Okay, my name is Devine. This is episode 427 of the Devine Intervention Podcast.

To this podcast I'm going to be continuing the rapid review series for the US

SME Step 2K exam this is going to be series 88.

Let's jump right into it.

So, what if they give you a question about a patient? They tell you that this patient for the last six weeks has been on famody dean and this person has like a long history of gird and the famodidin is not controlling their symptoms.

And then they tell you that the person has started having mild pain with swallowing.

And then they ask, what is your next best step in management?

What should you do on an NBM exam?

Well, obviously one reasonable answer they offer to you is to switch to some kind of

PPI.

And then the answer you may see is, hmm, let's go ahead and get an EGD and basically ago gastrotoidinoscopy, right? That's operatingoscopy.

I would really hope in this circumstance you're saying, or divine,

I think I'm going to go with an EGD I'm going to do a

grandoscopy. So the thing is knowing the indications for EGD is pretty

high-yield for exams you know first things first for person has gird, you know, typically if you try and answer say that it doesn't work, a smart place to say

let's go for a PPI. But there are certain things that can really scare you that will make you say,

I don't know, I think I'm going to go ahead and do an EGD. And what are some of those things?

Well, the first one is if the person has alarm symptoms

when person has greater alarm symptoms you need to take them for an EGD right and

what are some of these alarm symptoms the obvious one is weight loss if person is losing weight, then we're kind of worried about cancer. So in those circumstances, it would make sense to get an EGD. And then if a person has dysfasia, that's also an alarm symptom. If a

person has this phasia, that's also an alarm symptom.

If a person has difficulty swallowing, that's an alarm symptom.

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