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Old 11-07-2012
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Arrow Gyrus Daily Questions; Internal Medicine #72

A 35-year-old man with no significant medical history presents to the emergency department with severe chest pain The pain is worse with ingestion of cold or hot liquids There is no history of weight loss and no oral lesions The remainder of the physical examination is normal A cardiac workup is negative. What is the MOST appropriate diagnostic test to confirm the diagnosis'?

A. 24-hour pH monitoring
B. Barium swallow
C.-Endoscopy
D. Manometry
E. Trial of PPI
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Old 11-07-2012
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D...manometry as the history is most suggestive of Diffuse esophageal spasm
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ans...D. Manometry
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Old 11-07-2012
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Yes the answer is D Manometry..

Parasternal pain precipitated by cold .hot or carbonated liquids is suggetive of esophageal spasm.Manomatry can confirm the diagnosis by revealing intermittent simulataneous contractions .Intermittent high pressure peristalitic contractions on manomety are diagnostic of nutcracker esophagus.

Calcium channel blockerc or nitrates before meal are useful for the chest pain and dysphagia associated with esophageal motiliy disorder.
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Old 11-07-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
A 35-year-old man with no significant medical history presents to the emergency department with severe chest pain The pain is worse with ingestion of cold or hot liquids There is no history of weight loss and no oral lesions The remainder of the physical examination is normal A cardiac workup is negative. What is the MOST appropriate diagnostic test to confirm the diagnosis'?

A. 24-hour pH monitoring
B. Barium swallow
C.-Endoscopy
D. Manometry
E. Trial of PPI
D. Manometry
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