Master the board step 3

Master the Boards: USMLE Step 3
Diagnostic Testing
All the diagnostic tests will be normal. On CCS, you should order the following:
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Stool guaiac, stool white cells, culture, ova, and parasite exam
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Colonoscopy
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Abdominal CT scan
Treatment
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Best initial therapy: Fiber. Bulking up the stool helps relieve the pain. Fiber
gives the guts a stretch, like sending the colon to yoga class!
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If there is no relief of pain with fiber, then you should add antispasmodic/
anticholinergic agents, such as dicyclomine or hyoscyamine, which “relax”
the bowel.
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If there is no response to the antispasmodic/anticholinergic agents, you
should add a tricyclic antidepressant, such as amitriptyline.
Basic Science Correlate
Tricyclic antidepressants help IBS because they are anticholinergic; relieve
neuropathic pain; and are antidepressant.
Colon Cancer
• Hamartomas and
hyperplastic polyps:
Benign
• Dysplastic polyps:
Malignant
The most important thing for you to know about colon cancer, by far, is what
screening to perform.
Diagnostic Testing
General Population
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Begin screening at age 50.
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Screen with the following:
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Colonoscopy every 10 years
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Fecal occult blood testing yearly
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Barium enema
What is the best method of screening for colon cancer?
Answer: Colonoscopy every 10 years is the best method by far. All other methods are
less accurate.
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