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* Q9 Archer Qbank
  aravindk - 01/07/17 16:10
  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
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* Re:Q9 Archer Qbank
  dermat - 01/09/17 16:05
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* Re:Q9 Archer Qbank
  hesslid - 01/10/17 16:28
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* Re:Q9 Archer Qbank
  aravindk - 01/12/17 23:56
  lol ..COKE  
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* Re:Q9 Archer Qbank
  dermat - 01/14/17 13:36
  can u please explain on that?
The pt in the vignette has developed gastroparesis secondary to DM
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* Re:Q9 Archer Qbank
  lamonti - 01/14/17 17:46
  Interesting case!

Xray looks like fecal impaction. Look at the dilated loops of bowel. History of wt loss in 2 months duration is alarming!

I will go for A
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* Re:Q9 Archer Qbank
  lamonti - 01/14/17 19:28
  OKay, it's a volvulus. 1st step in mx will be endoscopic reduction [proctosegmidoscpy with rectal tube left for 48 hrs]
Thanks for sharing!
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* Re:Q9 Archer Qbank
  chenna - 01/22/17 23:09
  Gastric Bezoar - Coca cola is ans  
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* Re:Q9 Archer Qbank
  nodiroygr - 01/24/17 09:38
  Can you please send me the link of Archar q bank??
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