Question:
An elderly patient presents with a prolonged history of weakness and lethargy. On examination he is found to be anemic and the stool is positive for occult blood. Which of the following is the investigation of choice?
An elderly patient presents with a prolonged history of weakness and lethargy. On examination he is found to be anemic and the stool is positive for occult blood. Which of the following is the investigation of choice?
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Elderly plus iron deficiency plus occult blood means look in the colon, and you need a biopsy.
Updated On: Jun 24, 2026
- Colonoscopy
- Barium meal
- Barium enema
- CT abdomen
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Verified By Collegedunia
The Correct Option is A
Solution and Explanation
Step 1: Pull out the key features. An elderly patient with iron deficiency anaemia and stool positive for occult blood is the classic presentation of a slowly bleeding colorectal lesion, often a right sided colon cancer.
Step 2: The investigation of choice must both find the lesion and allow tissue diagnosis. Colonoscopy directly visualises the entire colon and rectum, lets you biopsy any mass, and can remove polyps. This makes option A correct.
Step 3: Why the others are wrong. Option B, barium meal, studies the upper gastrointestinal tract (oesophagus, stomach, duodenum). It would miss a colonic source of bleeding.
Step 4: Option C, barium enema, can outline a colonic filling defect but cannot take a biopsy and misses small or flat lesions. It has been largely replaced by colonoscopy.
Step 5: Option D, CT abdomen, helps with staging once cancer is found but is not the first test to detect and confirm a colonic source.
Step 6: Colonoscopy both detects and biopsies, so it is the single best investigation here.
Answer: Option A.
Step 2: The investigation of choice must both find the lesion and allow tissue diagnosis. Colonoscopy directly visualises the entire colon and rectum, lets you biopsy any mass, and can remove polyps. This makes option A correct.
Step 3: Why the others are wrong. Option B, barium meal, studies the upper gastrointestinal tract (oesophagus, stomach, duodenum). It would miss a colonic source of bleeding.
Step 4: Option C, barium enema, can outline a colonic filling defect but cannot take a biopsy and misses small or flat lesions. It has been largely replaced by colonoscopy.
Step 5: Option D, CT abdomen, helps with staging once cancer is found but is not the first test to detect and confirm a colonic source.
Step 6: Colonoscopy both detects and biopsies, so it is the single best investigation here.
Answer: Option A.
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