A 22-Year-Old Man Comes to the Emergency Department Due to Dysphagia

question 41

Multiple Choice

A 22-year-old man comes to the emergency department due to dysphagia for the past 3 hours.  He was eating steak with his friends when he suddenly noticed a catching sensation in his throat.  He tried to drink a few sips of beer, but the sensation continued to worsen.  The patient has also had a hoarse voice for the last hour and difficulty swallowing his saliva.  He has never had similar problems before.
Medical history includes seasonal allergic rhinitis, bronchial asthma, and gastroesophageal reflux disease.  Current medications include albuterol metered-dose inhaler as needed and over-the-counter omeprazole.  The patient has consumed 5 or 6 beers daily for the past 4 years but does not use tobacco or illicit drugs.  His mother has atopic dermatitis.
Temperature is 37.5 C (99.5 F) , blood pressure is 100/60 mm Hg, pulse is 92/min, and respirations are 14/min.  Examination shows no abnormalities except for a lethargic young man who is drooling and speaking in broken sentences.  An emergency endoscopy is planned.
In addition to a food bolus, which of the following would be the most likely endoscopic finding?

• A)Abnormal peristaltic waves and a hiatal hernia
• B)Grossly dilated esophagus with distal tapering
• C)Large irregular mass in the lower esophagus
• D)Multiple esophageal rings, and furrows
• E)Smooth tight stricture in the upper esophagus

Be able to calculate the Net Present Value of various investment proposals using present value factors.

Comprehend the concept of the time value of money and its importance in capital budgeting decisions.

Understand how to determine and interpret the internal rate of return (IRR) for an investment.

Ability to compare and assess different capital investment opportunities based on NPV and IRR computations.

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