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NBME 20 Answers

nbme20/Block 1/Question#13 (42.3 difficulty score)
A 6-week-old girl is brought to the physician ...
Immature lower esophageal sphincter🔍,📺

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submitted by suku008(9),
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’tsI a mnomco sedeais atht ipcmats basebi and rdhce.nil DERG nadtss rof toagrs paleosghae lufxre es.asied r.D irViane o,oesaryWaeir a itpcaedri sgoeeitorrotlgsnta no eht dcmilea affst of snooalGi sndeC’hilr staloipH fo hSeuwtsto iordFla, asys isntfna rea prneo ot ihnagv lexruf tniul rteih utg tearusm ta obuat 12 ot 18 smnht.o But GRED si rome nhat ustj rflxue. a“thW ihst slipime si uiidvdsainl ohw aveh oslrpmeb itwh otgars tstnoecn ttah mveo up ot het hosguesap ro tnio hte mt.uho

suku008 +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 +  

submitted by hayayah(1101),
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oN nmtielsa,orabi lnoy smeo ivntg,omi losko llwe /w no alueifr ot re.vhti tMos llkiye eamruitm L.ES

masonkingcobra +15  

submitted by ankirin(3),

What is esophageal spasm and how would it present differently?

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. +  

submitted by rockodude(23),

why can't this be pylori stenosis since the time period for pyloric stenosis is 4-6 weeks

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