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GERD with alarm symptoms — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareGERD with alarm symptomsUSMLE Step 3

A 58-year-old man reports 6 months of heartburn after large meals and when lying down. He has lost 9 lb unintentionally and has progressive difficulty swallowing solids. He has tried over-the-counter antacids with partial relief. Vital signs are normal and abdominal examination is benign. Which of the following is the most appropriate next step in management?

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

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Correct answer: C — Perform upper endoscopy

GERD symptoms with alarm features such as weight loss and progressive dysphagia require upper endoscopy to evaluate for malignancy, stricture, or other structural disease.

Reference: ACG guideline on GERD evaluation