infecious2 - a_antibody

[ArchivalUser]

A 23-year-old college student comes to the clinic because of odynophagia with solids and liquids and dysphagia that is most severe when eating solid foods. The patient had a past medical history of Shigella colitis last year while she was a Peace Corps volunteer in Peru. She takes oral contraceptives and smokes 1 pack of cigarettes daily. She does not drink alcohol. Vital signs are: temperature 37.8 C (100 F), blood pressure 100/70 mm Hg, pulse 79/min, and respirations 8/min. Physical examination is normal. Electrocardiogram reveals normal sinus rhythms with a rate of 85/min and a markedly enlarged QRS complex in leads V3-V5. Chest x-ray reveals an enlarged cardiac silhouette. A barium esophagram demonstrates a tapering of the distal esophagus that eventually releases as the esophagus is distended. There is no evidence for extrinsic or intrinsic compression of the distal esophagus or an esophageal mass. There is no reflux. The test most likely to lead to a unifying diagnosis in this case is
A. an agglutination test for trypanosomes

B. a chest CT

C. an esophageal manometry

D. a liver biopsy

E. a myocardial biopsy

[ArchivalUser]

I think it is Sarcoidosis...and diagnosed with Esophageal Manometry.....

[ArchivalUser]

what about chaga's .:)

[ArchivalUser]

I choose C

[ArchivalUser]

E. a myocardial biopsy

[ArchivalUser]

e)

[ArchivalUser]

a?

[ArchivalUser]

E??

[ArchivalUser]

Explanation:
The correct answer is A. The findings of achalasia and cardiomyopathy in a patient with history of travel to Central or South America support the diagnosis of Chagas disease. This is caused by infection of Trypanosoma cruzi in the muscles of the heart, esophagus, and colon. A serum agglutination test is a noninvasive means of testing for this infection, and is highly sensitive. Left untreated, heart failure and megacolon could develop.
A chest CT (choice B) would not reveal any specific findings of Chagas disease. Using a CT to evaluate for an occult cancer causing esophageal narrowing is superfluous given the findings on the barium esophagram, which is specific for achalasia.
An esophageal manometry (choice C) is a confirmatory test for achalasia. Given the highly suggestive findings of achalasia on the barium esophagram, manometry would not be necessary.
A liver biopsy (choice D) has no role in the evaluation of Chagas disease.
A myocardial biopsy (choice E) is not necessary to diagnose Chagas disease with the availability of the serum agglutination test for trypanosomes. Invasive procedures should be deferred until they are absolutely necessary.

[ArchivalUser]

Great explanation.....I missed looking for PERU ( which is famous for Trypanosomiasis)....Keep up the good work.....