Gastroenterology

Question 1

What is the best initial test for a pt presenting with dysphagia (difficulty swallowing) and you are not aware of the diagnosis?

Answer 1

barium study

Question 2

A young nonsmoker presents with dysphagia to both solids and liquids at the same time, regurgitation of food particles, possible aspiration of previously eaten food and the symptoms can progressively get worse most likely suffer from …

Answer 2

Achalasia

failure of the gastroesophageal sphincter to relax

Question 3

What is the best initial test for achalasia?

Answer 3

barium swallow (bird’s peak)

Question 4

What is the most accurate test for achalasia?

Answer 4

esophageal manometry (absence of normal esophageal peristalsis; abnormally high pressure at lower esophageal sphincter)

Question 5

What are likely causes of odynophagia (painful swallowing)?

Answer 5

1. HIV
2. HSV
3. Candida
4. CMV

Question 6

What is the best initial therapy for achalasia?

Answer 6

surgical myotomy (or pneumatic dilation if surgery fails)

Question 7

What is the best treatment for achalasia in a pt who refuses surgery or pneumatic dilation?

Answer 7

botulinum toxin injection (inhibits ACh to relax muscle)

Question 8

A pt > 50 years old with a history of smoking/drinking alcohol presents with dysphagia that progressive from just solids to include solids and liquids, has associated weight loss and heme positive stool/ anemia most likely suffers from….

Answer 8

Esophageal Cancer

Question 9

What is the best initial test for suspected esophageal cancer?

Answer 9

Endoscopy with biopsy

Choose barium swallow if endoscopy not available

Question 10

What is the best initial therapy for esophageal cancer?

Answer 10

Surgical resection followed by 5- fluorouracil (5-FU)

Question 11

A middle aged female pt presents with dysphagia, weight loss, history of iron deficiency anemia most likely suffers from…

Answer 11

Plummer Vinson syndrome

Proximal stricture

Question 12

What disease is Plummer Vinson syndrome associated with?

Answer 12

Squamous cell esophageal cancer

As well as iron deficiency anemia

Question 13

What is the treatment for Plummer Vinson syndrome?

Answer 13

Iron replacement

Question 14

What is the best diagnostic test for suspected webs/ rings/ strictures of the esophagus?

Answer 14

Barium swallow

Question 15

A pt presents with intermittent symptoms of dysphagia most likely suffers from …

Answer 15

Schatzki’s ring

Distal stricture of esophagus

Question 16

What is the best treatment for Schatzki’s ring?

Answer 16

Pneumatic dilation

Question 17

A pt presents with dysphagia and weight loss in association with acid reflux history most likely suffers from …

Answer 17

Peptic stricture

Tx with pneumatic dilation

Question 18

A pt presents with dysphagia and a history of allergies most likely suffers from …

Answer 18

Eosinophilia Esophagitis

Question 19

What is the best diagnostic test for eosinophilic esophagitis?

Answer 19

Endoscopy with biopsy

Question 20

What is the best initial treatment for eosinophilic esophagitis?

Answer 20

Proton pump inhibitors and budesonide

Question 21

A pt presents with dysphagia and history of bad breath most likely suffers from….

Answer 21

Zenker’s Diverticulum

Dilation of posterior pharyngeal constrictor muscle

Question 22

What is the best initial test for Zenker’s Diverticulum?

Answer 22

Barium studies (dilation of posterior pharyngeal constrictor muscle)

Question 23

What is the best initial treatment for Zenker’s diverticulum?

Answer 23

Surgical resection