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NBME p2ck_form7 Answers

step2ck_form7/Block 3/Question#26 (2.9 difficulty score)
A 47-year-old man comes to the physician ...

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submitted by carolebaskin(35),

Tricky! Yes, fecal occult blood test would pick up hemorrhoid blood and this is a male <50yo, so case closed right?

Wrong! Hematocrit = 35% --> hgb = 35/3 = 11.7 < 13.5 (normal)

Why is he anemic? Do a colonoscopy.

submitted by seagull(1432),

My understanding is that occult blood is commonly due to an upper GI bleed. Wouldn't the colon produce gross blood? I'm hopelessly lost in these matters.

krewfoo99  Yeah I am lost in this one too. Maybe colonoscopy is the right answer to rule out other serious causes of GI Bleeding (Ex: Cancer). +  

submitted by step_prep5(25),
  • Key idea: Patients get their first screening colonoscopy at 50 years old, so in this patient with bowel changes (constipation) and anemia (which cannot be fully explained by hemorrhoids), the next best step would be a colonoscopy