A 62-year-old man presents with a 3-month history of weakness, fatigue, and weight loss. He also reports a burning epigastric pain. The patient has an insignificant past medical history and smokes 2 packs of cigarettes per day. He drinks 4 to 5 beers per day as well. Work-up is initiated and the patient is found to have a positive fecal occult blood test. Esophagogastroduodenoscopy is performed and demonstrates a fundal ulcer. Biopsy is performed and is positive for adenocarcinoma. Which of the following is the best next step in management of this patient?
Question
A 62-year-old man presents with a 3-month history of weakness, fatigue, and weight loss. He also reports a burning epigastric pain. The patient has an insignificant past medical history and smokes 2 packs of cigarettes per day. He drinks 4 to 5 beers per day as well. Work-up is initiated and the patient is found to have a positive fecal occult blood test. Esophagogastroduodenoscopy is performed and demonstrates a fundal ulcer. Biopsy is performed and is positive for adenocarcinoma. Which of the following is the best next step in management of this patient?
Solution
The best next step in the management of this patient would be staging of the cancer. This is typically done through a combination of endoscopic ultrasound to evaluate the depth of invasion and the involvement of regional lymph nodes, and CT scan of the chest, abdomen, and pelvis to evaluate for distant metastasis. This will help determine the most appropriate treatment plan, which could include surgery, chemotherapy, radiation, or a combination of these.
Similar Questions
A 22-year-old man presents with bloody and tarry stools for the last month. The patient denies any associated symptoms and reports that he does not know his family history since he is adopted. Fecal occult blood test is positive and the patient has a hemoglobin level of 8.9 g/dL. Colonoscopy is performed and hundreds of colonic polyps are appreciated. Biopsy confirms that they are adenomatous polyps. What is the best next step in management for this patient's condition?Ask StudybuddyGroup of answer choicesRepeat colonoscopy and biopsy in 1 yearElective proctocolectomyMonthly FOBT and CEA levelsReassurance as the polyps are benign
A 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting. The pain is partially relieved by sitting up or bending forward. He has also had mild shortness of breath. The patient's other medical history includes hyperlipidemia and hypertension. He uses tobacco and alcohol. There is a family history of coronary artery disease and hypertension. Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min. There is dullness to percussion and decreased breath sounds at the left lung base. Abdominal examination shows epigastric tenderness. Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors
A 48-year-old man presents to the hospital with swelling of the abdomen and legs. He first noticed shortness of breath with exertion several months ago, and has had a few episodes where he momentarily became lightheaded and lost consciousness. Now the symptoms have been progressing with increased dyspnea and edema. He reports that he has always lived a healthy lifestyle and has no past medical history. There is no family history of any cardiac or pulmonary disease, or any cancer. He was born in Brazil and moved to the United States at the age of 43. He does not smoke or drink alcohol. On cardiac examination, the apex is displaced laterally with an S3 on auscultation. Estimated central venous pressure is 15 mmHg, and there are faint crackles at the base of his lungs. He has hepatomegaly with shifting dullness and bilateral pitting edema of the lower extremities. An ECG is normal, with no visible Q waves. Which infectious etiology is most likely responsible for this patient's disease?
A 68-year-old male with a history of lung cancer undergoes follow-up labs after recent cycle of chemotherapy. He has mild difficulty with concentration over the past week but is otherwise able to complete all of his daily tasks. He reports no nausea, vomiting, or positional lightheadedness. He has no other significant past medical history. He takes no medications. Vital signs are as follows: Temperature 99.8°F, RR 18, BP 135/88 mm Hg, pulse 76. On examination, he is alert and oriented. Cardiac examination reveals regular rate and rhythm, no murmurs, JVP not elevated. Lung and abdominal examinations are normal. There is no lower extremity edema. Skin turgor is normal. Neurologic examination reveals 5/5 strength in all extremities, no focal deficits, and normal gait. Laboratory tests reveal the following: serum Na+ 121 mEq/L, K+ 4.3 mEq/L, BUN 7.0 mg/dL, Cr 0.4 mg/dL, glucose 106 mg/dL. TSH 2.0 mU/L. Serum osmolality 250 mOsm/kg, urine Na 45 mEq/L, urine osmolality 450 mOsm/kg. What is the most appropriate management of this patient?
A 26-year-old man presents to his primary care physician with fatigue, headache, and a sore throat for the past week. There is also nausea and diarrhea, but no weight loss, productive cough, or difficulty breathing. He has no known past medical history, does not take any medications, and has no recent sick contacts. He is sexually active and uses condoms inconsistently; he drinks alcohol heavily on the weekends and has had previous IV drug use. On examination, his temperature is 39°C and the rest of his vital signs are normal. He has nontender cervical and axillary lymphadenopathy, tonsillar exudates, and mild splenomegaly. There are also several painful, well-demarcated ulcers within his mouth and a mild maculopapular rash over his chest and arms. A rapid Strep test and a monospot (heterophile antibody) test are negative; further screening for chlamydia, gonorrhea, syphilis, and HIV antibody is negative. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesUpper respiratory infectionSecondary syphilisHodgkin lymphomaAcute retroviral syndromeInfectious mononucleosis
Upgrade your grade with Knowee
Get personalized homework help. Review tough concepts in more detail, or go deeper into your topic by exploring other relevant questions.