USMLE PRACTICE QUESTION #101
TOPIC: Preventative Medicine.
Question #101 will test your understanding of an important, highly tested preventative medicine concept.
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A 50-year-old male visits your clinic for a routine check-up. The patient has no personal history of colorectal cancer or polyps and has no signs or symptoms suggesting colorectal cancer. As the patient's primary care physician, you want to address the patient's risk and discuss appropriate preventative measures. Which of the following recommendations is the most appropriate for this patient according to the current guidelines for preventative medicine?
A) Begin annual fecal immunochemical testing
B) Advise the patient to undergo a colonoscopy immediately and repeat every three years
C) Recommend sigmoidoscopy screening every 5 years starting at age 55
D) Schedule a colonoscopy
E) Begin annual fecal occult blood testing (FOBT)
F) Advise the patient that no screening is necessary until the age of 55
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The MENTAL MODEL used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your skills). Here’s how to think through this question:
Step 1. Read the last line to get to the heart of the question: “Which of the following recommendations is the most appropriate for this patient according to the current guidelines for preventative medicine?”
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order. 1st: Determine the patient’s status; 2nd: Based on status, identify the most appropriate next step in management
Step 3: Read the vignette carefully and ask yourself: “Based on the patient’s age and health status, what’s the most appropriate preventative step?”
Step 4. Look at the answer choices and select the option most closely resembling your final thought from “Step 3” above.
GENERAL ANALYSIS
This vignette presents a 50-year-old male with no personal history of colorectal cancer or polyps, who is asymptomatic and presents for a routine check-up. The question asks for the most appropriate colorectal cancer screening recommendation for this average-risk patient based on current guidelines.
ANSWER CHOICES:
CHOICE A: Begin annual fecal immunochemical testing
Explanation: The fecal immunochemical test (FIT) is a stool-based test that detects hidden blood in the stool, which can be an early sign of colorectal cancer. FIT is recommended as a non-invasive screening option for average-risk individuals. While FIT is an appropriate screening option, it is generally recommended every 1-2 years, not necessarily annually. The more common recommendation is every 2 years, as noted in some guidelines. Therefore, this answer is not the most accurate.
CHOICE B: Advise the patient to undergo a colonoscopy immediately and repeat every three years
Explanation: Colonoscopy is a highly effective screening method for colorectal cancer, but it is typically recommended every 10 years for average-risk individuals. Recommending a colonoscopy every 3 years is excessive for an average-risk patient. This frequency is reserved for individuals with high-risk factors (e.g., personal history of polyps or colorectal cancer). Therefore, this answer is incorrect for this patient.
CHOICE C: Recommend sigmoidoscopy screening every 5 years starting at age 55
Explanation: Sigmoidoscopy examines only the lower part of the colon and can be used as a screening tool for colorectal cancer. Sigmoidoscopy is a valid screening option, but it should be initiated at age 50, not 55, according to most guidelines. Additionally, colonoscopy or other tests are more commonly recommended at age 50. Therefore, this answer is incorrect.
CHOICE D: Schedule a colonoscopy
Explanation: Colonoscopy is the gold standard for colorectal cancer screening and allows direct visualization of the entire colon and removal of polyps during the procedure if necessary. For average-risk individuals, it is typically recommended to start at age 50 and repeated every 10 years if no abnormalities are found. This recommendation aligns with current guidelines that suggest starting colorectal cancer screening at age 50 in asymptomatic, average-risk individuals. Colonoscopy every 10 years is one of the preferred methods due to its high sensitivity and ability to detect and remove precancerous lesions.
CHOICE E: Begin annual fecal occult blood testing
Explanation: Fecal occult blood testing (FOBT) detects hidden blood in the stool and can be used as a non-invasive screening method for colorectal cancer. It needs to be done annually to be effective. While FOBT can be used as a screening tool, it requires annual testing.
CHOICE F: Advise the patient that no screening is necessary until the age of 55
Explanation: Some older guidelines recommended starting colorectal cancer screening at age 50. However, delaying screening until age 55 would miss early detection opportunities. Current guidelines recommend starting colorectal cancer screening at age 50 (or even earlier at age 45 in some cases). Waiting until age 55 would delay appropriate preventative care and increase the risk of undetected disease progression.
FINAL VERDICT…
Colonoscopy remains the gold standard for colorectal cancer screening because it can directly visualize the entire colon and remove any detected polyps during the procedure. According to current guidelines from organizations such as the American College of Physicians (ACP), U.S. Preventive Services Task Force (USPSTF), and American Cancer Society (ACS), asymptomatic adults at average risk should begin colorectal cancer screening at age 50.
For this patient, who has no personal history of polyps or colorectal cancer and no symptoms suggestive of colorectal disease, scheduling a colonoscopy now would be appropriate. If no abnormalities are found during the procedure, it should be repeated every 10 years.
Other options like FIT or FOBT are also valid but require more frequent testing (every year or two), whereas colonoscopy provides longer intervals between screenings (every 10 years). Therefore, scheduling a colonoscopy is both practical and convenient for long-term monitoring.
CORRECT ANSWER: D) Schedule a colonoscopy
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That’s it for question 101!
See ya tomorrow 👋