USMLE Forum Archives - USMLE Step 1 - Pathology 11
Pathology 11
TheOne - 10-06-06 12:05
A 50-year-old female with chronic dysphagia undergoes an upper endoscopy that reveals massive dilation of the distal esophagus. The esophagus is kinked and tortuous and partly filled with undigested foods. What is the most likely diagnosis for this patient?
A. Achalasia
B. Barrett's esophagus
C. Hiatal hernia
D. Plummer-Vinson syndrome
E. Zenker's diverticulum
TheOne - 10-06-06 12:05
A 50-year-old female with chronic dysphagia undergoes an upper endoscopy that reveals massive dilation of the distal esophagus. The esophagus is kinked and tortuous and partly filled with undigested foods. What is the most likely diagnosis for this patient?
A. Achalasia
B. Barrett's esophagus
C. Hiatal hernia
D. Plummer-Vinson syndrome
E. Zenker's diverticulum
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#1
Re: Pathology 11
TheOne - 10-10-06 15:05 Explanation: The correct answer is A. Achalasia (from the Greek "unrelaxed") is a disease of ganglion cells in the esophageal myenteric plexus causing a failure of relaxation in the lower esophageal (cardiac) sphincter. The cause of achalasia is usually not determined. The peristaltic waves in the esophagus stop before the sphincter, and the food collects in the esophagus, which becomes dilated and elongated. Barrett's esophagus (choice B) is metaplastic replacement of the squamous esophageal epithelium with columnar epithelium. Barrett's esophagus is an important risk factor for esophageal adenocarcinoma. Hiatal hernia (choice C) is a protrusion of the stomach into the thorax via the diaphragmatic hiatus, at the lower esophageal sphincter. Although hiatal hernia can produce gastroesophageal reflux, the esophagus does not become distended and food passes normally into the stomach. Plummer-Vinson syndrome (choice D) is a constellation of physical findings associated with severe iron-deficiency anemia. Plummer-Vinson syndrome includes koilonychia, atrophic glossitis, and dysphagia due to atrophy of the pharyngeal mucosa and mucosal webs in the upper esophagus. Zenker's diverticulum (choice E) is an oropharyngeal diverticulum occurring at the junction of the pharynx and esophagus. Zenker's diverticula occur because of wall weakness in the esophagus at this location, and may produce dysphagia
#2
Re: Pathology 11 galaxy - 05-27-10 19:04 A 50-year-old female with chronic dysphagia undergoes an upper endoscopy that reveals massive dilation of the distal esophagus. The esophagus is kinked and tortuous and partly filled with undigested foods. What is the most likely diagnosis for this patient?
A. Achalasia cardia
#3
Re: Pathology 11 babbu5508 - 06-21-10 14:49 A. Achalasia cardia due to insufficient dilatation of lower esophageal sphincter in response to food bolus resulting in dilatation of the distal esophagus
#4
Re: Pathology 11 bingousmle - 06-30-10 22:33 massive dilation of the distal esophagus. The esophagus is kinked and tortuous and partly filled with undigested foodspoints to achalasia
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