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Old 11-02-2012
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Arrow Gyrus Daily Questions; Internal Medicine #67

A 43 yeat old man recently diagnosed whith AIDS comes to the emergency department with pain on swallowitn that has vecome progressive worse ove the last several weeks.There is no pain when nor seallowitn.His CD4 count is 43 mm3 .The patient is not currently takinf any medication.

What is the most appropriate next step in managment?

a. Esophagram.
b. Upper endoscopy
c. oral nystatin and swish and swallow.
d. Intravenous amphotercin
e. Oral fluconazole.
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Old 11-02-2012
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E start with fluconazole
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Old 11-02-2012
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yes E ..........
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Quote:
Originally Posted by cingulate.gyrus View Post
A 43 yeat old man recently diagnosed whith AIDS comes to the emergency department with pain on swallowitn that has vecome progressive worse ove the last several weeks.There is no pain when nor seallowitn.His CD4 count is 43 mm3 .The patient is not currently takinf any medication.

What is the most appropriate next step in managment?

a. Esophagram.
b. Upper endoscopy
c. oral nystatin and swish and swallow.
d. Intravenous amphotercin
e. Oral fluconazole.

THis patient has candidiasis until proven otherwise, if he doesnt get better then

Do an endoscopy
Big punched out ulcers: CMV

Big ulcers that coalesce: Herpes
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Old 11-02-2012
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Correct answer E.

90% of esophageal infections in patient Aids are caused by candida.Empiric treatment with fluconazole is the best course of action.

Intravenous amphotericin is used in confirmed candidiasis not responding to fluconazole.

Nystatin is used in oral candidiasia.
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