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Riddler Q8

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  • 1. Riddler #7
    • A 40 y/o man has a 3 month history of dysphagia with solids. Symptoms occur twice a week, especially when he eats fast. Hard bread and tough meats are particularly bothersome. Denies heartburn or weight loss. Does not smoke or drink and takes no medications. Exam and Labs are nml.
  • 2. Riddler #7, con’t
    • A barium swallow is shown
    • 1pt) What’s the diagnosis
    • 1pt) Whats the treatment?
    • Bonus: Will the Redskins win? (must be answered today) 3pt’s
  • 3. Riddler #7, Answer
    • Intermittent dysphagia for solids -Schatzki’s Ring (smooth symetric mucosal ring at the junction of the E/G junction. Symptoms usually present with intraluminal narrowing of <13mm.
    • Dilation, usually with excellent response
    • Redskins are on a role
  • 4. Con’t
    • Things to remember:
      • Carcinoma usually seen in older patients with dysphagia and weight loss
      • Achalasia, pt’s have dysphagia for both solids and liquids and have regurgitation.
      • Barrett’s is an endoscopic/pathological diagnosis
  • 5. Riddler #8
    • 24 y/o man who formerly used injection drugs is found to have a blood urea nitrogen concentration of 24mg/dl, a serum creatinine concentration of 2.5 mg/dL, and a urine protein-to-creatinine ratio of 8. Tests are positive for HIV and negative for Hep b and C. Renal U/S shows kidneys of 11cm on Right and 10.5 on left. Renal biopsy is performed.
  • 6. 8 con’t
    • What is the most likely pattern of glomerular injury in this patient? (2pts)
    • A) Minimal change disease
    • B) Membranous glomerulopathy
    • C) Membranoproliferative glomerulonephritis
    • D) Allergic Interstitial Nephritis
    • E) Collapsing focal and segmental glomerulonephritis