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HHT Screening — RACP Adult Medicine MCQ

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HardGeneral Internal MedicineHHT ScreeningRACP Adult Medicine

A 58-year-old with 25 years of extensive ulcerative colitis has a well-demarcated 12 mm non-polypoid lesion completely removed en bloc during high-definition chromoendoscopy. Histology shows low-grade dysplasia with clear margins and no dysplasia elsewhere. What is the best next step?

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Reveal the answer and explanation

Correct answer: EConfirm pathology at an IBD dysplasia conference and undertake intensified surveillance

Explanation lettering: E = shown as A · A = shown as E

A is correct. Completely resected visible low-grade dysplasia can be managed with expert pathology confirmation, IBD multidisciplinary review and close site/colon surveillance when no unresectable or multifocal dysplasia remains. B overstates the indication for colectomy. C ignores field cancerisation. D delays surveillance and undervalues targeted inspection. E corticosteroid does not prevent dysplasia.

Reference: Cancer Council Australia, Clinical practice guidelines for colorectal cancer: https://www.cancer.org.au/clinical-guidelines/bowel-cancer