Delusional
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a 32 year old male patient comes back after a 3 year stay in central america with weight loss, long-standing non-bloody diarrhea for the past 8 months......
Physical exam reveals an anemic patient with hepatomegaly and a plapable spleen...
Investigation:
microcytic hypocheomic anemia
Stool: fat
examination of stool for parasites is -ve
evaluation and treatment would include all of the following except:
a....serum folate
b....trial of gluten free diet
c....upper GIT series
d....trial of tetracycline
e....small bowel biopsy
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| bikram
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TETRACYCLINE
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| Delusional
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No bikram........
Tetracycline is a good choice for treatment trial
give it another shot
Thanx man for trying out most of the questions.......
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| bikram
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what else git series then.i thought its used to diff. IBD
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| Delusional
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no it is actually Gluten free diet....
that is what shldn't be unnecessary in this patient
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| Delusional
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Sorry that is what shld be unecessary in this patient ...that is the wrong answe
Gluten free diet is a wrong answer
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| Ouli Maty
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serum folate
I think it is not necessary based on the fact that this man has a hypochromic microcytic anemia and not the classical type in folate deficiency where you have a macrocytic anemia.
What is the final diagnosis after all.
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deep breathing...
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| Delusional
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No maty sorry...
This is a typical case of Tropical Sprue....
Very similar to Celiac disease......but not similar in the fact that it is unrelated to gluten ..........
The key to the diagnosis here is the patient's visit to Central America..if that wasn't mentioned ...then Celiac is the choice.....
So the incorrect answer is Gluten free diet....
1...Folate is a good thing to check on because absorption is altered in proximal small bowel lesions.....
2...upper GIT series will confirm mucosal lesions
3...Bisposy will show subtotal villous atrophy
4...Tetracycline commonly gives a response
So here are the differences between the two :
1...skin lesion Dermatitis Herpetiforms seen in celiac
2....Vit B12 deficiency seen usuallly in Tropical Sprue but not in Celiac
3...Response to Tetracycline or Tri/Sulfa in Tropical and Gluten free diet in Celiac
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| new-here
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Hi,
Good thing we'll not have questions with "which one except?" in the exam.
Other than that this case and others here are excelent, great job!
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| Delusional
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Thanx ...
Well they're just meant to stimulate the mind and then come out with the best pieces of information.....
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| Ouli Maty
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Thank you, I screwed up. Of course, chronic diseases can expose to microcytic anemia.
I also read that Celiac sprue affects only the proximal small bowel and predispose to lymphoma, whereas Tropical sprue affects the entire length of the small intestine and can be treated in a long term with Tetracycline and Folic acid.
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deep breathing...
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| Delusional
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:wink: it is ok....
ur right Tropical sprue affects the whole length ....that is why it causes Vit. B12 deficiency (ileum)
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