question: Q:A 31-year old man presents to the emergency department for blood in his stool. The patient states that he saw a small amount of bright red blood on his stool and on the toilet paper this morning, which prompted his presentation to the emergency department. The patient denies any changes in his bowel habits or in his weight. The patient has a past medical history of asthma managed with albuterol and fluticasone. The patient has a family history of alcoholism in his father and suicide in his mother. His temperature is 97°F (36.1°C), blood pressure is 120/77 mmHg, pulse is 60/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical exam, the patient has a cardiac and pulmonary exam that are within normal limits. On abdominal exam, there is no tenderness or guarding and normal bowel sounds. Laboratory values are ordered and return as below.
  
  Hemoglobin: 15 g/dL
  Hematocrit: 42%
  Leukocyte count: 4,500 cells/mm^3 with normal differential
  Platelet count: 230,000/mm^3
  
  Serum:
  Na+: 139 mEq/L
  Cl-: 100 mEq/L
  K+: 4.3 mEq/L
  HCO3-: 24 mEq/L
  BUN: 20 mg/dL
  Glucose: 92 mg/dL
  Creatinine: 1.0 mg/dL
  Ca2+: 9.9 mg/dL
  
  Which of the following is the next best step in management?? 
  {'A': 'Anoscopy', 'B': 'Colonoscopy', 'C': 'CT scan', 'D': 'Mesalamine enema', 'E': 'Stool culture and analysis for red blood cells and leukocytes'},