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Gastroesophageal reflux disease — USMLE Step 2 CK MCQ

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HardInternal MedicineGastroesophageal reflux diseaseUSMLE Step 2 CK

A 63-year-old has 4 months of heartburn and sour regurgitation. During the past month, solid food has increasingly stuck behind the sternum, and he has lost 5 kg unintentionally. He has not yet tried acid suppression. What is the most appropriate next diagnostic step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Perform upper endoscopy to evaluate the progressive dysphagia

Explanation lettering: D = shown as C · C = shown as D

B is correct: progressive esophageal dysphagia and unintentional weight loss are alarm features requiring prompt upper endoscopy to assess malignancy, stricture, esophagitis, eosinophilic esophagitis, or another obstruction. A is appropriate for uncomplicated typical reflux but would delay evaluation here. C documents reflux after an unrevealing evaluation rather than excluding obstruction first. D follows endoscopy when a motility disorder remains likely. E does not evaluate the esophageal alarm symptoms.

Reference: American College of Gastroenterology: esophageal physiologic testing. https://gi.org/topics/esophageal-physiologic-testing/