phuluong2k
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3) A 62-year-old social worker complains of increasing difficulty with swallowing. She has had trouble with solid foods and senses a discomfort in the mid-lower chest after eating meats or dry bread. She has not lost any weight and denies any other medical problems. There is no family history of gastrointestinal malignancy. The physical examination is unremarkable. Which of the following would be the most appropriate next step in the evaluation of this patient's symptoms?
A. Barium esophagram
B. Chest x-ray
C. CT scan of the chest
D. Esophagoscopy
E. 24-hour pH monitor
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| GoStep2
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A
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| nisha
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A
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| mani
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A. Barium esophagram, 1st investigation in all cases of dysphagia
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| DrS
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A
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| ibraheem
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A 
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| kabu
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A
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| ARJ
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A
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| phuluong2k
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I did pick A too 
The correct answer is
D. This patient is presenting with symptoms of a peptic stricture after many years of gastroesophageal reflux disease (GERD) symptoms. An endoscopy not only will allow evaluation of the stricture but will also allow biopsy to ensure that it is of a benign nature. Furthermore, it would allow dilatation of the stricture using an endoscopic-guided balloon to relieve the patient's symptoms.
A barium esophagram (choice A) would demonstrate the typical smooth tapering nature of a peptic stricture, distinguishing it from the irregular, ulcerated, mass-like stricture seen in patients with esophageal carcinoma. However, it would not conclusively make this distinction and would require a follow-up endoscopy with biopsy anyway.
A chest x-ray (choice B) is not of specific diagnostic value in patients who are undergoing evaluation for dysphagia.
A CT scan of the chest (choice C) is not very useful in determining intraluminal esophageal lesions. CT is used for patients with suspected malignant strictures to evaluate the paraesophageal regions and assess for the possibility of local spread.
A 24-hour pH monitor (choice E) is useful to demonstrate that there is acid reflux, which is not in question with this patient with the longstanding history of typical symptoms
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| phuluong2k
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"This patient is presenting with symptoms of a peptic stricture after many years of gastroesophageal reflux disease (GERD) symptoms"
I can't see this in the question stem. Plz put more comments about this
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| DrS
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Yes that part certainly is lacking in the question
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| mani
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i think they have assumed " has had trouble with solid foods" to be pointing to stricture. Despite this, the FIRST investigation in dysphagia has to be barium swallow.
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