anastamosis
Forum Senior
Topics: 34
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D.
But i think the question is incomplete. It should be a complete clinical vignette not just lines that are considered significant by the posting person ie GOGETA. I would apprecaite if you can type the complete question with details like age, sex etc of the patient.
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| jasmin
Forum Junior
Topics: 7
Posts: 40
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C.
If the pt is hiv positive the diagnosis is confirmed by seeing the respose to emperic treatment with antifungal (fluconazole).If fluconozole doesnot work then endoscopy should be performed.Response to specific therapy is indirect diagnosis only in esophagitis
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| cool doctor
Forum Junior
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His T- 101,4
whats this?? is it CD4?
because then it will be C definitly
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| DrVirgo
Forum Hero
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anastamosis wrote:
D.
But i think the question is incomplete. It should be a complete clinical vignette not just lines that are considered significant by the posting person ie GOGETA. I would apprecaite if you can type the complete question with details like age, sex etc of the patient.
I AGREE... And it would also be nice to know the CORRECT ANSWER, since this question was posted MONTHS AGO! If the title is "I got this one wrong" I assume he/she now knows the right answer... SO WHY NOT POST IT??? along with an explanation, or maybe thats too much to ask for.  
PS I think T stands for Temperature, not T cell count.
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| GOGETA
I'm Dr. GOGETA
Topics: 299
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I was able to find from where the heck I did this question, hurrayyyyyyy for me.
I found it.
I truly apologize because I know, how it feels not knowing what is suppose to be the correct answer so sorry for that, bit likw I said I truly forgot where I did the question from.
Now this is the only explanation that has:
Answer is B…. barium is the initial/first test… Endoscopy/biopsy is the diagnostic
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| GOGETA
I'm Dr. GOGETA
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DrVirgo wrote:I'm dying of suspence! GOGETA... GoGetUsDaAnsa 
I just did sorry for the wait
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| DrVirgo
Forum Hero
Topics: 1042
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GOGETA wrote:I was able to find from where the heck I did this question, hurrayyyyyyy for me. I found it. I truly apologize because I know, how it feels not knowing what is suppose to be the correct answer so sorry for that, bit likw I said I truly forgot where I did the question from. Now this is the only explanation that has: Answer is B…. barium is the initial/first test… Endoscopy/biopsy is the diagnostic
Yes! AGREE!
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
In this case you should suspect cancer, and you need to do Barium FIRST to map out the esophagus so incase there is an obstruction like a tumor in the esophagus you don't bust through it with your scope because you didn't know it was there...
And AFTER barium, you do a SCOPE with Biopsy -obviously the BEST test for Cancer. So since they asked what is the most appropriate test for Dx, the answer is B. Scope and Biopsy.
I hope its clear. Thats how they explained in Kap.
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| DrVirgo
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GOGETA wrote: I just did sorry for the wait
No prob, and Thank you 
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| DrVirgo
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Ok, just to add... This is from a UW explanation:
If you have GERD type symptoms with DYSPHAGIA do in order:
Barium <------ INITIAL test for ALL patients with dysphagia.
Endoscopy
Manometry
If you have no dysphagia but just GERD symptoms, so in order:
Endoscopy
Manometry
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| arlete
Intern in 2009!!!!!
Topics: 30
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But typical, noncomplicated GERD symptoms in patient younger than 40 yo: go ahead and treat, no need for tests.
Right?
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| DrVirgo
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arlete wrote:
But typical, noncomplicated GERD symptoms in patient younger than 40 yo: go ahead and treat, no need for tests.
Right?
Yes, thats right...
-TYPICAL GERD --> NO need for Dx tests... Treat with PPI (BUT only AFTER you DO an EKG for cardiac causes of Chest pain -True?)
-Also in epigastric pain under sternum assoc with resp complaint or a bad taste in the mouth therapy should be initiated immediately with PPI.
-Another case is if a patient with ASTHMA presents with cough ONLY at night, treat for GERD.
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| arlete
Intern in 2009!!!!!
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I think if the patient is presenting heartburn right there, during the consult, when you are seeing him, an EKG is appropriate. But if asymptomatic, I wouldn't do it (younger than 40 yo...)
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| RX 135
Forum Elite
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HIV pt with odynophagia ....trial oral fllucanazole if does not improve endoscopy..candida esophagitis much much common than herpes esophagitits...any scopy makes pt apprehensive...for a pt pill is much likable than a tube shoved in
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| gatita007
Forum Junior
Topics: 8
Posts: 68
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Thanks guys, very good!
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