targeted preventive care method in them will be colonoscopy every 1 or 2 years starting at the age of 25 years.
Answer D	AnswerD::Sigmoidoscopy every 1 or 2 years and it should have been started at the age of 12 years.
Answer D Explanation	[[AnswerDExp::Incorrect-Sigmoidoscopy every 1 or 2 years, starting at the age of 12 years will be for patients with familial adenomatous polyposis.]]
Answer E	AnswerE::No screening recommendations.
Answer E Explanation	[[AnswerEExp::Incorrect-No screening recommendations will be for Gardner syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome and Turcot syndrome.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Surgeries for colon cancer in three family members from two generations, with one being below 50 years of age (premature) suggest a family history of Lynch syndrome or Hereditary nonpolyposis colorectal cancer. These patients will require colonoscopy every 1 or 2 years starting at the age of 25 years. Educational Objective: Family history of colon cancer in three family members from two generations, with one being below 50 years of age (premature) is suggestive of Lynch syndrome or Hereditary nonpolyposis colorectal cancer. As a targeted preventive care method, these patients will require colonoscopy every 1 or 2 years starting at the age of 25 years. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Lynch syndrome, WBRKeyword::Hereditary nonpolyposis colorectal cancer, WBRKeyword::Colorectal cancer, WBRKeyword::Colonoscopy, WBRKeyword::Familial adenomatous polyposis, WBRKeyword::Gardner syndrome, WBRKeyword::Peutz-Jeghers syndrome, WBRKeyword::Juvenile polyposis syndrome, WBRKeyword::Turcot syndrome
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