A 42-Year-Old Man Is Evaluated for a 3-Month History of Burning

question 328

Multiple Choice

A 42-year-old man is evaluated for a 3-month history of burning, substernal chest pain after every meal.  The patient has tried several over-the-counter antacids with partial relief.  He undergoes upper gastrointestinal endoscopy, which reveals mucosal irregularity and ulceration of the squamocolumnar junction above the lower esophageal sphincter.  Multiple biopsies are taken.  Four hours after the procedure, the patient develops worsening substernal pain radiating to the back, along with mild shortness of breath.  Temperature is 37.1 C (98.9 F) , blood pressure is 110/70 mm Hg, pulse is 120/min, and respirations are 34/min.  Chest x-ray reveals a small, left pleural effusion that was not present on a chest radiograph taken 2 weeks ago.  ECG shows sinus tachycardia but is otherwise unremarkable.  Which of the following is the best test to confirm the diagnosis?

• A)Repeat upper gastrointestinal endoscopy
• B)Serum amylase and lipase levels
• C)Thoracentesis with fluid analysis
• D)Transthoracic echocardiogram
• E)Water-soluble contrast esophagogram

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Definitions:

Tolerance Model

is a theory in ecology that describes how the ability of a species to tolerate environmental stress affects its success and distribution.

Inhibition Model

A concept used in various scientific disciplines, often referring to a process where one factor or substance decreases the rate or extent of a particular reaction or activity.

Commensalism

A relationship between two living organisms where one benefits without harming the other.

Mycorrhizal

Referring to a symbiotic association between the roots of plants and fungi, in which the fungus enhances the plant's nutrient absorption in exchange for carbohydrates.