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

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Definitions:

Pharmacological Intervention

The use of medications in the treatment or management of a disease or disorder.

Dissociative Identity Disorder

A severe form of dissociation, a mental process that produces a lack of connection in a person's thoughts, memory, and sense of identity.

Separate Personalities

Refers to the presence of two or more distinct personality states or identities in an individual, commonly associated with dissociative identity disorder.