Clinical Material Not Emphasized In Path

Question 1

Nutcracker Esophagus

Description (2), Presentation (2) and Diagnosis

Answer 1

Hypertensive peristalsis with normal coordinated contractions

Atypical chest pain
Solid/Liquid Dysphagia

Increased baseline LES pressure on manometry

Question 2

Boerhaave’s Syndrome

Description, History (2) and Clinical Findings (3)

Answer 2

Spontaneous transmural esophageal rupture at GEJ

Hx of forceful retching and alcohol abuse

Pneumomediastinum on CXR
Subcutaneous emphysema
Hamman’s Sign

Question 3

Diffuse Esophageal Spasm

Description, Presentation (2) and Diagnosis (2)

Answer 3

Uncoordinated esophageal peristalsis

Atypical chest pain
Solid/Liquid Dysphagia

Corkscrew appearance on barium CXR
Normal LES function on manometry

Question 4

GI Alarm Symptoms (6)

Answer 4

Unexplained weight loss
Constant/Severe pain
Persistent vomiting
Dysphagia/Odynophagia
Hematemesis/Melena
Anemia

Question 5

Esophageal Web

Diagnosis (2), Treatments (2) and Association

Answer 5

Barium swallow (more sensitive)
EGD

Bougie Dilator
Long term PPI

Plummer Vinson Syndrome

Question 6

Sjogren’s Syndrome

Presentation (2), Complications (3), Cancer Association, Diagnostics (2)

Answer 6

Excessively dry mouth
Oropharyngeal dysphagia

Candida infections
Dental caries
Bilateral Salivary gland enlargement

Non-Hodgkin B cell Lymphoma

Lip biopsy showing Ro/La Abs

Question 7

Scleroderma

Hallmarks (3) Diffuse Description (2) Limited Description (2)

Answer 7

Atrophy of esophageal smooth muscle
Esophageal fibrosis causes aperistalsis
Progressive dysphagia

Diffuse associated with Topoisomerase I Abs (Scl-70)
Early internal organ involvement (worse prognosis)

Limited associated with Anti-Centrome Abs
CREST syndrome

Question 8

Esophageal Stricture

Most Common Type, Presentation (2) and Diagnosis

Answer 8

Peptic stricture

Progressive dysphagia
Heartburn improves as stricture worsens

EGD with biopsy (to rule out esophageal carcinoma)

Question 9

Gastroparesis
Clinical Features (3) Etiologies (5) Diagnosis, Treatment (4)

Answer 9

Intermittent symptomology
Early satiety
N/V 1-3 hours after meals

Diabetes
Hypothyroidism
Post operative
Anorexia
Neurological conditions

Gastric Scintigraphy

Eat small meals
Avoid fiber, milk and fat
Metoclopramide
Erythromycin

Question 10

Pyrosis (Heartburn)

Symptoms (4) and Treatments (3)

Answer 10

Chest pain 30-60 minutes after eating
Water brash (bad taste in mouth)
N/V
Dysphagia

Antacids
PPI’s
Lifestyle modifications

Question 11

Zollinger-Ellison Syndrome

Description (2), Association, Diagnosis

Answer 11

Gastrinoma in proximal duodenum
Excess acid causes duodenal ulcer

MEN1 (Hyperparathyroidism and Pituitary neoplasm)
Check PTH/PLN/LH/FSH/GH to rule out

Fasting gastrin >1000
Positive secretin stimulation test
EGD showing hypertrophic rugae

Question 12

Menetrier Disease

Etiology, Clincal Features (3)

Answer 12

Excessive TGF-alpha secretion

Hypoproteinemia
Anasarca
Hypertrophic rugae

Question 13

Mallory Weiss Tear
Clinical Description (3) and Associations (2)

Answer 13

Superficial, non-transmural tear at GEJ
Bleeding precipitated by vomiting or vigorous coughing
Bleeding abates spontaneously

Alcoholism
Bulimia

Question 14

Mallory Weiss Tear
Clinical Features (3)

Answer 14

Superficial, non-transmural tear at GEJ
Bleeding precipitated by vomiting or vigorous coughing
Bleeding abates spontaneously

Question 15

Diarrhea Alarm Symptoms (6)

Answer 15

Nocturnal Diarrhea
Weight Loss
Anemia
(+) Fecal Occult Blood Test (Hematochezia)
Acute diarrhea onset
Fever

Question 16

Budd Chiari

Risk Factor, Clinical Features (5), Diagnosis (2)

Answer 16

Hypercoagulable state

Hepatic Vein obstruction causing:
Jaundice, RUQ pain, Ascites, Hepatosplenomegaly

Diagnose with Contrast Enhanced US*
Nutmeg liver on biopsy