USMLE Forum Archives - USMLE Step 2 CK - int.med./GI
int.med./GI
ysemak - 01-20-10 06:31
A 32-y/old male presents with substernal discomfort. The symptoms are worse after meals, particularly a heavy evening meal, and are sometimes associated with hot/sour fluid in the back of the throat and nocturnal awakening. The patient denies difficulty swallowing, pain on swallowing, or weight loss. The symptoms have been present for 6 weeks; the patient has gained 20 lb in the past 2 years. Your initial approach is
ysemak - 01-20-10 06:31
A 32-y/old male presents with substernal discomfort. The symptoms are worse after meals, particularly a heavy evening meal, and are sometimes associated with hot/sour fluid in the back of the throat and nocturnal awakening. The patient denies difficulty swallowing, pain on swallowing, or weight loss. The symptoms have been present for 6 weeks; the patient has gained 20 lb in the past 2 years. Your initial approach is
The correct answer and explanation will be available after you answer.
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#1
Re: int.med./GI conym5 - 01-20-10 23:34 My answer is: a.
For infrequent heartburn, the most common symptom of GERD, life-style changes and an occasional antacid may be all that is necessary. If heartburn is frequent, daily non-prescription-strength (over-the-counter) H2 antagonists may be necessary.
#7
Re: int.med./GI pratyush - 01-23-10 05:09 My answer is: a.
since the symptoms are associated with meals and obesity they suggest pud and gerd. the patient will thus be relieved of symptoms with a trial of ranitidine. since upper gi endoscopy an intrusive procedure the pt. shold not be subjected to it unnecessarily
#14
Re: int.med./GI ammulufy - 03-21-10 18:40 My answer is: a.
Since the ptnt has no other risk ptnts whch point towards a possible cardiac disease like increased age or typical symptoms of an angina......I fell the answer is 1 but again I feel b also can be the answer because at any pt of time a probable cardiac pathology is to be ruled wid d minimum invasice tests atleast as long as it is there in the DD.....but features of regurgitation of gastric contents point towards GERD,n its a known fact tht ptnt comfort is to b given d top priority.....I go wid a.
#17
Re: int.med./GI mtniharika - 04-29-10 08:38 My answer is: a.
as the symptoms point towards GERD supported by the postural variation and obesity, a trial with h2 blockers and when unrelieved, endoscopy is the preferred.
#18
Re: int.med./GI babbu5508 - 05-23-10 03:06 My answer is: a.
if the symptoms are severe or they come back after having been treated, one or more tests may help diagnose reflux or any complications:Esophagogastroduodenoscopy (EGD)
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