What 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?

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Achalasia. The presentation of difficulty swallowing, weight loss, regurgitation of undigested food, and 'bird beak' appearance on barium swallow are classic for achalasia. In achalasia, there is impaired relaxation of the lower esophageal sphincter and absent peristalsis in the esophagus. This leads to functional obstruction and dilation of the esophagus, causing the characteristic 'bird beak' appearance. Incorrect Choices: A: Esophageal cancer typically presents with progressive dysphagia, weight loss, and may show a mass or stricture on imaging. C: Peptic stricture is usually seen in patients with long-standing gastroesophageal reflux disease or esophagitis. Symptoms are often related to acid reflux. D: Gastroesophageal reflux disease commonly presents with heartburn, regurgitation, and chest pain. It does not typically cause weight loss or the 'bird

Correct Answer: C

Rationale: The most likely diagnosis for the 28-year-old woman with abdominal pain, diarrhea, weight loss, mouth ulcers, and perianal fistula is Crohn's disease. Crohn's disease is characterized by inflammation that can occur anywhere in the digestive tract, leading to symptoms like abdominal pain, diarrhea, weight loss, mouth ulcers, and fistulas. Ulcerative colitis primarily affects the colon, not the entire digestive tract like in this case. Irritable bowel syndrome typically presents with abdominal pain and changes in bowel habits but not with fistulas. Diverticulitis is inflammation of pouches that can develop in the colon, but it does not typically present with mouth ulcers or fistulas.

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.