Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 19-year-old woman presents with a 6-week history of bloody diarrhea, fecal urgency, and lower abdominal cramping. She reports 4-6 bowel movements daily with visible blood. Vital signs are normal. Laboratory studies show hemoglobin 11.2 g/dL, albumin 3.8 g/dL, and CRP 8.5 mg/dL. Colonoscopy with biopsy demonstrates continuous mucosal inflammation and crypt distortion limited to the rectum and sigmoid colon, with no dysplasia or pseudopolyps noted. She denies arthralgias, eye symptoms, or skin manifestations. There is no family history of inflammatory bowel disease or colorectal cancer. Which of the following best describes the appropriate colorectal cancer surveillance strategy for this patient?
Answer choices
- ASurveillance colonoscopy every 6 months indefinitely, given her young age at diagnosis
- BSurveillance colonoscopy every 1-2 years beginning 8 years after disease onsetCorrect answer
- CProphylactic total colectomy within 5 years to eliminate cancer risk
- DSurveillance colonoscopy every 3-4 years beginning immediately at diagnosis
- ENo surveillance colonoscopy needed, as left-sided colitis does not increase cancer risk
- FSurveillance colonoscopy every year beginning 1 year after diagnosis
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