18th July 2023

A 27-year-old woman presents to a general medical clinic with multiple vague symptoms

A 27-year-old woman presents to a general medical clinic with multiple vague symptoms. She complains of longstanding fatigue and a 2-month history of odynophagia and dysphagia. In the last 10 months she has gone down 2 dress sizes. She has no past medical history of note and only takes paracetamol for intermittent headaches. On general examination, the woman is slim and has palpable enlarged lymph nodes in the axillary and inguinal region. Looking into the back of her throat, you can see multiple small white spots on the oral mucosa, which can be scraped off with a tongue depressor. She subsequently undergoes gastroscopy, which reveals diffused, raised white plaques in the oesophagus that are removed from the mucosa by the endoscope. Her observations are:

Temperature 37.8oC

Heart Rate 105

Blood Pressure 97/55

Respiratory Rate 20

Oxygen saturation 94% RA

Which of the following is the most appropriate initial investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.