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MMLU / A 40-year-old male presents to the office with symptoms of odynophagia and…

Problem

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question

A 40-year-old male presents to the office with symptoms of odynophagia and gastroesophageal reflux. He also says that he experienced hematemesis once last week. Past medical history reveals AIDS, and his most recent CD4 count was 30 cells/mcL. The patient's tilt test result and hemoglobin level are normal. Rectal examination demonstrates brown stool that is positive for occult blood. What is the most appropriate initial step in this patient's management?

choices

  1. prescription for a proton pump inhibitor and a prokinetic agent
  2. prescription for an H2-blocker trial for 6 weeks
  3. prescription for clotrimazole troches
  4. referral for an upper endoscopy with biopsy

subject

professional_medicine

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