<prompt> 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?SclerodermaHiatus herniaRolling herniaDiffuse esophageal spasm  <response>: 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. 