git 1 - kylie

[ArchivalUser]

65 yr old woman,h/o fatigue and dyspnea.takes no medication.BP is 180/80,pulse is 100/min and resp is 21/min.auscultation shows 2/6 systolic murmur in the 2nd left intercostal space.No peripheral edema,Normal rectal exam.Stool is negative for occult blood.EKG show sinus tachycardia,non specific ST-T changes.
labs show low Hb and low MCV.
which of the following is most appropriate next step in management?
a.echo
b.bone marow biopsy
c.gastro deudenoscopy
d.colonoscopy
e.isotope-labeled erythrocyte scintography

[ArchivalUser]

This is a tough one. My answer is C, but I'm not sure.

It looks like the woman has fatigue and dyspnoea from anaemia. There is evidence of tachycardia with highish BP and a flow murmur.
Why would a 65 yo woman have microcytic anaemia? Blood loss, thalassaemia, etc.
Normal rectal exam does not completely exclude a GI source of bleed. You need to do further tests, esp in this post-menopausal woman with microcytic anaemia, to search for possible GI bleeding. I would do an upper endoscopy first.

[ArchivalUser]

c.

iron deficiency anemia.- could be colon ca.

[ArchivalUser]

sorry, not c, its D.

[ArchivalUser]

hmmm.its definitely anemia.and iron deficiency anemia is most common in elderly.MCC cause is colon cancer.So D is the answer.

[ArchivalUser]

but how about negativ stool test for ocult blood?
why is not a hemolitic anemia due to aortic stenosis?

[ArchivalUser]

hemolytic is normocytic, normochromic, no retic is given, murmur is not classical(left sided here), ekg no pressure oveerload and of course, colonoscopy is required not only 'coz she has anemia, but also has the right age for it. stool occult should be done 3 consecutive days and 3 slides should be examined from each sample before been reported negative, so it is poosible to miss on one.

[ArchivalUser]

its ddddd coz colon is the most common site to bleed in elderly...