Rosh Internal Medicine Practice Exam

A 35-year-old man with retrosternal burning after meals; lifestyle modification recommended for GERD?

Avoid caffeine, chocolate, and carbonated beverages Avoid foods containing tomatoes, onions, and garlic Sleep in a prone position Avoid eating a meal six hours before bedtime

Correct Answer:

Avoid caffeine, chocolate, and carbonated beverages

Explanation:

In GERD, reducing reflux through lifestyle changes is a key strategy. Caffeine, chocolate, and carbonated beverages are known triggers for many people because they can relax the lower esophageal sphincter or increase gastric distension, making reflux more likely. Therefore, avoiding these items is a practical and broadly applicable modification to lessen retrosternal burning after meals. The other options are less reliable: foods like tomatoes, onions, and garlic can provoke symptoms in some individuals but aren’t universal triggers; sleeping in a prone position isn’t recommended and can worsen reflux; and delaying meals for six hours before bedtime isn’t standard practice ( most guidance suggests avoiding eating within a few hours of lying down).

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