American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended surveillance for individuals beginning at ages 10 to 15 years with familial adenomatous polyposis?

1. Yearly colonoscopy

2. Yearly flexible sigmoidoscopy or colonoscopy

3. Every 2 to 3 years upper endoscopy

4. Every 5 years colonoscopy

The correct answer is: Yearly flexible sigmoidoscopy or colonoscopy

For individuals diagnosed with familial adenomatous polyposis (FAP), the recommended surveillance strategy starts between the ages of 10 to 15 years. This early surveillance is crucial because FAP is a genetic condition characterized by the development of numerous polyps in the colon and rectum, significantly increasing the risk of colorectal cancer. The correct approach to surveillance in these patients involves yearly flexible sigmoidoscopy or colonoscopy. The reason for this frequency is that polyps can develop at a young age, and early detection is essential for preventing malignant transformation. A flexible sigmoidoscopy allows for the examination of the rectum and the lower part of the colon, helping to identify polyps at their initial stages. In some cases, a complete colonoscopy might be preferred for a more thorough assessment of the entire colon. Regular surveillance is critical for patients with FAP to facilitate timely intervention, which may include polypectomy or, in some cases, prophylactic colectomy, thus reducing the risk of colorectal cancer. The recommendation for a yearly approach is supported by guidelines emphasizing the need to monitor these individuals more closely than the general population due to their high risk. In summary, the combination of yearly flexible sigmoidoscopy or colonoscopy is effective