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Clin Med 1 - Exam 4 > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

Most common cause of infectious esophagitis

A

Candida

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2
Q

Transmural rupture of the distal esophagus due to straining or vomiting is known as …

A

Boerhaave syndrome

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3
Q

Risk factors for esophageal adenocarcinoma

A

White male

GERD/Barrett’s esophagus

Obesity

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4
Q

This class of GERD medications can develop tachyphylaxis within 2-6 weeks

A

Histamine 2 receptor antagonists (famotidine/pepcid)

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5
Q

Premature, rapid contractions of the distal esophagus are suggestive of this condition

A

Diffuse/Distal esophageal spasm

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6
Q

After noting esophageal cancer on endoscopy, what is the next test?

A

CT of chest and abdomen to assess extent of disease and look for metastases

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7
Q

This medication is known to cause esophagitis

A

Minocycline

(tetracycline antibiotic used for acne)

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8
Q

Purpose of barium swallow in diagnosing esophageal disorders

A

Can identify subtle narrowings and motility disorders

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9
Q

Two common symptoms with achalasia

A

Slowly progressive dysphagia

Regurgitation

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10
Q

Purpose of metoclopramide in treatment of GERD

A

Prokinetic agent - enhance gastric clearance

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11
Q

A rosary bead or corkscrew appearance on barium swallow is suggestive of this condition

A

Diffuse/distal esophageal spasm

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12
Q

Esophageal cancer diagnosis methods

A

Barium swallow will show obstruction but won’t tell you the cause

X-ray may show irregular borders/sharp angles

Endoscopy best test, shows nodules protruding into lumen

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13
Q

Best initial diagnostic test in a patient complaining of chronic GERD

A

Endoscopy

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14
Q

This diagnostic test is often performed first in diffuse/distal esophageal spasm

A

Endoscopy

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15
Q

Gold standard test for esophageal motility disorder diagnosis

A

Esophageal manometry

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16
Q

Most common esophageal foreign body objects

A

Kids: coins

Adults: meat/other food

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17
Q

Treatments for infectious esophagitis

A

Mild = clotrimazole

Severe = fluconazole or amphotericin B

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18
Q

Test for tracking acid levels throughout a day

A

Ambulatory 24-hour esophageal pH monitoring

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19
Q

Most common type of esophageal cancer

A

Squamous cell carcinoma

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20
Q

Which type of esophageal cancer is more common in white men?

A

Adenocarcinoma

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21
Q

Most common age range for esophageal foreign bodies

A

6 months to 3 years

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22
Q

90% of patients with this autoimmune condition

A

Scleroderma

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23
Q

Form of calcium supplementation to use in patient on chronic PPI

A

Calcium citrate

(doesn’t require acid for absorption)

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24
Q

Two main medications to know for nutcracker esophagus

A

Nitrates, calcium channel blockers

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25
Q

Which esophageal disorders will have slowly progressive difficulty swallowing?

A

Benign lesions

Achalasia

26
Q

Raised white plaques seen in the throat that resemble cottage cheese is suggestive of …

A

Infectious candida esophagitis

27
Q

How to differentiate diffuse/distal esophageal spasm from nutcracker esophagus?

A

Both are non-progressive, disordered spasm of esophagus

DES: Esophagus contracts too early

Nutcracker: contracts on time, but too forcefully

28
Q

Risks associated with PPI use

A

Clostridium difficile (no acid in stomach to stop proliferation)

Magnesium malabsorption (leads to neuromuscular excitability initially and long QT/torsades if severe)

Fractures (need acid to absorb calcium)

Dietary B12 malabsorption

29
Q

Degeneration of the inhibitory neurons impairing relaxation of the esophagus causing a slowly progressive dysphagia is known as …

A

Achalasia

30
Q

Two most common symptoms in diffuse/distal esophageal spasm

A

Dysphagia and chest pain

31
Q

Initial diagnostic test for new onset GERD

A

PPI trial

32
Q

A patient complaining of GERD who failed a PPI trial and with negative endoscopy should get this test to identify a possible motility disorder cause of reflux

A

Manometry

33
Q

Three diagnostic studies for achalasia

A

Endoscopy - usually done initially

Esophageal manometry - gold standard

Barium swallow - dilated esophagus ending in bird’s beak

34
Q

Symptoms of GERD

A

Uncomfortable, burning sensation often radiating up throat

35
Q

Causes of nutcracker esophagus

A

Excessive excitatory neuronal activity/smooth muscle hypertrophy

36
Q

Best procedures for achalasia treatment

A

Pneumatic dilation therapy

Surgical myotomy (cuts lower esophageal sphincter)

Botulinum injection into lower esophageal sphincter

37
Q

Important method to manage cessation of PPIs

A

Must taper (50% each week) if patient has been on PPI for more than 6 months

38
Q

Gold standard diagnostic test for diffuse/distal esophageal spasm

A

Esophageal manometry

39
Q

If a patient with GERD fails BID H2RA therapy/has erosive esophagitis/has severe GERD, start these drugs

A

PPIs

40
Q

Diagnosis method for Barrett’s esophagus

A

Endoscopy with biopsy

41
Q

Describe benign esophageal stricture causes

A

Like scar tissue in the esophagus

(Can be caused by ingesting foreign bodies, history of candida, radiation to chest for cancer)

42
Q

Difference between dysphagia and odynophagia

A

Dysphagia = difficulty swallowing

Odynophagia = pain/discomfort swallowing

43
Q

This stomach condition sometimes co-occurs with GERD

A

Hiatal hernia

44
Q

Mechanism of action of PPI drugs

A

Inhibition of hydrogen potassium ATPase pump

45
Q

Which esophageal disorders will have rapidly progressive difficulty swallowing?

A

Malignant lesions

46
Q

Medications for achalasia

A

Nitrates and calcium channel blockers

(although surgery or dilation procedures work better)

47
Q

This condition is also called “hypercontractile esophagus”

A

Nutcracker esophagus

48
Q

Which esophageal cancer is more likely in black or asian men?

A

Squamous cell carcinoma

49
Q

Best treatment for infrequent GERD

A

Antacids (Tums)

50
Q

Treatment for Boerhaave syndrome

A

Surgical debridement - (emergency)

51
Q

Most common patient to get infectious esophagitis

A

Immunocompromised (HIV/AIDS)

52
Q

A bird’s beak barium swallow is suggestive of this condition

A

Achalasia

53
Q

Three best lifestyle modifications for GERD treatment

A

Elevate head of bed 4-8 inches

Avoid food 2-3 hours before bed

Dietary modification

54
Q

Odd folds of the mucosa at the distal esophagus that cause non-progressive dysphagia (mostly with solid foods) is called …

A

Schatzki rings

55
Q

Risk factors for esophageal squamous cell carcinoma

A

Black male

Smoking and alcoholism

Preserved foods, hot foods/drinks, achalasia

56
Q

Medications for diffuse/distal esophageal spasm

A

Nitrates, calcium channel blockers, sildenafil

57
Q

Diagnosis methods for Boerhaave syndrome

A

Chest/neck x-ray may show perforation

CT if x-ray fails to find it

(don’t give barium swallow, it will leak out)

58
Q

Which esophageal disorder presents with intermittent, non-progressive episodes?

A

Schatzki ring

59
Q

This esophageal is relieved by antacids and eliminated by PPIs

A

GERD

60
Q

Which is more sensitive for identifying subtle mucosal lesions of the esophagus, barium swallow or endoscopy?

A

Endoscopy

Clin Med 1 - Exam 4 (12 decks)

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