Dysphagia+ weight loss + asthma history + heartburn+ background melanoma Possible DD: 1) esophageal Carcinoma (considering the age, and the presenting S/S, although the melanoma was excised completely) 2) Achalasia cardia 3) Long standing Steroid induced candidiasis (unlikely in the absence of sore throat/ oral ulcer/ odynophagia) I think to rule out carcinoma completely, history of feeling tired/ generalized weakness, getting paler day by day or anemic symptoms and fever as a part of constitutional symptom should have been explored. Nonetheless, good wrap up of the history. A barium meal xray, a chest xray PA view, FBC, and an upper GIT endoscopy is needed anyway. From the investigation clues, an esophageal manometry or biopsy can be planned accordingly. Smoking cessation advice and advice regarding steroid use for asthma should be counselled.
@@CC-watches You may want to avoid "cessation lectures" if you'd like. Obviously it's not needed in a person who never has smoked or currently is a smoker. Depends on the surrogate's reply.. My "year old" comment was more generalized anyway!
The patients dysphagia was to both solids and liquids right away. Cancer is an important differential but this points away from cancer. Cancer statts with soilds and then progresses to liquids, coupled with lack of risk factors makes it even less likely. Myasthenia gravis is an important differential as well
FYI ocular melanoma can spread to the liver. My aunty died because medics didnt know this - 20 yrs after successful treatment of iculat melanoma liver disease started & took over. Mentioning as i didn't know this either.
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Dysphagia+ weight loss + asthma history + heartburn+ background melanoma
Possible DD: 1) esophageal Carcinoma (considering the age, and the presenting S/S, although the melanoma was excised completely)
2) Achalasia cardia
3) Long standing Steroid induced candidiasis (unlikely in the absence of sore throat/ oral ulcer/ odynophagia)
I think to rule out carcinoma completely, history of feeling tired/ generalized weakness, getting paler day by day or anemic symptoms and fever as a part of constitutional symptom should have been explored.
Nonetheless, good wrap up of the history.
A barium meal xray, a chest xray PA view, FBC, and an upper GIT endoscopy is needed anyway.
From the investigation clues, an esophageal manometry or biopsy can be planned accordingly.
Smoking cessation advice and advice regarding steroid use for asthma should be counselled.
She’s not a smoker and has never smoked in her life. Why would you include cessation lectures?
@@CC-watches You may want to avoid "cessation lectures" if you'd like. Obviously it's not needed in a person who never has smoked or currently is a smoker. Depends on the surrogate's reply..
My "year old" comment was more generalized anyway!
The patients dysphagia was to both solids and liquids right away. Cancer is an important differential but this points away from cancer. Cancer statts with soilds and then progresses to liquids, coupled with lack of risk factors makes it even less likely.
Myasthenia gravis is an important differential as well
FYI ocular melanoma can spread to the liver. My aunty died because medics didnt know this - 20 yrs after successful treatment of iculat melanoma liver disease started & took over. Mentioning as i didn't know this either.
Hello i subscribed to pass test n its nt showin my subscription omly message so many times to customer care what kind of service is this???
Too much talk exusting and overwhelming for both Doc and patient what an exaggerated prequiset of us on tests! That is not needed in real life!!😐
Shut up
💯
You better but the discussion similar to that in the exam for better yield.
Jeez I wonder what could be wrong with this lady.