USMLE Forum Archives - USMLE Step 2 CK - Psychaitry & Ethics 1
Psychaitry & Ethics 1
TheOne - 12-03-06 17:34
A patient with a history of hypertension calls his physician's office for advice. He has had longstanding heartburn and recently consulted with a gastroenterologist. He underwent an endoscopy and was told that "Barrett's mucosa" was found by biopsy. The patient has read in the newspaper that people with this condition will probably develop esophageal cancer. Which of the following is the most appropriate response to this concern?
A. "Your concerns are ungrounded"
B. "It is foolish to worry because this type of cancer is unlikely to develop and would occur
many years later"
C. "You should chew food very carefully to prevent the possibility of a mechanical
obstruction"
D. "Only a small minority of patients with Barrett's esophagus will develop cancer, and you
should undergo endoscopic surveillance"
E. "You should consult with an oncologist regarding esophageal cancer prevention
strategies"
TheOne - 12-03-06 17:34
A patient with a history of hypertension calls his physician's office for advice. He has had longstanding heartburn and recently consulted with a gastroenterologist. He underwent an endoscopy and was told that "Barrett's mucosa" was found by biopsy. The patient has read in the newspaper that people with this condition will probably develop esophageal cancer. Which of the following is the most appropriate response to this concern?
A. "Your concerns are ungrounded"
B. "It is foolish to worry because this type of cancer is unlikely to develop and would occur
many years later"
C. "You should chew food very carefully to prevent the possibility of a mechanical
obstruction"
D. "Only a small minority of patients with Barrett's esophagus will develop cancer, and you
should undergo endoscopic surveillance"
E. "You should consult with an oncologist regarding esophageal cancer prevention
strategies"
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#3
Re: Psychaitry & Ethics 1 Brainlab - 12-03-06 22:00 Correct answer is D.
For people who have Barrett's esophagus, the risk of getting cancer of the esophagus is small: less than 1 percent (0.4 percent to 0.5 percent) per year.
#4
correct
TheOne - 12-06-06 11:30 The correct answer is D. Barrett's esophagus may occur in a small number of patients who have gastroesophageal reflux disease (GERD). This condition is a metaplasia of the normal squamous mucosa of the esophagus to a columnar (glandular) type of epithelium, and is usually seen as a response to repeated acid exposure to the distal esophagus. Tobacco and alcohol use are also thought to contribute to the process. The significance of Barrett's esophagus is that it may lead to the development of low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. However, this is a very infrequent occurrence when considering the large number of patients with GERD and even those with Barrett's esophagus. Barrett's esophagus usually does not resolve with either medical or surgical therapy. Endoscopic surveillance (with multiple small biopsies, since dysplasia cannot be reliably evaluated by endoscopic appearance alone) every 1-2 years has been often recommended, but some studies suggest that it may not be cost-effective.
It is not factually true to inform the patient that his concerns are "ungrounded" (choice A), because there is in fact a small risk of adenocarcinoma.
It is never appropriate to belittle a patient's concerns and inform him that his worries are "foolish" (choice B).
Barrett's esophagus is a histologic change and, unless accompanied by a stricture, does not produce symptoms of mechanical dysphagia (choice C).
It is inappropriate to refer the patient to a cancer specialist (choice E) for the prevention of a very unlikely development of cancer; furthermore, preventive strategies should include instructions to avoid factors that exacerbate GERD and should be delivered to the patiebt directly through the physician who's examining him.
#6
Re: Psychaitry & Ethics 1 bingousmle - 07-19-10 08:43 D. "Only a small minority of patients with Barrett's esophagus will develop cancer, and you
should undergo endoscopic surveillance"
#8
Re: Psychaitry & Ethics 1 babbu5508 - 10-24-10 07:12 D. "Only a small minority of patients with Barrett's esophagus will develop cancer, and you
should undergo endoscopic surveillance"
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