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Continuing Medical Education Questions: January 2022

Howard, Dominique E. MD, FACG

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The American Journal of Gastroenterology: January 2022 - Volume 117 - Issue 1 - p 25
doi: 10.14309/ajg.0000000000001578
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Understand the indication and ages for colon cancer screening.


A 43-year-old African American man, who works as an IT specialist, presents to the outpatient GI clinic with an 8-month history of episodic rectal bleeding associated with bowel movements. He notes blood mixed in his stools at times, as well as a change in bowel habits with hard stools and incomplete evacuation. He also reports mild left lower quadrant abdominal discomfort, which is alleviated with bowel movements. He feels fatigued which he attributes to stress at his work during the COVID-19 pandemic. He does not have fevers or chills, dizziness, or anorectal pain. He does not have a family history of colon cancer, colon polyps, or inflammatory bowel disease. On physical exam his vital signs are stable. He is afebrile with normal blood pressure and heart rate. His abdominal exam is benign with normal bowel sounds. There is no point tenderness or rebound.

Which of the following should you do next?

  • A. Prescribe a hemorrhoid cream and have the patient follow up in 3 months
  • B. Tell the patient he has irritable bowel syndrome and prescribe Linaclotide
  • C. Perform a rectal exam, and if that is normal reassure the patient
  • D. Schedule a colonoscopy


An 89-year-old woman presents to the outpatient GI clinic for colon cancer screening. She has never had a colonoscopy. She has mild asthma which is controlled with bronchodilator inhalers. She has osteoarthritis and takes over the counter NSAIDs and acetaminophen as needed. She overall has regular formed bowel movements 1–2 times a day. She reports no abdominal pain, rectal bleeding, weight loss, fevers or chills, or change in bowel habits. She had a C-section and a tubal ligation 54 years ago. She does not have a family history of colon cancer or colon polyps. She feels she is overall relatively healthy.

On physical exam her vital signs are stable. She is afebrile with a normal blood pressure and pulse. Her abdominal exam is benign with normal bowel sounds, no point tenderness or rebound.

Which of the following should be done next?

  • A. Perform a colonoscopy in a hospital setting since she is a higher risk patient
  • B. Do not offer CRC screening
  • C. Order a CT colonography
  • D. Send patient home with occult stool test and if positive, do a colonoscopy


At what age should colon cancer screening start?

  • A. 50 years of age if individual is of average risk and asymptomatic
  • B. 45 years of age only in African American individuals
  • C. 45 years of age regardless of gender or race
  • D. 45 years of age if the individual has symptoms

© 2021 by The American College of Gastroenterology