A 35-Year-Old Man Comes to the Office for Follow-Up of an Abnormal

question 273

Multiple Choice

A 35-year-old man comes to the office for follow-up of an abnormal chest x-ray finding.  The patient went to the emergency department 2 weeks ago after a chest injury; during a softball game, he was struck in the chest by a ball thrown from a distance of 4 feet.  Initial evaluation showed no significant trauma or rib fracture, but the chest x-ray revealed an air/fluid level posterior to the cardiac silhouette consistent with a sliding hiatal hernia.  The patient feels well and has had no heartburn, regurgitation, difficulty swallowing, or abdominal discomfort.  He has no other medical conditions and takes no medications.  The patient does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Physical examination shows no abnormalities.  Which of the following is the best next step in management of this patient?

• A)24-hour esophageal pH monitoring
• B)Esophageal manometry
• C)Laparoscopic Nissen fundoplication
• D)Reassurance and observation
• E)Upper gastrointestinal endoscopy

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Definitions:

Fixed-Interval Schedule

A type of reinforcement schedule where the first response is rewarded only after a specified amount of time has elapsed.

Variable-Interval Schedule

A reinforcement schedule in operant conditioning where a response is rewarded after an unpredictable amount of time has passed, creating a variable pattern of reinforcement.

Fixed-Ratio Schedule

A schedule of reinforcement where a response is rewarded after a specified number of responses, leading to a high and steady rate of responding.