A 53-year-old male presents for follow-up after a routine screening colonoscopy. He is healthy and takes no medications, but his family history is positive for colon cancer. During a thorough, relatively easy colonoscopy, two adenomatous polyps measuring 0.7 mm were removed.
His next surveillance colonoscopy should be in:
Correct Answer C:
Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on colon cancer screening:
A healthy 48-year-old bookkeeper who works in a medical office has a positive PPD on routine yearly screening.
Which one of the following would be most appropriate at this point?
Correct Answer A: Clinical evaluation and a chest radiograph are recommended in asymptomatic patients with a positive PPD. The use of a two-step approach (i.e. retesting 1-4 weeks later in patients who initially test negative) is designed to decrease the false-negative rate of PPD testing.
Asymptomatic patients with a positive PPD and an abnormal chest film should have a sputum culture for TB, but a culture is not required if the chest film is negative.
Persons with a PPD conversion should be encouraged to take INH for 9 months with proper medical supervision. Patients with a negative PPD who are still at high risk for TB, especially HIV-positive patients, could be evaluated for anergy, but it is not recommended at this time.
A 55-year-old male is found to have three hyperplastic polyps on a routine screening colonoscopy. He has no personal or family history of colon cancer.
This patient’s next colonoscopy should be in:
Correct Answer D: Colonoscopy is the gold standard for screening for colon cancer. Because of differences in recommended screening intervals, the recommendations for follow-up in 2006 to bring some uniformity to the guidelines:
Other factors that influence the screening interval include the quality of the preparation and the ability of the physician to see the entire colon. Although this patient had three hyperplastic polyps removed, he is at low risk for colon cancer and should have repeat screening at the normal 10-year interval.
A 58-year-old white male has a negative screening colonoscopy. He has no symptoms and no family history of colon carcinoma.
His next screening colonoscopy should be scheduled in:
Correct Answer D:
The evidence supports a 10-year interval for colonoscopy in patients less than 80 years old.
For patients with a family history of colon cancer a 5-year interval is recommended, or 3 years if benign polyps are found.
Screening in patients over 80 years old is controversial.
What is the appropriate prophylaxis for contacts of someone who has developed a meningococcus infection?
Correct Answer C: Meningococcal diseases are infections caused by Neisseria meningitidis (also called the meningococcus) and include serious infections of the fluid and lining surrounding the brain (meningitis), bloodstream (bacteremia and sepsis), lungs (pneumonia), and joints (arthritis).
Symptoms include sudden high fever (usually 39º C or more), chills, severe headache, difficulty breathing, stiff neck and back, painful joints and vomiting. Antibiotics, such as penicillin G or ceftriaxone, can be used to treat people with meningococcal disease.
The bacteria is present in the noses and throats of ill persons and is spread to close contacts through saliva or nose and throat secretions when talking, coughing, sneezing, kissing, etc.
Close contacts of people with meningococcal disease are at increased risk for acquiring disease and should receive a prophylactic antibiotic. Options include rifampin and ceftriaxone.
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