QuestionSBA
QuestionChoice
Achalasia is the inability of the lower oesophageal sphincter to relax and the loss of oesophageal peristalsis due to a loss of inhibitory nitrinergic neurons. As a result, patients may experience difficulty swallowing and regurgitation. The history of episodic coughs, purulent sputum, fever, dyspnoea and chest pain is suggestive of an aspiration pneumonia which has occurred secondary to regurgitation.
10024365
a
Achalasia
QuestionChoice
Gastro-oesophageal reflux disease may present with regurgitation, chest pain and dysphagia (difficulty swallowing), however this would typically present with heartburn that occurs after having larger meals and is aggravated by lying down or bending forward. GORD is unlikely to cause an aspiration pneumonia or infective symptoms.
10024366
b
Gastro-oesophageal reflux disease (GORD)
QuestionChoice
Peptic ulcer disease may present with epigastric pain, nausea, vomiting and dyspepsia. It does not present with dysphagia.
10024367
c
Peptic ulcer disease
QuestionChoice
Dyspepsia describes multiple upper gastrointestinal symptoms which persist for 4 or more weeks. This includes heartburn, burping, bloating, nausea, vomiting and early satiety. It is also known as indigestion. Causes of dyspepsia include GORD, peptic ulcer disease and Barrett's oesophagus.
10024369
e
Dyspepsia
QuestionChoice
*Helicobacter pylori* is a gram-negative infection which causes peptic ulcers. It may present with abdominal pain, nausea, bloating and loss of appetite.
10024368
d
*Helicobacter pylori* infection
Concept
Chapter
2693
4006
Achalasia
Topic
136
Gastroenterology
17271
A 36-year-old female presents with a history of episodic coughing with purulent sputum, fever, dyspnoea, and chest pain over the last six days. She gives a history of vomiting and hiccups on and off for 7 years.  She says that she has difficulty swallowing her food and sometimes regurgitates it.

What is the most likely diagnosis?
a