2. GIT Path: Oral cavity & EO

Question 1

A 72 year old man comes to a visit to his doctor. During examination the doctor notes a white plaque in the mans mouth with which he can’t scrape away with a tongue depressor. The man’s history is positive for chewing tabos use and he has dentures. What infection is associated with this man’s condition?

A.HSV
B.EBV
C.Trypanosoma cruzi
D. CMV
E. HPV

RFA

Answer 1

ANS. E HPV-The man has Leukoplakia- white plaque that can be scrape away also has history of chewing tobacco and dentures

A. HSV- Esophagitis

B. EBV- Hairy Leukoplakia

C. Trypanosoma cruzi- Secondary achalasia

D. CMV- Esophagitis

Question 2

A 32 year old alcoholic man comes to the doctor saying” Doc i been throwing up a shit ton there has been blood on it and it hurts light a mother fucka….blwarargh”.You quickly exam his throat and notice longitudinal tears near the Esophagogastric junction. Now covered in vomit you think what is the pathophysiological cause for the mans issues?

A. Portal Hypertension 
B. Iron Deficiency 
C. Allergic Rhinitis 
D. Inadequate relaxation of the LES 
E. HPV infection 

RFA

Answer 2

Ans. D Inadequate relaxation of the LES- the patient has Mallory Weiss Syndrome- Longitudinal mucosal tears at EO junction, the syndrome is commonly found in alcoholics

A. Portal Hypertension- causes Esophageal Varies which are usually asymptomatic until they rupture usually causing death.

B.Iron Deficiency- Plummer-Vinson Syndrome- which is esophageal webs

C. Allergic Rhinitis- Eosinophilic Esophagitis - there is usualln o acid reflux in this disorder

E. HPV infection- Oral Leukoplakia

Question 3

A 55 year old caucasian male presents to the clinic with pain and difficulty swallowing that has gotten progressively worse over the past few weeks, chest pain, and frequent vomiting. He has also had a 15lb weight loss. Biopsy shows numerous mucinous glands with raised patches of intact mucosa. Which of the following is a risk factor for his condition? (MG)

A. Smoking
B. Drinking alcohol
C. Barrett’s esophagus
D. Plummer-Vinson Syndrome
E. Celiac disease

Answer 3

C. Barrett’s esophagus

Dx is adenocarcinoma of the esophagus

All other options are risk factors for squamous cell carcinoma of the esophagus. To elaborate, it is specifically pipe smoking as well as smokeless tobacco that are risk factors for SCC of esophagus.

Question 4

A 16 year old female presents with hematemesis. BP 110/65, RR 16/min, BMI 16. Upper endoscopy shows longitudinal mucosal tears where? (MG)

A. Pyloric sphincter
B. Ileocecal junction
C. Esophagogastric junction
D. Pharyngeal-esophageal junction
E. Sigmoid colon

Answer 4

C. Esophagogastric junction

Dx is Mallory Weiss Syndrome.

BMI is 16. We can assume the pt has an eating disorder and has been vomiting excessively. Remember that Mallory Weiss is not exclusive to alcoholics- anyone who has been retching a lot can have it.

Question 5

A 35 y/o homosexual male presents to you office with c/o white, fluffy like lesions on his tongue. He also c/o fatigue and dizziness. He has not had any STI testing in the past because he believes all his partners are “clean.” Which of the following can be another cause of his mouth symptoms?

A. HPV
B. CMV
C. Hep B
D. EBV
E. GERD

SZ

Answer 5

Ans. D. EBV

Pt is HIV positive and is dx with oral hairy leukoplakia.
EBV is also another major cause in immunocompromised pts.

Question 6

A 45 y/o female presents for c/o fatigue, angular rash around her mouth, and dysphagia. Which of the following is she at risk for developing?

A. Mallory Weiss Tear
B. HBV
C. Esophageal Atresia
D. Achalasia
E. Squamous Cell Carcinoma of Esophagus 

SZ

Answer 6

Ans. E. Squamous Cell Carcinoma of Esophagus

The patient has Plummer-Vinson Syndrome (Kelly Patterson Syndrome)

Triad of esophageal webs, glossitis, iron def anemia. Also have koilonychia and splenomegaly.