Rosh Emergency Medicine Practice Test

Which treatment is recommended for managing a patient with chest pain and suspected esophageal candidiasis?

1. Clotrimazole troches

2. IV amphotericin B

3. Nystatin swish and swallow

4. Oral fluconazole

The correct answer is: Oral fluconazole

In the context of managing a patient with chest pain associated with suspected esophageal candidiasis, the most appropriate treatment is oral fluconazole. This antifungal medication is often the first-line therapy for esophageal candidiasis due to its effectiveness against Candida species and its oral bioavailability, which makes it suitable for outpatient treatment. Esophageal candidiasis commonly occurs in immunocompromised patients or those with risk factors such as diabetes or antibiotic use. Symptoms often include chest pain, dysphagia (difficulty swallowing), and odynophagia (painful swallowing). Oral fluconazole not only targets the infection effectively but also has a good safety profile and is well-tolerated by patients. While other treatments are available, they serve different situations. Clotrimazole troches may help with mild oral thrush but are not as effective for esophageal infections. IV amphotericin B is typically reserved for more severe infections or cases where there's resistance to azoles, given its potential for significant side effects. Nystatin, while useful for oral candidiasis, is less effective for esophageal infections due to poor absorption when used in a swish-and-swallow manner. In summary, oral fluconazole represents the most effective and appropriate option for treating suspected