A 70-Year-Old Woman Comes to the Office for Routine Evaluation

A 70-year-old woman comes to the office for routine evaluation.  The patient feels well and has had no shortness of breath, fatigue, dizziness, chest pain, unexpected weight changes, or bloody stools.  Medical history is significant for constipation-predominant irritable bowel syndrome, hypertension, and diabetes mellitus.  Temperature is 37.1 C (98.8 F) , blood pressure is 138/86 mm Hg, pulse is 85/min, and respirations are 12/min.  Mild conjunctival pallor is noted.  Heart and lung sounds are unremarkable.  The abdomen is soft, nontender, and nondistended.  Rectal examination shows external hemorrhoids, and fecal occult blood testing is positive.  Complete blood count reveals a hemoglobin level of 10.5 g/dL.  Which of the following is the best next step in management of this patient?

A) Anoscopy
B) Colonoscopy
C) Hemoglobin testing in 3 months
D) Hemorrhoidectomy
E) Oral iron replacement
F) Topical hydrocortisone cream

Correct Answer:

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