#Usmle world step 1 q bank 2015 software

Q NO 41: A 45-year-old Caucasian male undergoes evaluation for intense fatigability. Barium swallow shows a dilated esophagus and a вЂњbirdвЂ™s beakвЂќ deformity of the LES. Achalasia presents with progressive dysphagia, chest pain, food regurgitation and aspiration. Mallory-Weiss tear is nota motility disorder and is not associated with abnormalities of esophageal manometry.Дecreased esophageal body peristalsis and poor relaxation of the LES on manometry are typical for achalasia. These tears are caused by forceful retching and vomiting and are common in alcoholics. (Choice E)Tears of esophageal mucosa at the esophagogastric junction are called Mallory-Weiss tears. Esophageal manometry in patients with GERD would show decreased LES pressure. (Choice D) Reflux of gastric contents into the distal esophagus occurs due to low tone of lower esophageal sphincter and its failure to contract after the transfer of food to stomach. Esophageal manometry shows multiple contractions on tracings from middle and lower esophagus. It occurs due to uncoordinated contractions of the esophageal body. (Choice B) Diffuse esophageal spasm (DES) is an esophageal motility disorder that presents with severe, non- cardiac chest pain. A video fluoroscopic swallowing study is used for diagnosis.

(Choice A) Cricopharyngeal dysfunction results from a failure of the cricopharyngeus to relax during swallowing and causes a choking or вЂњfood stickingвЂќ sensation and pain with swallowing. This motor dysfunction is associated with an elevated resting pressure of the LES and inability of the LES to relax during swallowing. These manometric findings are consistent with a diagnosis of achalasia (Choice C). The third diagram portrays the decrease in LES pressure that corresponds to its relaxation in the normal patient.Д®sophageal manometry of the patient A reveals normal contraction of upper esophageal sphincter, decreased peristalsis of the midesophagus illustrated by a lower amplitude of pressure increase on the second diagram, and no LES relaxation. Under normal conditions when the food bolus reaches the lower esophagus, the lower esophageal sphincter relaxes to allow the material to enter the stomach. The second diagram shows normal peristalsis of the middle esophagus. The cricopharyngeus muscle contracts behind the food bolus initiating a peristaltic wave to propel the bolus downward this contraction is shown on the first diagram as an upward deflection on both the normal and patient graphs. Which of the following is the most likely diagnosis in this patient?ДЄfter the contents of the oral cavity are collected on the tongue and propelled into the pharynx, involuntary contraction of the pharyngeal muscles pushes the material into the esophagus. Esophageal manometry tracings after a single swallow of 5 ml of water are shown on the slide below. Q NO 40: A 43-year-old male (Patient A) is being evaluated for an esophageal disorder.

#Usmle world step 1 q bank 2015 software

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