indidoc1
Forum Guru
Topics: 50
Posts: 978
|
10.
A 35-year-old man with heartburn is evaluated in clinic. Extensive workup for a cardiac source is negative. The patient responded to a trial of a proton pump inhibitor and is now on omeprazole 20 mg daily. However, he continues to complain of upper abdominal discomfort for the past 1 year. He wonders if he might have an infection with Helicobacter pylori as he read that this bacteria is associated with ulcers. He takes no other medications and has no allergies. His vital signs are stable. Examination reveals mid epigastric tenderness. Which of the following is the most appropriate management?
A. Increase omeprazole dose
B. Obtain urea breath test
C. Obtain serum antibody test
D. Refer for endoscopy
E. Treat with antibiotics
___________________
"Whether you think you can or whether you think you can't, you're right!" ~ Henry Ford
|
| smalley
Forum Elite
Topics: 51
Posts: 284
|
d endoscopy?
___________________
But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31
|
| darkhorse
Forum Elite
Topics: 56
Posts: 275
|
C.
___________________
When going gets tough, the tough gets going
|
| neuroblastoma
Forum Guru
Topics: 99
Posts: 1,011
|
D
___________________
yahoo mesenger and skype ID asdvsd2003
|
| neuroblastoma
Forum Guru
Topics: 99
Posts: 1,011
|
not d sorry / i guess C
___________________
yahoo mesenger and skype ID asdvsd2003
|
| cool doctor
Forum Junior
Topics: 1
Posts: 219
|
C
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
D.
for GERD endoscopy with biopsy is test of choice.
not sure that doc have to check pt only for HP bcs pt sayed so.
Also heartburn is cosistent with GERD, GERD is not associated with HP.
|
| Vietnamese
Forum Elite
Topics: 11
Posts: 277
|
D- Endoscopy is required for the suspicous Barret esophagus.
___________________
Nothing is impossible.
|
| Vietnamese
Forum Elite
Topics: 11
Posts: 277
|
D- Endoscopy is required for the suspicous Barret esophagus.
___________________
Nothing is impossible.
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
D. Refer for endoscopy -- to r/o organic causes since his meds are not working well
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
both B AND C NON INVASIVE METHODS FOR DETECT HP
HE RESPOND TO PPI
NOT GIVE AB BEFORE DIAGNOSE HP
ENDOSCOPY !!! NO I DON'T THINK SO
I THINK MAY WE CAN TRY INCREASE DOSE OF PPI FIRST
A
|
| indidoc1
Forum Guru
Topics: 50
Posts: 978
|
The correct answer is C. The serum antibody test has a >90 % accuracy and is inexpensive. It can be performed in the office setting. A positive test indicates active infection. It is not affected by use of proton pump inhibitors (PPI) or antibiotics.
It is advisable to confirm the diagnosis in addition to controlling symptoms (choice A).
The urea breath test (choice B) is more accurate than the antibody test. However, false negatives in the setting of concurrent PPI use is high.
Although accurate, the endoscopy for biopsy and urease test is an expensive alternative to the antibody test (choice D).
It is advisable to confirm the diagnosis before presumptively treating the patient (choice E).
___________________
"Whether you think you can or whether you think you can't, you're right!" ~ Henry Ford
|
| hgheith
Forum Elite
Topics: 39
Posts: 268
|
Good Q indidoc1! I would have guessed breath test, I didn't know it had false + with ppi.
Thanks!
|
|
| |
| | | | | | | | | | | | | |
