Tufts OpenCourseware
Search
Author: Laurence Scott Bailen, M.D.

1. Question 1

A 54 year-old man complains of frequent heartburn. He reports a burning sensation in his chest within an hour of eating a large meal. He notes a similar sensation when he is in a supine position, particularly at bedtime. He denies any dysphagia or odynophagia.

Which of the following is the most likely mechanism resulting in the patient’s symptoms?

  1. Absent peristalsis in the esophageal body

  2. Transient relaxations of the LES (lower esophageal sphincter) without peristalsis

  3. Multiple, simultaneous peristaltic contractions

  4. High amplitude peristaltic contractions in the esophageal body

  5. High LES pressure with failure of the LES to relax with swallowing

2. Question 2

A 75 year-old woman complains of severe chest pain. A cardiac evaluation is unrevealing. An upper endoscopy shows erythema and linear ulcerations in the distal esophagus. Her only medication is synthroid (thyroid hormone replacement).

Which of the following is the most likely explanation for these endoscopic findings?

  1. Caustic injury

  2. Cytomegalovirus infection

  3. Mucosal injury from bile

  4. Mucosal injury from acid

  5. Mucosal injury from a foreign body

3. Question 3

A 62 year-old woman complains of progressive dysphagia to both solids and liquids. She has intermittent symptoms of heartburn. Her physical exam is remarkable for very taut skin on the face as well as sclerodactly. An upper endoscopy is unrevealing. An esophageal motility study is performed.

Which of the following manometric findings is most likely in this patient?

  1. High LES pressure; Low or absent peristaltic activity in the esophageal body; Normal LES relaxation with swallowing

  2. High LES pressure; Normal peristaltic activity in the esophageal body; Abnormal LES relaxation with swallowing

  3. Low LES pressure; Low or absent peristaltic activity in the esophageal body with swallowing; Abnormal LES relaxation with swallowing

  4. Low LES pressure; Normal peristaltic activity in the esophageal body; Normal LES relaxation with swallowing

  5. Low LES pressure; Normal peristaltic activity in the esophageal body; Abnormal LES relaxation with swallowing