NBME Form 1, Section 1, Q# 4 - USMLE Forums
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Old 04-21-2011
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Arrow NBME Form 1, Section 1, Q# 4

A 45-year-old man has six months history of burning pain that begins in the epigastric area and ascends into the chest. Episodes occur more frequently after large meals and at night. Endoscopic examination shows moderately severe inflammation in the distal three centimeters of the esophagus. Which of the following is the most likely cause of this condition?

A) Diffuse spasm of the esophageal musculature
B) Failure of the lower esophageal sphincter (LES) to relax after a swallow
C) Helicobacter pylori infection
D) Hypersecretion of gastric acid
E) Inappropriate relaxation the LES
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Old 04-21-2011
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D is very possible!
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Old 04-21-2011
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Default GERD

GERD can cause E) Inappropriate relaxation of LES because of regurgitation.
Correct me if Im wrong though!
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B or E .........But will go with E
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Old 04-22-2011
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This is GERD, classic presentation plus the endoscopy confirms it.

A) Esophageal spasm.... acute chest pain & dysphagia, can be relieved by taking nitrates & CCB. In the differential for MI.
B) Achalasia
C) Helicobacter pylori infection does not involve esophagus.
D) Hypersecretion of gastric acid is a risk factor for development of peptic ulcer not GERD. Because normally acid should not come into the esophagus.
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Old 04-22-2011
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E) Inappropriate relaxation the LES
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