A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?

Correct Answer: B

Rationale: The correct answer is B: Esophageal cancer. This patient's symptoms of difficulty swallowing solids and liquids, along with unintentional weight loss, are concerning for a malignancy like esophageal cancer. The progressive nature of dysphagia and significant weight loss are red flags for cancer. Esophageal stricture (A) can cause dysphagia but typically presents with a history of chronic inflammation or injury. Achalasia (C) is characterized by dysfunction of the lower esophageal sphincter, leading to dysphagia, but it is less likely in this case due to the weight loss. Peptic ulcer disease (D) usually presents with epigastric pain and can cause weight loss, but it is less likely to cause progressive dysphagia.

Correct Answer: B

Rationale: The most likely diagnosis in this case is B: Mesenteric ischemia. Given the sudden onset of severe abdominal pain in an elderly patient with atrial fibrillation, mesenteric ischemia is a crucial consideration due to the risk of thromboembolism from the heart condition leading to inadequate blood supply to the intestines. Acute pancreatitis (A) typically presents with epigastric pain radiating to the back and elevated serum amylase/lipase levels. Peptic ulcer disease (C) usually presents with a history of dyspepsia and is less likely to cause sudden severe abdominal pain. Diverticulitis (D) commonly presents with left lower quadrant pain and tenderness, which contrasts with the soft abdomen and minimal tenderness seen in this case.

Correct Answer: C

Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a

Correct Answer: A

Rationale: The most likely diagnosis for a 50-year-old man with jaundice, dark urine, pruritus, and a mass in the head of the pancreas is pancreatic cancer. Pancreatic cancer commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor in the head of the pancreas. This leads to dark urine (due to increased bilirubin) and pruritus. Chronic pancreatitis typically presents with recurrent abdominal pain, not progressive jaundice. Gallstones can cause obstructive jaundice but are not associated with a mass in the pancreas. Primary sclerosing cholangitis presents with jaundice, but it typically involves intrahepatic and extrahepatic bile ducts, not the pancreas.

Correct Answer: B

Rationale: The correct answer is B: Esophageal cancer. Given the patient's age, symptoms of difficulty swallowing and weight loss, along with a history of chronic heartburn not responding to proton-pump inhibitors, esophageal cancer is the most likely diagnosis. Esophageal cancer commonly presents with dysphagia, weight loss, and a history of chronic reflux. Peptic stricture (A) typically presents with dysphagia but is less likely given the worsening symptoms despite treatment. Achalasia (C) presents with dysphagia and regurgitation, but not typically with weight loss. Esophageal spasm (D) presents with chest pain and dysphagia, but not typically with weight loss or chronic heartburn.