Question of the Week # 464

Posted on March 21, 2015 by Archer USMLE Reviews

464) A 68 year old man with history of Diabetes Mellitus type II and diabetic gastroparesis is evaluated in your office for lack of appetite, nausea, vomiting, weight loss and a feeling full after eating small amounts of food material. He has lost 10 lbs weight in past 2 months. He denies any rectal bleeding or melena. He does report some epigastric discomfort. On examination, he appears in no distress, blood pressure is at 120/80. Abdomen is mildly distended with slight tenderness in upper abdomen. Patient is admitted and started on IV hydration. A plain X-ray abdomen is shown below. Gastroenterology is consulted and an upper endoscopy is pending. What is the most appropriate evidence-based next step?

A) Arrange for Laparoscopy
B) Endoscopic removal
C) Give Coca-Cola
D) Give Pepsi or any other soda
E) Metoclopramide

Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, USMLE STEP 3 GASTROENEROLOGY |

21 Responses

laurentiu244, on March 21, 2015 at 11:26 pm said:

E

Reply
- Archer USMLE Reviews, on March 22, 2015 at 12:42 am said:
  
  what does the x-Ray show?
  
  Reply
ehteshamfarzana, on March 22, 2015 at 1:07 am said:

E

Reply
- Archer USMLE Reviews, on March 22, 2015 at 1:30 am said:
  
  Knowing what’s shown in this X-Ray will help you choose the correct answer. Diabetic gastroparesis is a distractor.
  
  Reply
GZ (@Neurofrantic), on March 22, 2015 at 2:49 am said:

A

Reply
Rohini, on March 22, 2015 at 2:49 am said:

Give metochlropramide- pro kinetic

Reply
Rohini, on March 22, 2015 at 2:50 am said:

Is it a volvulus? Laparoscopy?

Reply
- Rohini, on March 22, 2015 at 2:50 am said:
  
  Sorry I mean laparotomy ?
  
  Reply
  - Rohini, on March 22, 2015 at 2:53 am said:
    
    It’s a bezoar!!!!!
Rohini, on March 22, 2015 at 2:58 am said:

It seems to have a weird foggy appearance. I feel like it’s a gastric bezoar and that it needs to be removed endoscopically. Taking a wild guess

Reply
- Archer USMLE Reviews, on March 22, 2015 at 2:59 am said:
  
  Bezoar is correct but laparoscopy is not the first step!
  
  Reply
  - Rohini, on March 22, 2015 at 3:03 am said:
    
    Endoscopy
pratt, on March 22, 2015 at 3:05 am said:

give coca cola

Reply
- Rohini, on March 22, 2015 at 3:09 am said:
  
  What’s most interesting is there are 3 classes of sodas- coca cola, Pepsi and others :):)
  
  Reply
- Rohini, on March 22, 2015 at 3:19 am said:
  
  No kidding !! It is coca cola!!! Read about it online. Wow!!
  
  Reply
  - Archer USMLE Reviews, on March 22, 2015 at 3:35 am said:
    
    Though Pepsi or other colas might work , we only have evidence so far for coca cola. So Coca Cola wins this one 🙂
    1) http://www.ncbi.nlm.nih.gov/m/pubmed/23252775/?i=5&from=coca%20cola%20bezoar
    2) http://mobile.beveragedaily.com/R-D/Not-gettin-far-with-that-gastric-bezoar-Grab-a-Coke#.VQ41ioY8LCQ
    3) http://www.medpagetoday.com/MeetingCoverage/DDW/9611
    4) http://www.holliswalker.com/the-real-thing/
    5) http://www.medscape.com/viewarticle/777371
    6) http://www.ncbi.nlm.nih.gov/m/pubmed/12169994/?i=20&from=coca%20cola%20bezoar
Rohini, on March 22, 2015 at 3:06 am said:

Is this because he was eating something weird or because the gastroparesis predisposed the accumulation of insoluble food stuff leading to the bezoar?

Reply
Rohini, on March 22, 2015 at 11:00 am said:

Very interesting. Thank you for the links. For anyone trying to substantiate their coke intake, it does nt get better than this!! “Prescription coca cola” 🙂

Reply
laurentiu244, on March 22, 2015 at 12:20 pm said:

This is a good one . I did not know about coca cola and bezoar .Thank you

Reply
sauron, on July 31, 2015 at 4:27 pm said:

so would have got this question wrong in the exam, seems like for some questions in step 3 take the most weird answer to get it right, i have never heard of a phyto gastric bezoar, what is it??

Reply
dr_ahm, on July 20, 2018 at 6:55 pm said:

c

Reply