View source for WBR0827

{{WBRQuestion
|QuestionAuthor=Vendhan Ramanujam
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|MainCategory=Primary Care Office, Inpatient Facilities
|MainCategory=Primary Care Office, Inpatient Facilities
|SubCategory=Gastrointestinal, Surgery
|Prompt=A 44 year old Caucasian male presented to his primary care physician with complaints of bright red bleeding per rectum.  He had no prior history of a similar illness or a colonoscopy.  He had no family history of colon cancer.  He denied smoking and taking alcohol.  His vital signs were heart rate 92 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 37.2 C.  Physical examination was unremarkable.  Laboratory examination showed a normal complete blood count and a normal metabolic panel.  The patient was referred for a colonoscopy, which revealed a 0.5 cm, single, tubular polyp in the sigmoid colon.<BR>
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[[File:Adenomatous polyp.jpg|LEFT|300PX]]<BR>
<BR>
It was removed by snare electrocoagulation and a histopathological examination revealed an adenoma without any high-grade dysplasia.  The further line of management in this patient will be 
|Explanation=[[Adenomatous polyp]] <1 cm in size or ≤2 polyps in number or tubular type or without a high grade dysplasia carriers a low risk of neoplastic conversion and it should be followed up after removal with a repeat [[colonoscopy]] after 5 years.

'''Educational Objective:'''
Colonoscopic surveillance of colonic polyps is as follows

<table border="1" cellspacing="0" cellpadding="0" > 
<tr>
<td valign="top" bgcolor="#cccccc" ><p>'''Type of polyp'''</p></td>
<td valign="top" bgcolor="#cccccc" ><p>'''Repeat colonoscopy'''</p></td>
</tr>

<tr>
<td valign="top" ><p>Polyp with non infiltrating carcinoma</p></td>
<td valign="top" ><p>After 1 year</p></td>
</tr>

<tr>
<td valign="top" ><p>Adenomatous polyps &gt;1 cm in size or multiple (&gt;2) polyps in number or villous type or with a high grade dysplasia</p></td>
<td valign="top" ><p>After 3 years, if negative follow up again after 5 years</p></td>
</tr>

<tr>
<td valign="top" ><p>Adenomatous polyp &lt;1 cm in size or ≤2 polyps in number or tubular type or without a high grade dysplasia</p></td>
<td valign="top" ><p>After 5 years</p></td>
</tr>

<tr>
<td valign="top" ><p>Hyperplastic polyps</p></td>
<td valign="top" ><p>After 10 years</p></td>
</tr>


</table>


|AnswerA=Repeat colonoscopy after 1 year
	

|AnswerAExp='''Incorrect'''-Polyps with non-infiltrating carcinoma should be followed up with a repeat colonoscopy after 1 year.
|AnswerB=Repeat colonoscopy after 3 years
|AnswerBExp='''Incorrect'''-Adenomatous polyps >1 cm in size or multiple (>2) polyps in number or villous type or with a high grade dysplasia should be followed up with a repeat colonoscopy after 3 years. If it is negative, another repeat colonoscopy should follow after 5 years. 
|AnswerC=Repeat colonoscopy after 5 years
|AnswerCExp='''Correct'''-[[Adenomatous polyp]] <1 cm in size or ≤2 polyps in number or tubular type or without a high grade dysplasia carriers a low risk of neoplastic conversion and it should be followed up after removal with a repeat [[colonoscopy]] after 5 years.
|AnswerD=Repeat colonoscopy after 10 years
|AnswerDExp='''Incorrect'''-[[Hyperplastic polyp]] should be followed up with a repeat colonoscopy after 10 years.
|AnswerE=Repeat colonoscopy after 15 years
|AnswerEExp='''Incorrect'''-Repeat colonoscopy after 15 years is not the correct approach to any of above scenarios.
|RightAnswer=C
|WBRKeyword=Colonic polyp, Adenomatous polyp, Villous polyp, Tubular polyp, Hyperplastic polyp  
|Approved=Yes
}}