American Board of Internal Medicine (ABIM) Certification Practice Exam

When evaluating chest pain in a patient suspected of having gastroesophageal reflux disease, what diagnostic test should be considered?

1. CT Angiography

2. Echocardiogram

3. Exercise stress test

4. Esophageal pH monitoring

The correct answer is: Exercise stress test

In the context of evaluating chest pain related to suspected gastroesophageal reflux disease (GERD), esophageal pH monitoring is the most pertinent diagnostic test. This test measures the acidity levels in the esophagus and helps determine the presence and frequency of acid reflux episodes, which can correlate with chest pain. GERD is known to cause atypical chest pain that can mimic cardiac conditions, making it important to accurately diagnose the source of the symptoms. Esophageal pH monitoring provides valuable information regarding acid exposure in the esophagus over a 24-hour period, offering direct evidence of GERD when symptoms and other evaluations suggest it. While exercise stress testing assesses cardiovascular function and can help diagnose heart-related issues, and CT angiography visualizes the coronary arteries, these tests are not specifically aimed at diagnosing GERD. An echocardiogram would focus on heart structure and function, which is less relevant in this context when GERD is suspected. Thus, the emphasis on esophageal pH monitoring as the diagnostic tool aligns directly with confirming GERD as the cause of the patient's chest pain symptoms.