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Clinical case :ست عندها 56 سنة، جاية العيادة بتشتكي من ألم في أعلى البطن (epigastric pain) بقاله حوالي سنة. بتقول إن الألم: بيزيد بعد الأكل (postprandial) طبيعته crampy (مغص زي التقلصات) بييجي ويروح (intermittent) ومش بيشع لأي مكان تاني (non-radiating) كمان معاها: إحساس بالانتفاخ (bloating) وغثيان (nausea) لكن مفيش: فقدان وزن قيء (vomiting) إمساك أو إسهال دم في البراز سواء melena أو hematochezia أو أي تغيير في عادات الإخراج
Past history:عندها : (hypertension) (hypothyroidism)
Social history:مبتدخنش ومش بتشرب كحول
(Examination):العلامات الحيوية مستقرة البطن: في mild epigastric tenderness مفيش rebound tenderness ولا guarding ولا انتفاخ
(Labs):Hb = 10.2 → عندها anemia MCV = 105 → ده macrocytic anemia باقي التحاليل طبيعية ايه التشخيص المحتمل ؟
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A 12-year-old boy presents with intermittent dysphagia and episodes of food impaction. He has asthma and eczema. Endoscopy shows multiple esophageal rings.
What is the most likely diagnosis?
3 210
A 55-year-old man presents with progressive difficulty swallowing. Initially, he had difficulty swallowing solid foods, but over several months he developed difficulty swallowing liquids as well. He has lost 8 kg unintentionally.
What is the diagnosis?
3 210
A 30-year-old woman reports dysphagia to both solids and liquids for 1 year. She also has regurgitation of undigested food and nocturnal cough. A barium swallow shows a “bird-beak” appearance.
What is the underlying mechanism?
3 210
An elderly patient presents with dysphagia, halitosis, and regurgitation of undigested food several hours after eating.
What is the most likely diagnosis?
3 210
A 45-year-old patient presents with intermittent chest pain and dysphagia to both solids and liquids. Manometry shows uncoordinated esophageal contractions.
What is the diagnosis?
3 210
A 68-year-old man presents with difficulty initiating swallowing, nasal regurgitation, and coughing immediately after swallowing. He had a stroke 2 weeks ago.
What type of dysphagia is this?
3 210
A 65 year old woman presents with dysphagia and intermittent vomiting. Endoscopy shows a tight lower oesophageal sphincter suggestive of achalasia. Which of the following medical therapies is most effective because she is unfit for surgery?
3 210
61-year-old man presents with a 6-month history of progressive dysphagia, initially to solid foods and now also to liquids. He reports unintentional weight loss of 8 kg and occasional regurgitation of undigested food. He has a 30-pack-year smoking history and drinks alcohol daily. He also reports long-standing heartburn for which he has taken proton pump inhibitors intermittently.
Physical examination reveals mild cachexia. Upper endoscopy shows an ulcerated mass in the distal third of the esophagus extending to the gastroesophageal junction. Biopsy reveals malignant glands forming irregular structures with mucin production.
Which of the following factors most likely contributed to the development of this patient’s condition?
A. Viral infection leading to squamous dysplasia
B. Smoking-induced mutations in squamous epithelium of the upper esophagus
C. Chronic alcohol use causing direct mucosal toxicity in the mid-esophagus
D. Neural crest cell migration defect affecting esophageal motility
E. Chronic gastroesophageal reflux leading to intestinal metaplasia
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58-year-old woman presents with progressive dysphagia and odynophagia over 4 months. She reports a history of iron deficiency anemia and long-standing fatigue. She denies smoking or alcohol use. Physical examination shows glossitis and angular cheilitis.
Barium swallow demonstrates a proximal esophageal narrowing with a thin mucosal web. Endoscopy reveals an irregular mass in the upper esophagus. Biopsy confirms malignant squamous cells.
Which of the following mechanisms most likely underlies the development of this patient’s malignancy?
A. Chronic acid exposure causing metaplasia of squamous epithelium
B. Nutritional deficiency leading to mucosal atrophy and increased susceptibility to malignant transformation
C. Obesity-related increased intra-abdominal pressure causing reflux
D. Viral-mediated oncogenesis in glandular epithelium
E. Chronic fungal infection leading to epithelial dysplasia
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Which of the following is the strongest risk factor for esophageal adenocarcinoma?
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Patient with Plummer-Vinson syndrome is at increased risk of which esophageal cancer?
