<prompt> A young office executive, on tour, presents with bright red painless bleed since 7 days and abdominal pain. External and perrectal examinations are normal. As attending general practioner what will be your next step:proctoscopydo a barium enemarefer to surgeon for sigmoidoscopyrefer to gastroenterologist for colonoscopy  <response>: Proctoscopy Hemorrhoids is most likely the cause of fresh, painless bleed in this young patient. Other causes of fresh lower GI bleed are- fissures, diveicula, ischemic colitis, and aerio-venous malformations. So the next step would be to check for hemorrhoids using a proctoscope, before going for more invasive procedures like sigmoidoscopy or colonoscopy to diagnose other conditions. 