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Q- Achalasia is a motility disorder of the esophagus characterized by impaired
relaxation of the lower esophageal sphincter.
Which of the following is the most likely etiology of this condition?
A- Adenocarcinoma of the lower esophagus
B- Degeneration of the inhibitory neurons of the myenteric plexus
C- Obstruction caused by Schatzki rings
D- Prolonged intubation

Q- Which of the following is the most common cause of infertility in women in the
United States of America?
A- Congenital adrenal hyperplasia
B- Pelvic inflammatory disease
C- Polycystic ovarian syndrome
D- Uterine fibroids

Q- A 55-year-old man underwent internal fixation of fractured femur after a
motorcar accident and massive bleeding 24 hours ago. He was stable after the
surgery and his urine output was normal after he received intravenous fluids.
Now he complains of substernal chest pain and shortness of breath. On
examination, His temperature is 98.8 F, Pulse is 110/min, blood pressure is
160/100 mmHg and his respiratory rate is 24/min. There is no jugular vein
distention. His extremities have established pulses bilaterally and good perfusion.
Auscultation reveals harsh systolic murmur across the precordium and crackles on
both lung bases. ECG shows sinus tachycardia with delayed precordial transition
and no other changes. Laboratory tests including cardiac enzymes are all normal.
What is the most likely diagnosis?
A- Acute myocardial infarction
B- Left bundle branch block
C- Septic shock
D- Hypertrophic cardiomyopathy
E- Pericardial effusion

Answer and Explanation
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