A 49-Year-Old Man Comes to the Office for Evaluation of a Dry

question 102

Multiple Choice

A 49-year-old man comes to the office for evaluation of a dry cough that occurs mainly at night.  His symptoms have been present on and off for several years, but he has not been previously evaluated.  The patient also reports a frequent sore throat and occasional epigastric discomfort.  He has tried a variety of antihistamines and over-the-counter cough medications without relief.  Past medical history is notable for obesity and diet-controlled type 2 diabetes mellitus.  He does not smoke or drink alcohol.  Cardiopulmonary and abdominal examinations are unremarkable.  Chest x-ray reveals no abnormalities, and pulmonary function testing is normal.  The patient undergoes upper gastrointestinal endoscopy with mucosal biopsies.  Microscopic findings on lower esophageal biopsy are shown in the image below. This patient is at highest risk of which of the following complications?

• A)Achalasia
• B)Adenocarcinoma
• C)Crohn disease
• D)Squamous cell carcinoma
• E)Variceal bleeding

---

Definitions:

Lesions

Any abnormal tissue or damage in the body, seen on the skin or within the body on an organ or tissue.

Modified Allen Test

A diagnostic procedure used to evaluate the adequacy of blood flow through the arteries of the hand.

Capillary Patency

The state of being open or unobstructed, specifically referring to the condition where blood capillaries are adequately open for blood flow.

Collateral Circulation

An alternate network of blood vessels that can supply blood to an area if the main vessel is blocked or narrowed.