GOGETA
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Q) A patient with Few pounds weight loss. He has been unable to eat due to pain with swallowing either liquid or solids. He smokes one pack of cigarettes per day. On PE, he is a thin man with diffuse cervical and axillary lymphadenopathy . His T- 101,4. There is no oral thrush and his lung have fine bronchi at right base. What is most appropriate diagnostic test?
A) Barium esophagram
b) endoscopy with biopsy
C) empiric trial of antifungal with ketocanazole
d) empiric treatment with ganciclovir
E) give him a prednisone
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| neuroblastoma
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B. odynophagia + lympadenopathy-->squamous cell ca in upper esophagous.
indication for endoscopy--wht loss,smoking, dyphagia, age >45
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| hanialkhadher
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b) endoscopy with biopsy
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| Kamsi
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A barium is done Ist in dysphagia,It's like a map for U before endoscopy n biopsy
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| DrVirgo
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Most approp. dx. test would be B
BUT NEXT BEST STEP would be A
-these questions always confuse me becasue of the wording.
Whats the right answer GOGETA??
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| titly
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yeah even i think so
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| drdg
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D) empiric treatment with ganciclovir
The patient has fever, odynophagia and lympadenopathy indicate the esophagitis ( inflammation). It is not squamous cell ca in upper esophago or other malignancy.
The most common causes of esophagitis are candida and cytomegalovirus. Since there is no oral thrush, then esophagitis results from cytomegalovirus must be considered. Therefore, empiric treatment with ganciclovir is the management of choice.
I am reviewing GI system right now. I pretty sure I answer this question right. If I am wrong, I will be very very upset.
GOGETA , what is the correct answer?Please!
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| neuroblastoma
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intial would be barium swallow but here they asked most appropriate for the diagnosis
i still think B is the answer
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| kpmle2
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b) endoscopy with biopsy
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| DrVirgo
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neuroblastoma wrote:
intial would be barium swallow but here they asked most appropriate for the diagnosis
i still think B is the answer
my thoughts exactly. 
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| Ivonne
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(B)The final diagnosis is almost always by pathology
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| treblechar
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scope. please what is the answer?
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| dr in trouble
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B--For CMV inf the T cell count shud be low or pt shud be immunsuppressed,which is not a case here. moreover the pt has some features of aspiration due to mass in esophagus, all point towards esophageal Ca.
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| DrVirgo
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I'm dying of suspence! GOGETA... GoGetUsDaAnsa 
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| hgheith
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This pt is a smoker with bronchi and diffuse cervical and axillary lymphadenopathy that has Pain with eating and drinking. There is no mention of an immunocomprimised pt. I agree with neuroblastoma, there is no way to know if this pt has esophagitis or anything else with out endoscopy + biopsy.
Even if it was esophagitis, you still have to biopsy to see the difference if it's hsv, cmv, or even an hiv ulcer because there is no oral thrush.
b) endoscopy with biopsy
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| knockingdown
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D
pt has high fever, definately inflammation is going on with the pt.
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| arlete
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B to know if it's CMV or HSV. If you treat with gancyclovir, you won't have the exact diagnosis.
Good question.
We need to know the answer...
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| DrVirgo
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GOGETA, this is a good question... Have you found the answer yet? Or can you at least tell us where it's from? UW, Qbank, NBME??? So we can search ourselves???
THanks buddy!
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| dr penicillin
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B
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| steppingsam
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B is likely the answer.
Because: Pt has Odynophagia and he is unable to eat due to pain with swallowing either liquid or solids. it would be difficult to perform Barium Esophagogram (choice A).
2) Endoscopy with Biopsy is the study of choice according to CMDT 2006 (page 564) for Odynophagia and Barium Esophagograpgy for Dysphagia.
Answer C, D, E are not the diagnostic test anyhow.
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| sandra
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hmmm..looks like this man has got AIDS(fever, thin man, wt loss) ...considering his fever and odynophagia, more likely to be an infection. since its not candidiasis, must be cmv esophagitis. i go for d.
what say?
question stem is kinda lacking details, i must say
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| drduck
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i feel....next best investigation will be barium but looking at the history the best investigation will be endoscopy and biopsy...to rule out or to diagnose sq cell carcinoma esophagus.
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| arlete
Intern in 2009!!!!!
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It could be squamous cell carcinoma, it could be AIDS (plus candidiasis - since abesence in oral cavity not always discard the hypotheses, or CMV, or HSV). I think the key word is DIAGNOSTIC test. If you treat with ganciclovir, you may miss the definitive diagnosis. Does anybody agree/disagree with my point of view?
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| neurom
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Odynophagia - Upper endoscopy!
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| cool doctor
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whats the T- 101,4?
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