{"id":5886,"date":"2025-04-30T12:01:37","date_gmt":"2025-04-30T20:01:37","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5886"},"modified":"2025-10-01T11:38:24","modified_gmt":"2025-10-01T19:38:24","slug":"usmle-step-2-ck-question-of-the-day-hematochezia","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Hematochezia"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>An Osmosis USMLE\u00ae Step 2 CK-style clinically-focused practice question to test your medical knowledge. Identify the feature that would most significantly increase the risk for the underlying condition in a 46-year-old woman presenting with episodic lower abdominal discomfort, bloating, hematochezia, and anemia after a four-month history of symptoms.<\/em><\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 46-year-old woman presents to the clinic with episodic lower abdominal discomfort, bloating, and hematochezia for four months. She has not had diarrhea, and the amount of stool she passes with each bowel movement has been smaller than usual. She reports weight loss of 4 kg (8.8 lbs) over the past four months. Her appetite has remained unchanged, but she feels &#8220;full&#8221; earlier than usual after starting meals. Past medical history includes gastroesophageal reflux disease (GERD) managed with omeprazole and irritable bowel syndrome diagnosed in her 30s. Family history is positive for endometrial cancer in her mother at the age of 32. Her diet is significant for high consumption of dairy products. Body mass index (BMI) is 20 kg\/m2. Temperature is 36.9\u00b0C (98.4\u00b0F), blood pressure is 124\/80 mm Hg, pulse is 76\/min, respiratory rate is 14\/min, and oxygen saturation is 99% on room air. Abdominal examination shows mild distention with hyperactive bowel sounds and mild tenderness in the left lower quadrant without palpable masses. Digital rectal examination (DRE) reveals stool with blood in it and no evidence of hemorrhoids or fissures. Laboratory results are significant for a hemoglobin of 10.3 g\/dL and an MCV of 72 fl. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following features would most significantly increase this patient\u2019s risk for the most likely underlying condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Family history of endometrial cancer at an early age<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. History of irritable bowel syndrome (IBS)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Body mass index (BMI) &lt;21 kg\/m2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Chronic use of proton pump inhibitors (PPI)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Diet high in dairy<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Family history of endometrial cancer at an early age<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Correct: See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. History of irritable bowel syndrome (IBS)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder. While its symptoms can mimic those seen in colorectal cancer, IBS itself does not increase the risk of developing colorectal cancer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Body mass index (BMI) &lt;21 kg\/m2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> A low BMI can be seen in colorectal cancer due to cancer-related weight loss. However, having a low BMI is not a risk factor for developing CRC. Conversely, obesity is a recognized risk factor for colorectal cancer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Chronic use of proton pump inhibitors (PPI)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>Chronic use of PPIs like omeprazole has been associated with various gastrointestinal problems, including Clostridium difficile infection, atrophic gastritis, malabsorption of minerals and vitamins, and an increased risk of developing gastric polyps. It has not been directly correlated with an increased risk of colorectal cancer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Diet high in dairy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: High dairy consumption has been suggested to have a protective effect against colorectal cancer due to its calcium content. Conversely, a diet high in red and processed meats is recognized as a risk factor for colorectal cancer.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with episodic <strong>lower abdominal discomfort<\/strong>, bloating, early satiety, weight loss, <strong>change in stool caliber<\/strong>, <strong>hematochezia,<\/strong> and <strong>microcytic anemia<\/strong>. This clinical presentation is highly suggestive of <strong>colorectal cancer (CRC).<\/strong> Multiple risk factors can contribute to the development of CRC. In this patient, a <strong>family history of endometrial cancer in a first-degree relative at an early age <\/strong>raises the possibility of<strong> Lynch syndrome <\/strong>(hereditary nonpolyposis colorectal cancer or HNPCC).&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Lynch syndrome<\/strong> is an autosomal dominant condition characterized by a high risk of developing <strong>CRC<\/strong>, <strong>endometrial cancer<\/strong>, and <strong>ovarian cancer<\/strong>. Defective DNA mismatch repair genes, predominantly MLH1, MSH2, MSH6, and PMS2, lead to a rapid accumulation of errors in the DNA, especially in areas known as microsatellites. These genetic errors accelerate the progression from adenoma to carcinoma in the colon.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Signs and symptoms associated with CRC can vary based on the location of the tumor.<strong> Right-sided (proximal) colon tumors<\/strong>, encompassing the cecum to the right half of the transverse colon, lead to occult blood loss and iron-deficiency anemia. <span style=\"margin: 0px;padding: 0px\">In contrast,&nbsp;<strong>left-sided (distal) tumors<\/strong>&nbsp;involving the left transverse colon to the sigmoid frequently cause changes in bowel habits, colicky abdominal pain, and sometimes blood-streaked stool.<\/span> Tumors located in the <strong>rectum<\/strong> may produce symptoms of <strong>tenesmus<\/strong>, rectal bleeding, and <strong>stool caliber changes<\/strong>.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"946\" height=\"973\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-8.png\" alt=\"RISK FACTORS FOR COLORECTAL CANCER (CRC)\nFamily history of CRC or adenomatous polyps\nLynch syndrome (HNPCC)\nFamilial adenomatous polypsis (FAP)\nPersonal history of CRC or adenomatous polyps\nInflammatory bowel disease\nAge &gt; 45\nDiet high in red &amp; processed meats\nObesity\nAlcohol consumption\nTobacco use\nPhysical inactivity\nType 2 diabetes &amp; insulin resistance\" class=\"wp-image-5890\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-8.png 946w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-8.png?resize=292,300 292w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-8.png?resize=768,790 768w\" sizes=\"auto, (max-width: 946px) 100vw, 946px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In patients presenting with clinical signs and symptoms suggestive of colorectal cancer, the finding of early-onset endometrial cancer in a first-degree relative, adenomatous polyps, or early-onset colon cancer in first-degree relatives suggests hereditary colon cancer syndrome.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Colorectal_cancer\">Colorectal cancer<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Benson AB, Venook AP, Al-Hawary MM, et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(3):329-359. Published 2021 Mar 2. doi:10.6004\/jnccn.2021.0012&nbsp;<\/li>\n\n\n\n<li>Benson AB, Venook AP, Al-Hawary MM, et al. Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(10):1139-1167. doi:10.6004\/jnccn.2022.0051<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png\" alt=\"\" class=\"wp-image-4633\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prep for the USMLE\u00ae Step 2 CK exam with this clinical case involving a 46-year-old woman presenting with hematochezia and abdominal discomfort. Learn to identify the most significant risk factor related to her condition, focusing on the importance of family history in diagnosing potential hereditary cancer syndromes. Strengthen your clinical knowledge and improve your diagnostic skills for effective patient management!<\/p>\n","protected":false},"author":202,"featured_media":5889,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,45],"tags":[150,657,654,323,655,265,653,448,245,656,149,185],"class_list":["post-5886","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-2","tag-clinical-practice","tag-colon-cancer","tag-colorectal-cancer","tag-endometriosis","tag-gastrointestinal-health","tag-healthcare-training","tag-hematochezia","tag-medical-diagnosis","tag-nursing-education","tag-oncology","tag-patient-care","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0Hematochezia - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hematochezia\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Hematochezia - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prep for the USMLE\u00ae Step 2 CK exam with this clinical case involving a 46-year-old woman presenting with hematochezia and abdominal discomfort. Learn to identify the most significant risk factor related to her condition, focusing on the importance of family history in diagnosing potential hereditary cancer syndromes. 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