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-   -   Chest Pain and bitter taste at night! (https://www.usmle-forums.com/usmle-step-1-forum/5802-chest-pain-bitter-taste-night.html)

aktorque 01-07-2011 03:57 PM

Chest Pain and bitter taste at night!
 
NBME form 7 block 2

A 72 year old woman comes to the physician because of an 8-month history of burning chest pain & a bitter taste in her mouth; both symptoms occur at night when she lies down. The pain does not radiate & is not associated with shortness of breath. Physical examination shows no abnormalities. Which of the following is most likely to be associated with her symptoms?

(choice C is incorrect according to NBME)

a) atrophic gastritis
b) H.pylori infection
c) impaired relaxation of the lower esophageal sphincter
d) metaplasia of the esophageal epithelium
e) spasm of the esophageal smooth muscle


What do you guys think about the best choice...!!!!!!!

JJtheMD 01-07-2011 04:14 PM

I made a mistake, i thought my thinking was wrong lol, its D.. vasospasm is very very rare for GERD..

But when you look @ metaplasia of esophagus,, 5-15% of patients have symptoms of GERD... plus i failed 2 notice that this has been occuring for 8 months, meaning its chronic and very likely of metaplasia lol... The trick is the period of symptoms.

Hope 2 god i didn't get this q on the exam hahaha. I think this q is in the kaplan q bank as well lol.. always remember, first guess are the best answers lol..

dr z 01-07-2011 04:22 PM

D
 
D: metaplasia of the esophageal epithlium :notsure:

aktorque 01-07-2011 05:00 PM

Quote:

Originally Posted by JJtheMD (Post 23908)
I made a mistake, i thought my thinking was wrong lol, its D.. vasospasm is very very rare for GERD..

But when you look @ metaplasia of esophagus,, 5-15% of patients have symptoms of GERD... plus i failed 2 notice that this has been occuring for 8 months, meaning its chronic and very likely of metaplasia lol... The trick is the period of symptoms.

Hope 2 god i didn't get this q on the exam hahaha. I think this q is in the kaplan q bank as well lol.. always remember, first guess are the best answers lol..

Man.. you are smart and funny too. I agree with you, for qn #2 clues for the answer are patients age and duration of symptoms. As you mention, chronic GERD may lead to metaplasia of the esophagial epithelium. I will go with your choice D)

evavar 01-07-2011 05:16 PM

Absolutely choice D. Tricky questions, sometimes we know it but in the rush our mind thinks to fast and not the correct way. This is why we have to be masters in the fast thinking. LOL


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