It must be surgery EOR week or something, because the top three questions for miss rates are all surgery this week.
This is a straightforward question dealing with the patient symptoms. The tricky part is that there are three answers related to the cluster of symptoms for colon cancer, and two of them deal with common presentations in right-sided colon cancer.
The most often incorrect answer is iron deficiency anemia which is a lab result, not a presentation symptom, leaving #4 melena as the correct answer. (Constipation is more common in left-sided colon cancer).
The questions learning objectives are defined as:
- Differentiate Presentations Based on Tumor Location:
- Recognize that right-sided colon cancers often present with occult bleeding resulting in melena and iron deficiency anemia, whereas left-sided cancers are more likely to cause obstructive symptoms like increasing constipation.
- Understand the Pathophysiology of Bleeding:
- Learn that slow, chronic bleeding from right-sided tumors allows the blood to be digested, resulting in melena.
- Identify Key Clinical Signs:
- Be able to associate melena with gastrointestinal bleeding from right-sided colon cancer, even in the absence of overt anemia symptoms.
- Avoid Common Pitfalls:
- Distinguish between laboratory findings (iron deficiency anemia) and clinical signs (melena) in the context of colon cancer presentations.
It’s not a bad question, but the number of test-takers answering anemia probably indicates that the fourth learning objective for the question shouldn’t be clustered with the other three, or the question needs to be made clearer. Maybe we can underline ‘symptom’. 😀
This question appears in Med-Challenger Physician Assistant Exam Review with CME
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