GERD Fitz

Question 1

75. A 35-year-old woman complains of a 6-month history of periodic “heartburn” primarily after eating tomato-based
    sauces. Her weight is unchanged and examination reveals a single altered finding of epigastric tenderness without rebound. As first-line therapy,
    you advise:
    A. avoiding trigger foods.
    B. the use of a prokinetic agent.
    C. addition of sucralfate with meals.
    D. increased fluid intake with food intake.

Answer 1

A. avoiding trigger foods.

Question 2

76. You see a 62-year-old man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at
increased risk for:
A. esophageal stricture.
B. esophageal adenocarcinoma.
C. gastroesophageal reflux.
D. H. pylori colonization

Answer 2

B. esophageal adenocarcinoma.

Question 3

77. In caring for a patient with symptomatic gastroesophageal
reflux, you prescribe a PPI to:
A. enhance motility.
B. increase the pH of the stomach.
C. reduce lower esophageal pressure.
D. help limit H. pylori growth.

Answer 3

B. increase the pH of the stomach.

Question 4

78. A 38-year-old nonsmoking man presents with signs and symptoms consistent of GERD. He has self-treated
    with over-the-counter antacids and acid suppression therapy with effect. His weight is stable, and he denies
    nausea, vomiting, diarrhea, or melena.

Which of the following represents the most appropriate diagnostic
plan for this patient?
A. fecal testing for H. pylori antigen
B. upper GI endoscopy
C. barium swallow
D. no specific diagnostic testing is needed

Answer 4

D. no specific diagnostic testing is needed

Question 5

79. Which of the following is most likely to be found in a 40-year-old woman with new-onset reflux esophagitis?

A. recent initiation of estrogen-progestin hormonal therapy
B. recent weight loss
C. report of melena
D. evidence of H. pylori infection

Answer 5

A. recent initiation of estrogen-progestin hormonal therapy

Question 6

80. Which of the following is likely to be reported in a patient with persistent GERD?
A. hematemesis
B. chronic sore throat
C. diarrhea
D. melena

Answer 6

B. chronic sore throat

Question 7

81. A 58-year-old man recently began taking an antihypertensive
    medication and reports that his “heartburn” has become much worse. He is most likely taking:
    A. atenolol.
    B. trandolapril.
    C. amlodipine.
    D. losartan

Answer 7

C. amlodipine.

Question 8

82. You prescribe a fluoroquinolone antibiotic to a 54-year-old woman who has occasional GERD symptoms
    that she treats with an antacid. When discussing appropriate medication use, you advise that she should
    take the antimicrobial:

A. with the antacid.
B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone.
C. without regard to antacid use.
D. apart from the antacid by about 1 hour on either
side of the fluoroquinolone dose.

Answer 8

B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone.

Question 9

83. A 48-year-old man with obesity and a 1-year history of classic GERD symptoms has been on the consistent use
    of a therapeutic dose of a PPI for the past 6 months. He states he is “really no better with the medicine and I have cut out most of the food that bothers my stomach.
    I even cut out all alcohol and
    soda.” Physical examination
    reveals stable weight, mildly erythematous pharynx, and epigastric tenderness without rebound.

Next step options include:

A. obtaining an upper GI series.
B. referral for GERD surgery.
C. further evaluation with upper GI endoscopy.
D. obtaining FOBT testing.

Answer 9

C. further evaluation with upper GI endoscopy.

Question 10

85. Risk factors for Barrett esophagus include all of the following except:
A. a history of cigarette smoking.
B. being older than 50 years of age.
C. male gender.
D. African American ethnicity.

Answer 10

A. a history of cigarette smoking

Question 11

86. A 57-year-old male is in need of evaluation for Barrett
    esophagus. You recommend:
    A. H. pylori testing.
    B. CT scan.
    C. upper GI endoscopy with biopsy.
    D. barium swallow.

Answer 11

C. upper GI endoscopy with biopsy.

Question 12

87. A 64-year-old male with diagnosed Barrett esophagus has shown no sign of dysplasia in two consecutive
    evaluations within the past year. You recommend additional surveillance testing should be conducted
    every:
    A. 6 months.
    B. 12 months.
    C. 2 years.
    D. 3 years.

Answer 12

D. 3 years.

Question 13

88. The most common form of esophageal cancer in the United States is:
A. squamous cell cancer.
B. adenocarcinoma.
C. basal cell carcinoma.
D. melanoma.

Answer 13

B. adenocarcinoma.

Question 14

89. Esophageal adenocarcinoma is usually located:
    A. in the upper esophagus.
    B. near the upper esophageal sphincter.
    C. at the junction of the esophagus and stomach.
    D. in the lower esophagus.

Answer 14

C. at the junction of the esophagus and stomach.

Question 15

90. Esophageal squamous cell cancer is usually located:
    A. in the upper esophagus.
    B. near the upper esophageal sphincter.
    C. at the junction of the esophagus and stomach.
    D. in the lower esophagus

Answer 15

A. in the upper esophagus.

Question 16

91. Which of the following is at greatest risk of esophageal cancer?
    A. a 34-year-old male who eats a high-fat diet
    B. a 76-year-old male who stopped smoking 15 years ago
    C. a 45-year-old woman with a history of 6 full-term pregnancies
    D. a 58-year-old female vegetarian

Answer 16

B. a 76-year-old male who stopped smoking 15 years ago

Question 17

92. The presence of esophageal cancer is commonly associated with: 
A. renal impairment.
B. chronic bronchitis.
C. iron-deficiency anemia.
D. unexplained weight gain.

Answer 17

C. iron-deficiency anemia.