DrVirgo
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A 40 year old female presents with abdominal discomfort. The discomfort is localized to the center of the upper abdomen and is not related to meals or fatty food. She has a history of similar symptoms. She has not had GI bleeding, fatigue, dysphagia, or weight loss. Her mother has a history of gastric ulcer. Her vital signs are within normal limits. Complete physical examination is unremarkable. Stool for heme occult is negative. Complete blood count and serum chemistries are within normal limits. Which of the following is the most appropriate next step in management?
A. Barium swallow
B. Endoscopy
C. Empiric trial of H2 blockers
D. H. pylori breath test
E. Empirical antibiotic trial
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| DrVirgo
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This question is asking what are the recommendations for a person less than 45 with upper abdominal pain/discomfort and NO alarm symptoms???
Anyone???
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| nadiabarati
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I think D
because more than 90% association make it worth doing and then go for treatment.
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| young_doc
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C
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| DrVirgo
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Thats the problem with this question:
For a person who is :Under 45 with epigastric pain and no alarm symptoms:
Kaplan says.... treat symptomatically with H2 Blockers or PPIs.
UW says..... They should have a non-invasive H. pylori test (serology or breath test.)
So according to UW, the answer is D.
But according to Kaplan, the answer sould be C!!!
I am about to break my computer!!! 
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| krsna
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D
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| Justice
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D. H. pylori breath test
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| cirus
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I went through the same dilemma when I faced this quest on the UW and i solved it H2 blockers, but I decided to put more Faith in Uw than kaplan so just stick to one of them, my advice UW is of greater value
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| DrVirgo
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That's the problem I am having... I learn something and stick it in my head well. Then when I do questions, I have to RELEARN the material all over again because Kaplan was supposedly wrong and UW is supposedly right. This is wasting my time... I don't have time to learn the wrong material only to be confused later into learning something else...
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| zainee
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man i totally agree with you, its so very annoying, and a waste of time
dont know what we can do in such short time,
but hopefully there will be less than 10 percent questions like this
more tham 90 percent is what we know and sure about the answe
so instead of getting worried about 10 % concentrate on 90% and i m sure you will pass , and thank God score doesnt matter , yuo just have to pass it
good luck
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