American Board of Internal Medicine (ABIM) Certification Practice Exam

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What type of cancer surveillance is recommended annually after colectomy for those at risk for recurrent polyposis?

  1. Colonoscopy

  2. Flexible sigmoidoscopy

  3. Rectal or ileal pouch examination

  4. Upper endoscopy

The correct answer is: Rectal or ileal pouch examination

After colectomy for individuals at risk for recurrent polyposis, the recommended form of cancer surveillance is rectal or ileal pouch examination. This is particularly relevant for patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis, as they are at increased risk for developing dysplasia or cancer in the pouch. The annual examination focuses on detecting any early signs of cancer or dysplastic changes in the ileal pouch, allowing for timely intervention if necessary. This method is crucial, especially in patients with familial adenomatous polyposis (FAP) or similar conditions that predispose them to polyps and consequently increase their risk for colorectal cancer. In contrast, while colonoscopy and flexible sigmoidoscopy are important tools for monitoring the colon, they are not typically the primary focus after a colectomy. An upper endoscopy is usually not indicated within this specific context since it examines the upper gastrointestinal tract and does not address the risks associated with the lower gastrointestinal tract post-colectomy. Therefore, rectal or ileal pouch examination is the most appropriate method for annual cancer surveillance in this scenario.