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Old 10-27-2012
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Arrow Gyrus Daily Questions; Internal Medicine #56

A 39-year-old woman comes to the cdnic very concerned about her risk of developing cancer. When questioned further she attests to a family history of colon cancer—her father was diagnosed at the age of 43. rd her mother was dagnosed with breast cancer at the age of 52. The patient states that she is sexually active en muitipie partners and has not seen a physician since a motor vehicle accident that occurred 15 years ago. She denies any symptoms at this time, and physical examination is nomial. At the end of the interview she asks what is recommended for a woman her age.

A. Annual fecal occult blood.
B. Mammography.
C. Papanicolau smear.
D. Self breast examination
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C. Papanicolau smear.

Tough one......have to decide if the family history is more important or risky behavior. I went for C due to 15 year duration since Colon Ca takes 10 years to develop but not sure about the Ca Breast screening.

She needed colon cancer screening at age 33.
Needs Mammography too but PE is normal.
However, she is at most risk of cervical ca since she hasn't had a Pap smear for 15 years.
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Last edited by Novobiocin; 10-27-2012 at 08:10 AM.
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Quote:
Originally Posted by cingulate.gyrus View Post
A 39-year-old woman comes to the cdnic very concerned about her risk of developing cancer. When questioned further she attests to a family history of colon cancer—her father was diagnosed at the age of 43. rd her mother was dagnosed with breast cancer at the age of 52. The patient states that she is sexually active en muitipie partners and has not seen a physician since a motor vehicle accident that occurred 15 years ago. She denies any symptoms at this time, and physical examination is nomial. At the end of the interview she asks what is recommended for a woman her age.

A. Annual fecal occult blood.
B. Mammography.
C. Papanicolau smear.
D. Self breast examination
This is a cute question, because the question gives you all this crap and then just asks about what is recommended for a woman her age..

It is so cute because we have 2 pretty strong choices here...

It can be either A (which is pathetic one must scope the ass of this woman ASAP) and it can be C (she is a little hoe and prob hasnt even had a Pap smear)

She is at risk for 2 cancers.. Both Colon cancer and Cervical Cancer..

IF we go by epidemiology and more dangerous I would be inclined to pick A, even tho Fecal occult test is not that recommended, it is better to scope... lets see whats the answer!
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tough one.........would pick A....colonic CA has higher incidence and mortality compared to cervical cancer.....

eagerly waiting for the correct answer
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Ans ........C.........

she need Pap smear since age of 21 while for colon ca with family H/o screening starts at 40 yrs .......will wait for her birthday to put a scope in her ass .......
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Originally Posted by Hitman View Post
Ans ........C.........

she need Pap smear since age of 21 while for colon ca with family H/o screening starts at 40 yrs .......will wait for her birthday to put a scope in her ass .......

The thing is that recommendation for colon cancer in persons with first degree relatives is
Either age 40 OR 10 years younger to when the family member WAS diagnosed with colon cancer... WHICHEVER COMES FIRST...

That is why this question is kind of hard... her colonoscopy should've be done when she was 33 years old, she is 39 and is a little slut... so really it depends to what the question writer likes more, either vagina or ass!
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The question doesn't ask you what would you do in this patient but "At the end of the interview she asks what is recommended for a woman her age. "

and the only choice which fits in is the Pap smear.

Others which are recommended: Colonoscopy and Mammography (once she is 50).
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Quote:
Originally Posted by Novobiocin View Post
The question doesn't ask you what would you do in this patient but "At the end of the interview she asks what is recommended for a woman her age. "

and the only choice which fits in is the Pap smear.

Others which are recommended: Colonoscopy and Mammography (once she is 50).

yup your right ........ though i missed it completely ..........

where did you guys read about doing colonoscopy 10 yrs earlier than the age her first relative was diagnosed did not find it in MTb or UW . Infact UW says if first degree relative involved do colonoscopy at 40 yrs ??????
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Originally Posted by Hitman View Post
where did you guys read about doing colonoscopy 10 yrs earlier than the age her first relative was diagnosed did not find it in MTb or UW . Infact UW says if first degree relative involved do colonoscopy at 40 yrs ??????
It is there in both MTB2 & MTB 3 --co-incidentally on page 262 in both!
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Quote:
Originally Posted by Novobiocin View Post
It is there in both MTB2 & MTB 3 --co-incidentally on page 262 in both!
oops thank you , was searching in the preventive medicine section , seems MTb needs another read .............
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Thanks for the discussion ...

Answer is C. Papanicolau smear.

The three malignancies for which regular screening is recommended are cancers of the colon, breast, and cervix.

In the patient with no significant family history of colon cancer, screening should begin at the age of 50. The choices are annual fecal occult blood testing, sigmoidoscopy every 5 years, and barium enema.

The preferred screening modality for colon cancer is colonoscopy every 10 years.

Patients who have a single first-degree relative with colorectal cancer diagnosed before the age of 60, or who have multiple first-degree relatives with colon cancer at any age, should undergo colonoscopy starting either at the age of 40 or at an age that is 10 years younger than the age at which the youngest affected relative was diagnosed, whichever age occurs earlier.
In this group of high-risk patients, colonoscopy should be repeated every 5 years.



The three tests used to screen for breast cancer are mammography, manual breast examination, and self-breast examination.

Mammography with or without clinical breast examination is recom-mended every 1-2 years from age 40 and over.

Breast examination performed by a physician is recommended for all women from ages 20 to 30, every 3 years. As of 2006, the American Cancer Society no longer recommends monthly self breast examinations alone as a screening tool.

The screening test of choice for the early detection of cervical cancer is the Papanicolaou smear (the "Pap" test). Women should be tested annually, starting 3 years after they become sexually active or at the age of 21, whichever comes first. If the patient is <30, screen annually if using conventional methods or every 2 years if using liquid-based methods. If the patient is screen every 2 years if >3 normal annual PAP smears.
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Among the options, Pap smear seems to be a clear choice.

What if there were Colonoscopy instead of fecal occult blood testing as an option?
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Quote:
Originally Posted by cingulate.gyrus View Post
A 39-year-old woman comes to the cdnic very concerned about her risk of developing cancer. When questioned further she attests to a family history of colon cancer—her father was diagnosed at the age of 43. rd her mother was dagnosed with breast cancer at the age of 52. The patient states that she is sexually active en muitipie partners and has not seen a physician since a motor vehicle accident that occurred 15 years ago. She denies any symptoms at this time, and physical examination is nomial. At the end of the interview she asks what is recommended for a woman her age.

A. Annual fecal occult blood.
B. Mammography.
C. Papanicolau smear.
D. Self breast examination
Secret answer E: colonoscopy.
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Originally Posted by troglodyte View Post
Secret answer E: colonoscopy.

Secret CK 2 Score report : FAIL :sorry:
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Quote:
Originally Posted by docwedsengr27 View Post
What if there were Colonoscopy instead of fecal occult blood testing as an option?
Answer would still be Pap smear.
Fecal occult blood testing is an acceptable answer for colon ca screening.
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