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Old 09-03-2011
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Idea! Response to therapy to make a diagnosis.

As we know, in medicine in general we do not use response to therapy to make a diagnosis, but there are few exception to that, I will mention what I know, please add to that:
1. esophageal candidacies & fluconazole.
2.
Opiate & naloxone.
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Old 09-03-2011
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CNS toxoplasmosis treatment with pyrimethamine-sulfadiazine or TMP-SMX
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Old 09-03-2011
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minimal change disease in children and pednisolone
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Old 09-03-2011
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That is good guys, our list getting longer.
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Old 09-03-2011
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lyme rash and doxycycline, amoxicillin in pregnant and children less than 9yrs.

herpes vesicles and acyclovir


i hope am right about these
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Old 09-03-2011
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Thanks busterbee, you are trying hard.
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Lactose intolerance and lactose free diet. Diarrhea should resolve in 24-48 hs.
Gluten entheropathy - gluten free diet (biopsy is indicated) but also gluten free diet and siarrhea resolves in several weeks.
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a very good post but i thought TZANK smear or PCR was required for herpes simplex..... can we give trial of acyclovir as a means of diagnosis???

plus though diarrhoea of celiac disease resolves with gluten free diet, its also not used as a means of dx..firstly because it takes several weeks as dr mhm already mentioned, plus dietary compliance is difficult..n easy means of diagnosing a pt r available like ttg antibodies..n once these r +ve, biopsy can b done
i hope im ryt....
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Quote:
Originally Posted by aasiaafzal View Post
a very good post but i thought TZANK smear or PCR was required for herpes simplex..... can we give trial of acyclovir as a means of diagnosis???

plus though diarrhoea of celiac disease resolves with gluten free diet, its also not used as a means of dx..firstly because it takes several weeks as dr mhm already mentioned, plus dietary compliance is difficult..n easy means of diagnosing a pt r available like ttg antibodies..n once these r +ve, biopsy can b done
i hope im ryt....
I would also second that...
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Quote:
Originally Posted by step1an View Post
I would also second that...
i guess you guys are right..we still will get tzank smear if vesicles have ruptured or PCR if vesicles are intact
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Just to have summary up to now, that what we have- about the other suggestion, really Iím not so sure.
1. Esophageal candidiasis & fluconazole.
2. Opiate & naloxone.

3. CNS toxoplasmosis treatment with pyrimethamine-sulfadiazine or TMP-SMX.
4. Minimal change disease in children and pednisolone
5. Lactose intolerance and lactose free diet. Diarrhea should resolve in 24-48 hs.
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ok so as far as I know the Standard of care for the diagnosis of esophageal candidiasis is to do an endoscopy. You can give temporary treatment but GOLD standard for diagnosis is endoscopy. Right??

and adding to the list
1. Gastritis
2. Reflux
3 .Peptic Ulcer dz
for these I guess you can use PPIs to make the diagnosis.

Correct me if I'm wrong please.

And for toxoplasmosis I thought we had to see the ring enhancing lesions??? IDK I haven't started studying for CK yet...so lemme know if I'm wrong.Thank you
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Hi KiKi, that what I got from Conrad Fischer lecture-(esophageal candidacies & fluconazole). But let us see what the other fellows say.
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Old 09-04-2011
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Quote:
Originally Posted by kiki View Post
ok so as far as I know the Standard of care for the diagnosis of esophageal candidiasis is to do an endoscopy. You can give temporary treatment but GOLD standard for diagnosis is endoscopy. Right??

and adding to the list
1. Gastritis
2. Reflux
3 .Peptic Ulcer dz
for these I guess you can use PPIs to make the diagnosis.

Correct me if I'm wrong please.

And for toxoplasmosis I thought we had to see the ring enhancing lesions??? IDK I haven't started studying for CK yet...so lemme know if I'm wrong.Thank you
yes pt of candidial esophagitis can be diagnsed with a trial of fluconazle, but only if he is HIV +ve, with cd4 count <200....which makes candida the likely cause.. n if trial fails, then endoscopy can be performed....
on endoscopy u get:
  • if candida, whitish plaques..........n biopsy show hyphae n pseudohyphyae
  • if HSV, multiple ulcers................n biopsy shows intra nuclear inclusions,
  • if cmv, a large ulcer...................n biopsy shows intra cytoplasmic inclusions.
plus for gerd, peptic ulcer n gastrtis...response to PPI therapy is used as dx only if pt is young <45, otherwise health, with no alarm symptoms...(i.e anemia, occult blood in stools, wt loss or >6 month duration of symtom)

this is what kaplan says...!! do correct me if im wrong
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well I'm sure you are right, I haven't started studying at all so was just throwing it in the air... but Thank You...
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Quote:
Originally Posted by kiki View Post
And for toxoplasmosis I thought we had to see the ring enhancing lesions??? IDK I haven't started studying for CK yet...so lemme know if I'm wrong.Thank you
n the same is true for toxoplasmosis...i.e only in an HIV pt with cd4 count around 100, this response to therapy is used as a means of diagnsis.

plus i would say yes u r right kiki..because ring enhancing lesions are seen on CT in all pts suspected of toxoplasmosis, n CT is a must irrespective of their HIV status.. however, those with HIV count around 100, are not aspirated or biopsied, assuming toxoplasma as the commonest cause of encephlitis, whereas in non-HIV pts examination of fluid is a must.

so what is meant here when its said that response to therapy is used as a means of dx, is that examination of abcess fluid is not performed in HIV pt...n not CT.. i hope im able to explain my point
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Quote:
Originally Posted by kiki View Post
well I'm sure you are right, I haven't started studying at all so was just throwing it in the air... but Thank You...
no really ur knowledge is good, if u havent started ur prep yet...!! coz these r things even we have to check again in our notes, n here we r, preparing for this exam for last 3 months...lol
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This is great explanation aasiaafzal
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Old 02-26-2012
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also in rheumatic arthritis if doubt give salicylate it give good dramatic response to acetylsalicylic acid
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Old 02-27-2012
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myasthenia gravis and Edrophonium
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