--- title: Most Missed PA Prep Question -Melena in Right-Sided Colon Cancer description: Learn why melena—not anemia—is the key symptom of right-sided colon cancer in this week’s most-missed PA exam question and what it teaches test-takers. image: https://challengercme.com/hubfs/Screenshot%202025-02-28%20105731.jpg --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) Physician Assistant # Most Missed PA Prep Question -Melena in Right-Sided Colon Cancer Learn why melena—not anemia—is the key symptom of right-sided colon cancer in this week’s most-missed PA exam question and what it teaches test-takers. [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Mar 6, 2025 [Commonly Missed Questions](https://challengercme.com/blog/tag/commonly-missed-questions) [Physician Assistant](https://challengercme.com/blog/tag/physician-assistant) ### < [All Posts](https://challengercme.com/blog) Try Med-Challenger Start a free trial today and save! Pass-guaranteed board exam review with CME/CE credits built-in. Target weak areas, study smarter, stay on track. Act now and save. [BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![PA Board Review Melena in Right-Sided Colon Cancer](https://challengercme.com/hubfs/Screenshot%202025-02-28%20105731.jpg) Right-sided colon cancer typically presents with melena due to chronic occult bleeding, while anemia is a lab finding rather than a symptom. Understanding this distinction helps PA test-takers correctly identify right-sided tumor presentations and avoid common exam pitfalls. [![Don't Stop With Just One Question - Check Out Our Library of Over 35,000 Q&A With Remediation!](https://no-cache.hubspot.com/cta/default/9106197/interactive-186303376223.png) ](https://challengercme.com/hs/cta/wi/redirect?encryptedPayload=AVxigLLVoHhd%2BVir1B0oYZ8E5sx6SsTAQfU2dzrEjflYuy4CpLTdxRWIzSEkwE5xXwUt2cljhNMk%2Fx14jW2s%2BBZO9f%2Brumvtvz5%2BjuFAHY5delvS8L%2BCdtL1iivem0t9JOk%2BvH%2FpzHutKOZL3HpjdH3lAmzjLUZEMAC0AH1S9aY0EmXFqx0rGwwkL8IqawhqxdbP1K6VaXphCMKpao6rR%2FsWoQ0laXM%3D&webInteractiveContentId=186303376223&portalId=9106197) Which set of symptoms and signs are usually associated with right-sided, sporadic colon cancer? **Answer Options:** 1. colovesical fistula 2. increasing constipation 3. iron deficiency anemia 4. melena 5. pain and fever   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). ## Learning Objectives - ### **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](https://challengercme.com/physician-assistant-exam-review-cme-course) [Try for free and save](https://fuse.challengercme.com/fulltrial/204). Ace your exams and meet your CME requirements for just $26 a month! 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "Right-sided colon cancer", "melena", "occult gastrointestinal bleeding", "iron deficiency anemia (laboratory finding)", "left-sided vs right-sided colon cancer presentations", "exam preparation", "test-taking pitfalls", "medical education" ], "articleSection" : "Physician Assistant Exam Prep", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-12-03T16:34:34.727Z", "datePublished" : "2025-03-06T13:15:00.000Z", "description" : "Learn why melena—not anemia—is the key symptom of right-sided colon cancer in this week’s most-missed PA exam question and what it teaches test-takers.", "headline" : "Most Missed PA Prep Question -Melena in Right-Sided Colon Cancer", "image" : [ { "@type" : "ImageObject", "alternateName" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "contentUrl" : "https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625#image1", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation (image used on article)" }, { "@type" : "ImageObject", "alternateName" : "Explore the most missed question in Internal Medicine exam prep. Follow up for COPD.", "contentUrl" : "https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625#image2", "description" : "Promotional/related image referencing most missed question series" } ], "inLanguage" : "en-US", "keywords" : [ "melena", "right-sided colon cancer", "occult bleeding", "iron deficiency anemia", "constipation", "PA exam", "Med-Challenger", "exam prep", "learning objectives", "test-taking tip" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/1-missed-question-for-physician-assistants-this-week030625", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Melena. Right-sided colon cancer often presents with slow, chronic occult bleeding that is digested and appears as melena; iron deficiency anemia is a laboratory finding rather than a presenting symptom, and constipation is more common with left-sided tumors." }, "name" : "Which set of symptoms and signs are usually associated with right-sided, sporadic colon cancer?", "text" : "Which set of symptoms and signs are usually associated with right-sided, sporadic colon cancer?\\nAnswer Options: colovesical fistula; increasing constipation; iron deficiency anemia; melena; pain and fever" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Melena due to chronic occult bleeding from right-sided tumors." }, "name" : "What is the most characteristic presenting sign of right-sided colon cancer?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Iron deficiency anemia is a laboratory finding, not a presenting symptom." }, "name" : "Is iron deficiency anemia a symptom or a laboratory finding in the context of colon cancer presentation?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Left-sided colon cancer is more likely to cause obstructive symptoms such as increasing constipation." }, "name" : "Which side of colon cancer is more commonly associated with increasing constipation?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Slow, chronic bleeding from right-sided tumors allows the blood to be digested, resulting in melena." }, "name" : "Why does bleeding from right-sided tumors commonly present as melena?" }, "position" : 4 } ], "name" : "Practice Questions", "numberOfItems" : 4 } ```