Nokea
A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
- A. Upper endoscopy
- B. Chest/abdominal CT scan
- C. Barium swallow
- D. Esophageal manometry
Correct Answer: C
Rationale: The correct answer is C: Barium swallow. In this case, the patient's symptoms suggest a possible esophageal disorder affecting solid food ingestion. Barium swallow is a non-invasive test that can detect structural abnormalities in the esophagus, such as strictures or tumors, that may be causing dysphagia. It is the best initial test to evaluate the patient's symptoms as it provides a detailed visualization of the esophagus and can identify the cause of dysphagia. Upper endoscopy (choice A) would be appropriate if structural abnormalities are suspected. Chest/abdominal CT scan (choice B) may not provide as detailed information about esophageal function. Esophageal manometry (choice D) is more useful for evaluating motor function of the esophagus, which is not the primary concern in this case.
You may also like to solve these questions
A 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Primary biliary cirrhosis
- B. Primary sclerosing cholangitis
- C. Gallstones
- D. Pancreatic cancer
Correct Answer: A
Rationale: The most likely diagnosis is A: Primary biliary cirrhosis.
Rationale:
1. Pruritus, jaundice, and xanthomas are classic symptoms of cholestatic liver disease.
2. Elevated cholesterol and alkaline phosphatase levels are characteristic of primary biliary cirrhosis.
3. Primary biliary cirrhosis is an autoimmune disease affecting small bile ducts, leading to liver damage.
4. Primary sclerosing cholangitis (B) presents with similar symptoms but typically affects larger bile ducts.
5. Gallstones (C) could cause jaundice but would not explain the elevated cholesterol levels.
6. Pancreatic cancer (D) may present with jaundice but is less likely given the specific lab findings.
A 35-year-old man presents with fatigue, weight loss, and hyperpigmentation of the skin. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
- A. Cushing's syndrome
- B. Addison's disease
- C. Hypothyroidism
- D. Pheochromocytoma
Correct Answer: B
Rationale: The most likely diagnosis is Addison's disease (Choice B) because the symptoms match adrenal insufficiency. The low cortisol levels indicate adrenal cortex dysfunction, leading to fatigue and weight loss. Hyponatremia and hyperkalemia result from mineralocorticoid deficiency. Hyperpigmentation occurs due to elevated ACTH levels stimulating melanin production in Addison's. Cushing's syndrome (Choice A) presents with high cortisol levels, opposite to the low levels seen here. Hypothyroidism (Choice C) does not typically cause hyponatremia or hyperkalemia. Pheochromocytoma (Choice D) manifests with hypertension and catecholamine excess, not seen in this case.
The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?
- A. She is at low risk for reinfection with H. pylori
- B. A positive serum IgG indicates that eradication of H. pylori was successful
- C. The urease breath test is an ideal test to document failure of eradication
- D. Dyspepsia typically worsens with H. pylori eradication
Correct Answer: C
Rationale: The correct answer is C because the urease breath test is the ideal test to document failure of H. pylori eradication. This test directly measures the presence of the H. pylori bacterium in the stomach by detecting the enzyme urease produced by the bacterium. If the patient still has symptoms after treatment, a positive urease breath test would indicate that the bacterium is still present, leading to treatment failure.
Choice A is incorrect because a positive antibody test does not indicate low risk for reinfection. Choice B is incorrect because a positive serum IgG may persist even after successful eradication. Choice D is incorrect because dyspepsia can improve after successful H. pylori eradication rather than worsen.
A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?
- A. Acute pancreatitis
- B. Mesenteric ischemia
- C. Peptic ulcer disease
- D. Diverticulitis
Correct Answer: B
Rationale: The most likely diagnosis in this case is B: Mesenteric ischemia. Given the sudden onset of severe abdominal pain in an elderly patient with atrial fibrillation, mesenteric ischemia is a crucial consideration due to the risk of thromboembolism from the heart condition leading to inadequate blood supply to the intestines. Acute pancreatitis (A) typically presents with epigastric pain radiating to the back and elevated serum amylase/lipase levels. Peptic ulcer disease (C) usually presents with a history of dyspepsia and is less likely to cause sudden severe abdominal pain. Diverticulitis (D) commonly presents with left lower quadrant pain and tenderness, which contrasts with the soft abdomen and minimal tenderness seen in this case.
A 60-year-old man presents with fatigue, weight gain, and constipation. Laboratory tests reveal low TSH and high free T4 levels. What is the most likely diagnosis?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Thyroiditis
- D. Thyroid cancer
Correct Answer: B
Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate an overactive thyroid gland, leading to symptoms like fatigue, weight gain, and constipation. The low TSH is due to negative feedback as the high free T4 suppresses TSH production. Hyperthyroidism fits this clinical picture, as opposed to hypothyroidism (choice A) which would have high TSH and low free T4 levels. Thyroiditis (choice C) typically presents with symptoms of both hyperthyroidism and hypothyroidism and is usually transient. Thyroid cancer (choice D) is less likely given the presentation of symptoms and specific lab results.