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  #1  
Old 03-21-2012
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Question epigastric pain...next step...confusing!

A 65-year-old male smoker with history of chronic atrophic gastritis comes to the physician for fatigue, weight loss, nausea, vomiting, bloating, early satiety, and epigastric pain. These symptoms began gradually evolving 3 months ago. The epigastric pain is not related to or alleviated by food consumption. It appears as if his vomitus contains coffee grounds. He denies cough, fever, headache, visual changes, focal numbness, weakness, hoarseness, dysphagia, or difficulty walking. Upon physical examination, vital signs are normal. Skin is warm and dry without rashes. Head is atraumatic and normocephalic. There is no scleral icterus. Cranial nerves (CNs) II through XII are intact. There is a markedly enlarged firm lymph node in the left supraclavicular region. No other lymphadenopathy is noted. Chest is clear to A and P. Cardiac examination is unremarkable. There is no organomegaly, abdominal masses or bruits. Prostate is mildly enlarged without nodularity by digital rectal exam. Fecal occult blood test is positive. Blood chemistries and liver function tests (LFTs) are normal with the exception of decreased serum albumin and total protein. Amylase and lipase levels are WNL. Complete blood count (CBC) shows hematocrit (hct), 30%; hemoglobulin (hgb), 8.5 g/dL; platelet (Plt), 200k; white blood cell (WBC) count, 7k; neutrophils, 60%; segmented neutrophils (segs), 56%; bands, 4%; lymphocytes, 30%; monocytes, 3%; eosinophils, 2%; basophils, 1%.
What is the most appropriate initial diagnostic test?

A. Barium swallow
B. Colonoscopy
C. Computed tomography (CT) scan
D. Esophagogastroduodenoscopy (EGD)
E. Laryngoscopy
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  #2  
Old 03-21-2012
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D, i think is the ans, we have a clue already that the guy has stomach cancer, so you want to do EGD and biopsy it. just my opinion
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Old 03-21-2012
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I wanted it to be C. because it is cancer by history, but once asked for initial test and because of bleeding I will go for D.
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Old 03-22-2012
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Quote:
Originally Posted by um aala View Post
I wanted it to be C. because it is cancer by history, but once asked for initial test and because of bleeding I will go for D.

hi, like i said i am not too sure, it could be c.
can someone else help us
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Old 03-22-2012
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chronic atrophic gastric is risk of gastric cancer, and in this case pt also has alarming symptoms e.g age 65, wt loss, fatigue, so go for ESOPHAGOGASTRODUODENOSCOPY get biopsy exclude malignancy, other option are not suitable
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Old 03-22-2012
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Quote:
Originally Posted by usmlepak View Post
chronic atrophic gastric is risk of gastric cancer, and in this case pt also has alarming symptoms e.g age 65, wt loss, fatigue, so go for ESOPHAGOGASTRODUODENOSCOPY get biopsy exclude malignancy, other option are not suitable
yup. that what i thought. just to revise, epigastric pain + red flag [dysphagia.odynophagia.duration>5years] need a scope.

but ans is barium..A...any reason why? in real exam i would go with EGD.
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Old 03-23-2012
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Quote:
Originally Posted by tyagee View Post
yup. that what i thought. just to revise, epigastric pain + red flag [dysphagia.odynophagia.duration>5years] need a scope.

but ans is barium..A...any reason why? in real exam i would go with EGD.
@ TYAGEE, in which bank this qs is mentioned? why ans is barium? whats in explanation of barium, i think in this qs there's also hint to go for EGD, may b barium is correct before going to invasive diagnostic test we have to go first noninvasive test as barium is noninvasive.
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Old 03-23-2012
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Quote:
Originally Posted by usmlepak View Post
@ TYAGEE, in which bank this qs is mentioned? why ans is barium? whats in explanation of barium, i think in this qs there's also hint to go for EGD, may b barium is correct before going to invasive diagnostic test we have to go first noninvasive test as barium is noninvasive.
its consult.

epigastric pain + red flag ->next step-> scope. period. that what i learned.

if u can site reference, that wud help. regrds.
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Old 03-23-2012
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Quote:
Originally Posted by tyagee View Post
its consult.

epigastric pain + red flag ->next step-> scope. period. that what i learned.

if u can site reference, that wud help. regrds.
KAPLAN MEDICINE pg.69 EPIGASTRIC PAIN edition 2010-2011

here all is writthen read it carefully.take care
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Old 03-23-2012
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Quote:
Originally Posted by usmlepak View Post
KAPLAN MEDICINE pg.69 EPIGASTRIC PAIN edition 2010-2011

here all is writthen read it carefully.take care
i have 08-09 ones.

...All patients with epigastric pain and alarm symptoms, such as weight loss, dysphagia, odynophagia,
or heme-positive stool, should undergo endoscopy. In addition, endoscopy is recommended for
those above the age of 45, essentially to exclude gastric cancer....

this is what u mentioning?
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Old 03-24-2012
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Quote:
Originally Posted by tyagee View Post
i have 08-09 ones.

...All patients with epigastric pain and alarm symptoms, such as weight loss, dysphagia, odynophagia,
or heme-positive stool, should undergo endoscopy. In addition, endoscopy is recommended for
those above the age of 45, essentially to exclude gastric cancer....

this is what u mentioning?
yes this is.
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  #12  
Old 03-24-2012
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its scopy first then do the biopsy ..if its cancer then look where it has spread by CT- scan
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