On Phytobezoars, HIV-Associated Candida, Progressive Dysphagia

December 13, 2013

Four photos, 5 short real-life cases: can you solve these 5 diagnostic mysteries?

Question 1:

A 59-year-old woman with a history of peptic ulcer disease presented with a several day history of epigastric pain. Her past medical history included a Billroth II procedure with Roux-en-Y revision for an anastomotic bleed. Upper endoscopy showed a normal gastric remnant, an ulcer at the anastomotic site, and a large bezoar on the gastric side of anastomosis. Biopsy confirmed the diagnosis of phytobezoar.

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Question 2:

A 45-year-old man complained about moderate itching and scaling between his toes on both feet.

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Question 3:

A 44-year-old woman presented with progressive dysphagia and associated nausea and vomiting of 2 weeks’ duration.

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Question 4:

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Question 5:

A 47-year-old HIV-positive man presented with severe thrush, profound dysphagia, and a 30-lb weight loss. He underwent an upper endoscopy with biopsies. Specimens revealed unspeciated Candida.

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ANSWER KEY:

Question 1. G

Question 2. D

Question 3. B

Question 4. A

Question 5. A