A 34-year-old female presents with hypertension, pinched facies and progressive dysphagia with decreased tone of lower esophageal sphincter (LES) The clinical diagnosis is?
Scleroderma
Hiatus hernia
Rolling hernia
Diffuse esophageal spasm
Ans. A SclerodermaRef: CMDT 2019 page 323* Pinched facies with hypertension points to presence of scleroderma. The tone of LES is reduced in scleroderma due to fibrosis.* Choice B and C can lead to GERD but it does not have other features like systemic hypertension.* Choice D presents with chest pain and dysphagia and is hence ruled out.
Misc.