Gastrointestinal system

Gastrointestinal system




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USMLE® Step 1 questions

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A 40-year-old woman comes to the office due to difficulty swallowing, food regurgitation, and reflux for the past several months. The patient describes difficulty swallowing both liquids and solids. She occasionally regurgitates chunks of undigested food. Medical history is unremarkable except for a C-section 8 years ago. She has had no recent illness, weight loss or fatigue, and she does not smoke cigarettes or use illicit drugs. She drinks alcohol socially. She has not traveled out of the country recently. A barium swallow test is performed and shown below:  


Reproduced from: Wikimedia Commons

Which of the following patterns is most likely to be seen in this patient on manometry of the esophagus?  


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Achalasia p. 385

esophageal cancer and p. 387

LES tone in p. 380

Chagas disease p. 155

achalasia in p. 385


achalasia p. 385

Esophageal cancer p. 387

achalasia and p. 385

Lower esophageal sphincter

achalasia and p. 387

Trypanosoma cruzi p. , 155

achalasia and p. 385

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Achalasia is a rare disorder of the esophagus in which the lower esophageal sphincter fails to relax. This interferes with the normal movement of food and liquid from the mouth to the stomach. The main symptoms are difficulty swallowing (dysphagia) and regurgitation of food or liquid. These symptoms may get worse over time. Achalasia can also cause chest pain, heartburn, and problems with breathing.

The diagnostic workup of achalasia may involve esophageal manometry, upper GI endoscopy, and esophageal barium swallow. The treatment can require surgery to correct the defect or pneumatic dilation in which a balloon can be used to dilate narrowed segments of the esophagus. Achalasia


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