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regurgitation

Practice targeted AMC-style multiple-choice questions on regurgitation.

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Order a barium swallow study
B. Initiate high-dose proton pump inhibitor therapy
C. Referral for surgical assessment and repair
D. Perform an urgent upper endoscopy
E. Advise watchful waiting and lifestyle modifications
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 68-year-old male presents to his general practitioner with a three-month history of progressive dysphagia to both solids and liquids, accompanied by postprandial regurgitation. He also reports experiencing early satiety and occasional episodes of nocturnal coughing. His past medical history is significant for well-controlled hypertension and a remote history of smoking (quit 20 years ago). Physical examination reveals mild epigastric fullness, but is otherwise unremarkable. His vital signs are within normal limits. An abdominal CT scan with contrast was performed, and a representative image is shown. Given the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in the management of this patient?

A. Referral to a gastroenterologist for surgical evaluation
B. Esophageal manometry to evaluate esophageal motility
C. Empiric treatment with antibiotics for possible aspiration pneumonia
D. Initiation of a proton pump inhibitor and lifestyle modifications
E. Barium swallow study to further delineate the anatomy
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. He reports occasional regurgitation of undigested food. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A. H. pylori testing and eradication if positive
B. Surgical repair
C. Trial of proton pump inhibitors
D. Endoscopic surveillance
E. Dietary modification and lifestyle advice
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A 45-year-old man presents to the clinic with a 3-month history of progressive difficulty swallowing both solids and liquids. He also reports regurgitation of undigested food and occasional chest pain. He has lost 5 kg over this period. On examination, there are no abnormalities noted. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

A. Gastroesophageal reflux disease (GERD)
B. Achalasia
C. Diffuse esophageal spasm
D. Esophageal stricture
E. Esophageal cancer
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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

An 82-year-old patient presents with a 6-month history of chronic cough, intermittent dyspnea, and occasional regurgitation, particularly when lying flat. They deny significant chest pain or weight loss. Past medical history includes well-controlled hypertension and mild asthma managed with salbutamol PRN. On examination, vital signs are stable, and lung sounds are clear with no wheeze. An outpatient chest X-ray was performed as part of the workup for the cough and dyspnea. Considering the radiographic findings in conjunction with the clinical history, which of the following investigations is most appropriate at this stage?

A. High-resolution CT chest
B. Oesophago-gastro-duodenoscopy (OGD)
C. Pulmonary function tests
D. 24-hour oesophageal pH monitoring
E. Cardiac stress test
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A 60-year-old man presents to the clinic with a 6-month history of progressive difficulty in swallowing both solids and liquids. He also reports unintentional weight loss and occasional regurgitation of undigested food. On examination, there is no lymphadenopathy or abdominal masses. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

A. Hiatal hernia
B. Esophageal stricture
C. Achalasia
D. Gastroesophageal reflux disease (GERD)
E. Esophageal cancer
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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 68-year-old patient presents with chronic intermittent upper abdominal discomfort, postprandial fullness, and occasional regurgitation. Physical examination is unremarkable. A chest radiograph is performed as part of the workup. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate next step in management?

A. Initiate a trial of high-dose proton pump inhibitor therapy.
B. Advise dietary modifications and schedule follow-up in 3 months.
C. Referral for upper gastrointestinal endoscopy.
D. Arrange urgent surgical consultation for repair.
E. Request a barium swallow study to assess anatomy.
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A 50-year-old man presents to the general practice with a 3-month history of persistent heartburn and regurgitation, especially after meals. He has tried over-the-counter antacids with minimal relief. He denies any weight loss, dysphagia, or gastrointestinal bleeding. What is the most appropriate next step in the management of this patient?

A. Prescribe H2 receptor antagonists
B. Refer to a gastroenterologist
C. Order an upper endoscopy
D. Advise dietary modifications only
E. Start a proton pump inhibitor
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