WBR0915

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office, MainCategory::Inpatient Facilities
Sub Category	SubCategory::Gastrointestinal, SubCategory::Oncology
Prompt	[[Prompt::A 68 year old Caucasian woman came to ER with complaints of left lower abdominal pain, fever, nausea and vomiting. She denies passing blood in her stool. She was a known hypertensive and hypercholesterolemia patient for the past 20 years who was on regular treatment. She also had the complaint of chronic constipation for the past 7 years. On physical examination, tenderness was elicited over the left lower quadrant without any guarding and rigidity. Vitals were recorded as blood pressure 130/80 mmHg, pulse rate 92/minute, respiratory rate 18/ minute and temperature 38 C. A complete blood count reveled leukocytosis of 18 x 109/L. An abdominal CT revealed a sigmoid diverticulitis. The patient was admitted for an in-patient conservative management like nil oral, intravenous fluids, analgesics and anti emetics along with intravenous ciprofloxacin and metronidazole. The patient’s condition gradually improved in the next couple of days and finally she got discharged with oral antibiotics and relevant counseling regarding drug compliance and dietary advice. Which of the following is recommended during this patient follow up?]]
Answer A	AnswerA::Elective resection of the involved bowel segment
Answer A Explanation	AnswerAExp::'''Incorrect'''-Elective resection of involved bowel after 2 episodes of uncomplicated diverticulitis or after an episode in younger or immunocompromised patients have been recommended, but the recommendation yet remains controversial.
Answer B	AnswerB::Colonoscopy evaluation of the involved bowel segment
Answer B Explanation	AnswerBExp::'''Correct'''-2 to 6 weeks after recovering, uncomplicated diverticulitis patients have to be followed up with colonoscopy to rule out colon cancer or an extension of the diverticulum.
Answer C	AnswerC::A repeat abdominal CT after 4 weeks
Answer C Explanation	AnswerCExp::'''Incorrect'''-Repeat abdominal CT is not as sensitive as colonoscopy in ruling out colon cancer or an extension of the diverticulum.
Answer D	AnswerD::Periodic surveillance of CEA for colon cancer
Answer D Explanation	[[AnswerDExp::Incorrect-Periodic surveillance with CEA is recommended only for post surgical resection of colon cancer.]]
Answer E	AnswerE::Virtual colonoscopy evaluation of the involved bowel segment
Answer E Explanation	[[AnswerEExp::Incorrect-Colonoscopy has the advantage of biopsy when compared to virtual colonoscopy where tissue biopsy is not possible. So colonoscopy is preferred over virtual colonoscopy.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::2 to 6 weeks after recovering from an uncomplicated diverticulitis since the patients have a risk of extension of the diverticulum and a probability of identifying a preexisting colon cancer, they have to be followed up with colonoscopy. Educational Objective: 2 to 6 weeks after recovering, uncomplicated diverticulitis patients have to be followed up with colonoscopy to rule out colon cancer or an extension of the diverticulum. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Diverticulitis, WBRKeyword::Colon cancer
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::