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Retired NBME 20 Answers

nbme20/Block 1/Question#13 (reveal difficulty score)
A 6-week-old girl is brought to the physician ...
Immature lower esophageal sphincter ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: GI

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 +7  upvote downvote
submitted by โˆ—hayayah(1212)
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No abnormalities, only some vomiting, looks well w/ no failure to thrive. Most likely immature LES.

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masonkingcobra  http://www.sedico.net/English/SedicoInformationCenter/Physicians/gerd_e.htm +15



 +7  upvote downvote
submitted by suku008(9)
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Itโ€™s a common disease that impacts babies and children. GERD stands for gastro esophageal reflux disease. Dr. Viraine Weerasooriya, a pediatric gastroenterologist on the medical staff of Golisano Childrenโ€™s Hospital of Southwest Florida, says infants are prone to having reflux until their gut matures at about 12 to 18 months. But GERD is more than just reflux. โ€œWhat this implies is individuals who have problems with gastro contents that move up to the esophagus or into the mouth.

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suku008  https://www.youtube.com/watch?v=DFcySw14rIo +2
j44n  if youve ever had GERD like me you know exactly what they're talking about. You legit bring up food you ate hours before +



 +2  upvote downvote
submitted by ankirin(3)
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What is esophageal spasm and how would it present differently?

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baja_blast  I had narrowed it down to that and the correct answer. I think the difference is that esophageal spasm tends to present with pain and dysphagia. FA 2019 p. 371, right at the top of the page. +
orthonerd  Relating the phrase "diffuse painful contraction" to esophageal spasm has helped me remember the associated descriptions they go to. +



 +1  upvote downvote
submitted by โˆ—rockodude(39)
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why can't this be pylori stenosis since the time period for pyloric stenosis is 4-6 weeks

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sohadiha  This pt is vomiting a small amount. Pyloric Stenosis has projectile vomiting (so high force). Also would likely mention a small mass palpated or "olive shaped" mass w/ PS. +4
sohadiha  Also, the infant with PS would not being able to hold food or obtain any nutrients without projectile vomiting it out and this pt is nl height & WT and is only spitting up a few times a day and not with every feed. +3
rockodude  tysm! +1



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