This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Corkscrew esophagus is seen in which of the following conditions ? \nSelect and explain. \nA. Carcinoma esophagus, B. Scleroderma, C. Achalasia cardia, D. Diffuse esophagus spasm', 'role': 'user'}, {'content': 'Answer: D \nExplanation: • Esophageal contractions are repetitive, simultaneous, and of high amplitude.\n• Basic pathology is related to a motor abnormality of the esophageal body that is most notable in the lower two thirds of the esophagus.\n• More common in women and is often found in patients with multiple complaints. Clinical Features]\n• Clinical presentation: Chest pain and dysphagia\xa0(may be related to eating or exertion and may mimic angina)\n• Complain of a squeezing pressure in the chest that may radiate to the jaw, arms, and upper back.\n• The symptoms are often pronounced during times of heightened emotional stress.\nDiagnosis\n• Barium swallow:\n−− Corkscrew or rosary-bead esophagus, segmental spasm or pseudodiverticulosis appearance\n−− Due to presence of tertiary contractions\n−− Indicative of advanced disease\n• Hypermotility disorder also known as supersqueeze esophagus.\n• Esophagus with hypertensive peristalsis or high-amplitude peristaltic contractions.\n• Most common and most painful esophageal hypermotility disorder.\n• Associated with hypertrophic musculature resulting in high-amplitude contractions of the esophagus\nClinical Features\n• Chest pain and dysphagia are typical symptoms.\nDiagnosis\n• The gold standard of diagnosis is the subjective complaint of chest pain with simultaneous objective evidence of peristaltic esophageal contractions 2 standard deviations above the normalQ values on manometric tracings.\n• On manometry, amplitude >180 mmHg and duration of contraction >6 seconds\nTreatment\n• The treatment of nutcracker esophagus is medical (Calcium channel blockers, nitrates, and antispasmodics)\xa0\n• The LES pressure is above normal, motility of esophageal body may be hyperperistaltic or normal.\nClinical Features\n• Patients with hypertensive LES present with chest pain or dysphagiaQ.\nDiagnosis\n• Diagnosis is made by manometry.\n−− Elevated LES pressure (>26 mm Hg) and normal relaxation of the LES.\n−− Esophageal body may be hyperperistaltic or normal.\nTreatment\n• Botox injections alleviate symptoms temporarily, and hydrostatic balloon dilation may provide long-term symptomatic relief.\n• Surgery in patients who fail interventional treatments and those with significant symptoms.\n• A laparoscopic modified Heller esophagomyotomy is the operation of choice.', 'role': 'assistant'}]