If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.
A 58-year-old woman comes to the physician for a follow-up examination two weeks after undergoing a barium enema. She denies fever, weight loss, rectal bleeding, or fatigue. She has a four-year history of hypertension controlled with hydrochlorothiazide. Examination shows no abnormalities. The barium enema shows four to five polyps scattered throughout her colon, ranging in size from 4 mm to 1.1 cm.
Which of the following is the most appropriate next step in management?
A. Colonoscopy.
B. Fecal DNA testing.
C. Repeat barium enema in six months.
D. Screening colonoscopy for her 25-year-old son.
E. Upper gastrointestinal barium study.
The correct answer is A.
Kaplan Medical explains why
Kaplan Medical explains why
This patient underwent a screening barium enema for colorectal cancer and was found to have multiple polyps. The next best step is for her to undergo evaluation via colonoscopy to assess the appearance of the polyps for premalignant or malignant lesions and intervene if necessary.
Why the other answers are wrong
Why the other answers are wrong
Choices B and C: Additional screening tests such as a fecal DNA test (Cologuard) or a repeat barium enema would not be helpful. A fecal DNA test looks for DNA in the stool shed by polyps or cancers. Abnormal screening tests for colorectal cancer need to be followed up with evaluation by colonoscopy, assuming colonoscopy was not done initially.
