Repeated USMLE Questions Step 2 CK- 432

A 43-year-old man visits his physician concerned about finding traces of bright red blood on toilet paper after he wipes. His stool has normal color and not mixed with blood. His medical and surgical histories are unremarkable. He has no family history of colon cancer.

What is the most appropriate next step in management?

A- Anoscopy

B- Barium enema

C- Colonoscopy

D- Fecal occult blood test

E- Sigmoidoscopy


This is a case of scant hematochezia which is characterized by a few drops of bright red blood on toilet paper after defecation. It is not stools mixed with blood. Anoscopy or proctoscopy is the appropriate next step to evaluate the anal canal for hemorrhoids, fissures, polyps, ulcers or tumors. Other tests are used in older age, stool mixed with blood or dark-colored stool.

The correct answer is A

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