A 5-month-old child regularly regurgitates a large portion of her feeds. A pH probe study showed significant periods of low esophageal pH. The child has normal growth and no other significant past medical history. Which of the following is the best management at this point?
a. Barium swallow and upper GI series
b. Oral reflux medications
c. Esophageal manometry
d. Close observation only
e. Surgical correction with fundoplication
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE. Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of Americ
The correct answer is d; Close observation only.
Barium swallow and upper GI series are helpful in detecting anatomic abnormalities such as antral web, pyloric stenosis, malrotation, and annular pancreas. To confirm the presence of gastroesophageal reflux (GER), the best test is the esophageal pH probe, which measures the frequency and duration of falls in pH, thereby indicating acid reflux. Esophageal manometry is used to identify poor tone of the lower esophageal sphincter. In this child, who is growing well and developing properly and has no other medical problems such as reflux-induced apnea or bradycardia or aspiration pneumonia, pharmacologic treatment is not necessary, as most infants will outgrow this common problem of esophageal reflux. Surgical correction is reserved for infants with poor weight gain or reflux-associated apnea and bradycardia who have failed pharmacologic therapy.