sunny2
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Mr. Sa bi deru, A 53-year-old male , carpenter by profession presents with the complaint of difficulty swallowing both liquids and solids, which was mild initially but has worsened gradually. His pets Mr.Totu and Mrs. Totu also have similar complaints since last 4 months.
He also complains of nocturnal cough, which disturbs his sleep as well as regurgitation of undigested food eaten several hours earlier. His Physical examination is normal except for a swollen big toe. Ba studies are performed which shows dilated esophagus and loss of esophageal peristalsis, and narrowing of the distal esophagus. What will be the most appropriate next step in the management of this patient?
A. Esophagoscopy
B. Esophageal manometry
C. Esophageal PH monitoring
D. Botulinum toxin ingestion
E. Pneumatic dilation
F. ECG
G. Repeat Ba Swallow
H. CXR
I. 24 hr.Ph monitoring
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| doyoudig
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A. Esophagoscopy - To R/o any Orgnaic Probls, even though clinical pictures points to Achalasia, once r/o do manometry to confrim and then pneumatic dilation as the best Rx (Cna use box Tox but only good for 6 mon and need to be repeated, maybe in Pts who don't wnat dilation....)
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| Doc750
transfer:step 3 prison
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Kill Mr. and Mrs. Totu ......
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| Doc750
transfer:step 3 prison
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A
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| Kamsi
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A
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| starcraftbw
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brain biopsy of the pets for rabies? j/k........... EGD
A............... esophageal cancer until proven otherwise
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| doyoudig
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 funny poor dogs....
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| sunny2
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It's good that Mr. and Mrs. Totu are not writing USMLE otherwise they would have been so disaapointed by the treatment being prescribed. I thought I should close this before someone shoots M-Totu and F-Totu.
So, the answer is indeed -A , as explained by doyoudig.
This is simple but good to revise these type of questions once in a while.
Have fun guys, 
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| starcraftbw
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have a great weekend everyone..........
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| Justice
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A. Esophagoscopy
Just cannot understand how Mr/Mrs Totu could complain...
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| sunny2
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by not eating and drinking properly, by frequent vomiting....and also I forgot to mention that Mr.Sa bi deru while cutting wood in the jungle got a gift from his friend Mr. Chimpu Chipanzee which can decode and translate the voices of the pets.
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| dr19
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Are we speaking about an infectious disease?between pets and humans?!
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| DrVirgo
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sounds like achalisia, but:
A. Esophagoscopy first to R/O Eso. Cancer
Then you can consider Manometry to dx. or r/o Achalasia.
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| Ivonne
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(A ) 
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