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Average-risk colorectal cancer screening — ABIM Board MCQ

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HardGeneral Internal MedicineAverage-risk colorectal cancer screeningABIM Board

A 67-year-old man has hemoglobin 10.2 g/dL, MCV 74 fL, ferritin 8 ng/mL and transferrin saturation 7%. He has no overt bleeding, abdominal symptoms or recent blood donation. Which evaluation is most appropriate while iron replacement begins?

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Correct answer: A — Arrange bidirectional endoscopy with both upper endoscopy and colonoscopy

The best answer is “Arrange bidirectional endoscopy with both upper endoscopy and colonoscopy”. Confirmed iron deficiency anemia in an adult man warrants evaluation for occult gastrointestinal blood loss and malignancy with bidirectional endoscopy. A negative stool test does not reliably exclude an important lesion, and small-bowel capsule evaluation is generally reserved for persistent unexplained anemia after appropriate upper and lower endoscopy.

Reference: AGA Guideline: Gastrointestinal Evaluation of Iron Deficiency Anemia: https://gastro.org/clinical-guidance/gastrointestinal-evaluation-of-iron-deficiency-anemia/