Rosh Internal Medicine Boost Practice Exam

In which condition would you primarily perform scheduled mechanical dilation of the esophagus?

1. Esophagitis

2. Achalasia

3. Proximal esophageal stricture

4. Gastroesophageal reflux disease

The correct answer is: Proximal esophageal stricture

Scheduled mechanical dilation of the esophagus is primarily indicated in cases of esophageal stricture, particularly when a proximal esophageal stricture is present. A proximal esophageal stricture can lead to symptoms such as difficulty swallowing (dysphagia), and mechanical dilation is a therapeutic procedure used to widen the esophageal lumen, helping to alleviate these symptoms gradually over time. In the context of esophageal conditions, dilation aims to improve the passage of food and liquids through the esophagus, addressing the physical narrowing caused by scarring or other structural alterations. This procedure can be performed on an outpatient basis and is typically scheduled at regular intervals to ensure effective and sustainable results. Other conditions listed, while they may involve some degree of esophageal narrowing or dysfunction, do not primarily rely on scheduled mechanical dilation as the first approach to treatment. For example, esophagitis usually requires medical management through medications to reduce inflammation and treat the underlying cause rather than dilation. Achalasia, characterized by the inability of the lower esophageal sphincter to relax, generally responds better to different treatments such as pneumatic dilation or surgical interventions, rather than mechanical dilation aimed at structural narrowing. Gastroesophageal reflux disease (GERD) typically involves lifestyle modification and medication and is not