A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?

Correct Answer: C

Rationale: The correct answer is C: Barium swallow. In this case, the patient's symptoms suggest a possible esophageal disorder affecting solid food ingestion. Barium swallow is a non-invasive test that can detect structural abnormalities in the esophagus, such as strictures or tumors, that may be causing dysphagia. It is the best initial test to evaluate the patient's symptoms as it provides a detailed visualization of the esophagus and can identify the cause of dysphagia. Upper endoscopy (choice A) would be appropriate if structural abnormalities are suspected. Chest/abdominal CT scan (choice B) may not provide as detailed information about esophageal function. Esophageal manometry (choice D) is more useful for evaluating motor function of the esophagus, which is not the primary concern in this case.

Correct Answer: D

Rationale: The correct answer is D: Calcium channel blocker. Odynophagia is often associated with esophageal ulcers, which can be exacerbated by NSAIDs (A) due to their effect on the gastric mucosa. Alendronate (B) is a bisphosphonate used to treat osteoporosis and can cause esophagitis. Iron sulfate (C) can also irritate the esophagus. However, calcium channel blockers (D) are least likely to contribute to esophageal ulcers or odynophagia as they do not directly affect the esophagus or increase the risk of ulcers.

Correct Answer: B

Rationale: The correct answer is B: Endoscopic balloon dilatation. This is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR because these symptoms suggest achalasia, a motility disorder of the esophagus. Endoscopic balloon dilatation helps to disrupt the lower esophageal sphincter muscle, relieving symptoms and improving esophageal emptying. Proton-pump inhibitors (A) are used for acid-related conditions, not for achalasia. Sucralfate (C) is a mucosal protective agent and not indicated for achalasia. Esophageal resection (D) is a more invasive option and usually reserved for severe cases or when other treatments have failed.

Correct Answer: B

Rationale: The correct answer is B: Irritable bowel syndrome (IBS). The key clues in the question are chronic constipation, bloating, abdominal pain relieved with defecation, and absence of alarming symptoms. These symptoms align with the Rome IV criteria for IBS. Inflammatory bowel disease (A) typically presents with more severe symptoms, including weight loss and blood in stools. Celiac disease (C) is associated with malabsorption symptoms and autoimmune features, not typically seen in this case. Lactose intolerance (D) presents with symptoms after consuming dairy, which is not mentioned in the patient's history. Therefore, based on the clinical presentation and exclusion of other conditions, the most likely diagnosis is IBS.

Correct Answer: C

Rationale: The correct answer is C: Acute pancreatitis. The patient's symptoms of severe epigastric pain radiating to the back, along with nausea, vomiting, and a history of heavy alcohol use, are classic for acute pancreatitis. Elevated serum amylase and lipase levels further support this diagnosis, as they are key markers of pancreatic inflammation. Acute cholecystitis (A) typically presents with right upper quadrant pain and fever. Peptic ulcer disease (B) is characterized by burning epigastric pain that improves with food intake. Gastroesophageal reflux disease (D) presents with heartburn and regurgitation, not the severe symptoms seen in this case.