ROSH Gastrointestinal Practice Exam

What study is contraindicated for a 68-year-old man presenting with abdominal pain and fever?

1. Colonoscopy

2. Contrast computed tomography

3. Magnetic resonance imaging

4. Ultrasound

The correct answer is: Colonoscopy

In evaluating a 68-year-old man presenting with abdominal pain and fever, the contraindications for certain studies typically revolve around the patient's overall clinical condition and the presence of specific symptoms or findings. In this case, a colonoscopy is contraindicated primarily due to the risk of perforation or exacerbation of any potential underlying conditions such as diverticulitis, inflammatory bowel disease, or other acute abdominal processes that may be present. Colonoscopy involves the insertion of a scope into the bowel, which can introduce complications, especially in a patient who is older or showing signs of acute illness, such as fever and abdominal pain. Prior to performing such an invasive procedure, it is critical to ensure that the patient is stable and that no acute contraindications exist. On the other hand, imaging studies such as contrast computed tomography, magnetic resonance imaging, and ultrasound can be performed to evaluate the cause of abdominal pain non-invasively. These methods can help reveal issues such as appendicitis, diverticulitis, or abscess formation without the immediate risks associated with inserting instruments into the gastrointestinal tract. Thus, the primary consideration against performing a colonoscopy in this scenario is related to patient safety and potential complications, making it the least appropriate study in this context.