som
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another que frm UW:
45 yr male c/o progressive dysphagia to solids and liquids with nocturnal cough, occassional regurgitationof undigested food. PE normal. Ba study shows dilated esophagus, loss of peristalsis and bird beak appearance. Next step in Mx?
esophagoscopy
manometry
eso. pH monitoring
pneumatic dilation
botulinum inj
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| msyamp
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esophagoscopy to rule out cancer.
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| MAZI
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i agree with you msyamp
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| achilles
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i remember this. i had the same confusion...i am assuming that why yu have posted this question som ! is it manometry or esophagoscopy as the next step !
as kaplan says that esophagoscopy will eventually be needed to be done to rule out cancer, so a manometry must have been done earlier so i'll go for B - manometry as the next step. but really there's little to choose between the two as both need to be done eventually so why even bother which one to do next !! i guess to pass the exam
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| msyamp
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som what was the answer given??
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| MAZI
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i think that this patient has obviouse sign of achalasia ( bird bike sign, dilated esophagous, aspiration, comorbide progresssive dysphagia to liquid and solid ).,
achilles do you think that he need confirmation of diagnosis ,yet.
i realy don,t know??//
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| som
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achilles, you got it right why i posted the que. Though the given criteria in the que stem are pointing enough to make a diagnois I was thinking of manometry to make a definite diagnosis of achalsia here. but the expln in UW says to do endoscopy to rule out the cancer which has to be ruled out eventually. Mazi, may be you are right, these clues are good enuf and 1st rule out the danger 1st. I still have to dig a little.
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| yasmeen
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esophagoscpy is right
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| achilles
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point taken  thanks guys.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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