ROSH Gastrointestinal Practice Exam

An elderly woman presents with difficulty swallowing after antibiotic treatment. What is the most likely causative agent for her symptoms?

1. Herpes simplex virus type I

2. Cytomegalovirus

3. Mycobacterium tuberculosis

4. Candida

The correct answer is: Candida

In the scenario described, an elderly woman experiencing difficulty swallowing after antibiotic treatment suggests the development of esophagitis, commonly associated with Candida. Antibiotics can disrupt the normal flora of the mouth and gastrointestinal tract, leading to an overgrowth of Candida species, which are opportunistic fungi. Candida esophagitis typically presents with symptoms such as odynophagia (painful swallowing) and dysphagia (difficulty swallowing). This condition is especially prevalent in immunocompromised patients and those with altered microbial balance due to antibiotic use. The presentation aligns well with the effects of antibiotics leading to a proliferation of Candida, making it the most likely causative agent in this case. In contrast, the other pathogens are less common in this context. Herpes simplex virus type I usually causes oropharyngeal lesions and may lead to swallowing difficulties, but it is not as directly associated with antibiotic use. Cytomegalovirus can cause esophageal ulcers, particularly in immunocompromised individuals, but it is less frequently implicated immediately following antibiotic treatment. Mycobacterium tuberculosis is associated with extrapulmonary manifestations but is an unlikely cause of swallowing difficulty in this particular scenario.