Question:easy
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?
Show Hint
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
Show Solution
The Correct Option is A
Solution and Explanation
Decode the vignette first. An older person with iron deficiency anaemia plus occult blood in the stool almost always has a chronic bleed from the large bowel, and colorectal carcinoma must be excluded.
Ask what one test gives the most. The ideal investigation should see the lesion and grab a sample for histology in the same sitting. Colonoscopy does exactly that across the whole colon and rectum, and it can snare polyps too. So option A wins.
Weigh the alternatives. A barium meal images only the stomach and duodenum, the wrong region for colonic bleeding, so option B is irrelevant. A barium enema can show a filling defect but offers no biopsy and overlooks subtle lesions, making it inferior, so option C is out. A CT abdomen is a staging and spread tool used after a diagnosis is made, not the initial diagnostic test, so option D is out.
Because only colonoscopy both locates and confirms the source with biopsy, it is the investigation of choice.
\[\boxed{\text{Colonoscopy}}\]
Ask what one test gives the most. The ideal investigation should see the lesion and grab a sample for histology in the same sitting. Colonoscopy does exactly that across the whole colon and rectum, and it can snare polyps too. So option A wins.
Weigh the alternatives. A barium meal images only the stomach and duodenum, the wrong region for colonic bleeding, so option B is irrelevant. A barium enema can show a filling defect but offers no biopsy and overlooks subtle lesions, making it inferior, so option C is out. A CT abdomen is a staging and spread tool used after a diagnosis is made, not the initial diagnostic test, so option D is out.
Because only colonoscopy both locates and confirms the source with biopsy, it is the investigation of choice.
\[\boxed{\text{Colonoscopy}}\]
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