Mehl. oral/eso info from IM file

Question 1

mouth or fingernail picture of telangiectasias (siaip mazos kraujosruvos) = Dx?

Answer 1

hereditary hemorrhagic telangiectasia; autosomal dominant.
Osler-Weber-Rendu

Question 2

Q will give nosebleeds + show you the above pic. There can be what cardiac pathology?

Answer 2

There can be high-output cardiac failure due to pulmonary AV fistulae.

GI bleeding can occur leading to anemia.

Question 3

Lip psoriasis = exists.

USMLE can mention it on upper lip or forehead, and this somehow confuses students, where they think it has to be on extensors only.

Answer 3

.

Question 4

Vasculitis that causes 5+ days of fever + injected (red) eyes and/or lips/tongue + cervical lymphadenopathy + edema of dorsa of the hands + desquamation of palms/soles (often mentioned as palms/soles “rash,” but not true rash).

Coronary artery aneurysms as complication.

Answer 4

.

Question 5

Herpes labialis. Virus structure?

Answer 5

DNA, enveloped, linear.

Question 6

Herpes labialis. Tx = acyclovir. MOA?

Answer 6

DNA polymerase inhibitor causing chain termination.

HSV resistance to it will be due to altered thymidine kinase.

Question 7

Hand-foot-mouth = virus?

Answer 7

Coxsackie A

Usually pediatric, but can present in adults (i.e., daycare workers, parents).

Don’t confuse with coxsackie B, which can cause dilated cardiomyopathy, diabetes type I, and pleurodynia (latter I discussed in HY Pulm PDF).

Question 8

Herpangina = virus?

Answer 8

Also caused by coxsackie A.

Presents as oropharyngeal vesicles or sores (buvo ant gomurio virsaus baltos opeles, bet be koplik!! ir ne aphtous)

Can occur with or without hand-foot-mouth.

Question 9

measles = rubeola = Koplik

Answer 9

.

Question 10

rubella (German measl.) = sub-occipital and post-auricular lymphadenophaty as

Answer 10

.

Question 11

Sometimes a Q can say a patient has pain or inflammation on the buccal mucosa across from the second upper molar =Dx?

Answer 11

sialadenitis (inflammation) or sialolithiasis can be an answer.

Stensen duct is the opening of the parotid duct (from parotid gland) into the oral cavity, which is located near the 2nd upper molar bilaterally.

Question 12

Leukoplakia = due to smoking, bad, precursor for SCC.

Answer 12

Oral hairy leukoplakia = oloks like leukoplakia, but caused by EBV. Not considered premalignant (no dysplasia on biopsy).

Question 13

Oral candidasis = Tx with nystatin mouthwash.

Answer 13

.

Question 14

Paraesophageal hernia = Protrusion of the fundus into the chest above the level of T10

Answer 14

.

Question 15

Hiatal hernia = “Abnormal relation of the cardia to the lower end of the diaphragm” is answer on NBME.

Answer 15

.

Question 16

Hiatal hernia = Dx?

Answer 16

Endoscopy

Question 17

Hiatal hernia - surgery usually not indicated.

Assoc. with GERD

Answer 17

.

Question 18

GERD = 2 pneumo CP?

Answer 18

Can present with nocturnal cough or recurrent pneumonitis.

These are HY findings in patients who don’t have classic esophageal irritation symptoms.

Question 19

GERD. 1st step Dx?

Answer 19

2-week trial of proton pump inhibitor (PPI), such as omeprazole, which will decr. symptoms.

PPI more efficacious then H2. Choose PPI if listed

Question 20

GERD. Dx 2nd is PPI trial is not effective?

Answer 20

24-hour esophageal pH monitoring is the answer.

Question 21

GERD. Last resort Tx?

Answer 21

Nissen fundoplication is used last resort, but is asked on NBMEs.

Question 22

Pediatric GERD - CP? Cause?

Answer 22

Coughing up milk 2-3x daily.
Cause - immature LES

It will not be described as high-energy or forceful (i.e., pyloric stenosis); it will not be bilious (i.e., duodenal atresia; annular pancreas); it will not occur as choking or spitting up during the first feed (i.e., tracheoesophageal fistula).

Question 23

Pediatric GERD Tx?!!!!

Answer 23

Tx for pediatric GERD is thickened feeds (addition of dry rice to formula) and positional change prior to any use of PPIs.

Question 24

Will present in patient over 50 who is heavy smoker/drinker who has
1) new- onset dysphagia to solids,
or
2) dysphagia to solids that progresses to solids and liquids.

Dx?

Answer 24

Squamous cell carcinoma of esophagus

Question 25

Squamous cell carcinoma of esophagus. First to Dx? 2nd?

Answer 25

First = endoscopy --> do biopsy is lesion is present

Question 26

Will present in patient over 50 who has Hx of GERD with either 1) new-onset dysphagia to solids, or 2) dysphagia to solids that progresses to solids and liquids. Dx?

Answer 26

Adenocarcinoma The “new-onset dysphagia” can refer to 3-6-month Hx in patient with, e.g., 10-20-year Hx of GERD.

Question 27

Adenocarcinoma Dx?

Answer 27

Endoscopy => biopsy if lesion is present

Question 28

Achalasia = what nerves?

Answer 28

“enteric ganglia”

Question 29

Achalasia = CP?

Answer 29

dysphagia to both solids and liquids from the start.

Question 30

Achalasia Dx? first => second?

Answer 30

barium swallow => esophageal manometry [confirmatory]. Biopsy - traditionally not done.

Question 31

Achalasia Tx? 1st => 2nd

Answer 31

Treatment is pneumatic (balloon) dilation, followed by myotomy (cutting of muscle fibers of the LES).

Question 32

Esophageal varices = in splenic vein thrombosis. the incr.­ splenic venous pressure causes formation of collaterals to circumvent the thrombosis. This means nearby veins will form small tributaries/branches from the splenic vein. The left gastric vein is one of them -> incr. esophageal venous pressure.

Answer 32

.

Question 33

Esophageal varices = prophylaxis?

Answer 33

Propranolol

Question 34

Esophageal varices Tx?

Answer 34

Treatment is endoscopy + banding. Octreotide can also be used for acute bleeding, but endoscopy + banding is best answer on USMLE if you are forced to choose.

Question 35

Esophageal varices. There is a 2CK Q where patient has low BP due to ruptured varix and the answer is “IV fluids,” where endoscopy is the wrong answer. I’ve had a student say, “Wait but I thought you said endoscopy and banding is what we do first.” And my response is, yeah, but you always have to address ABCs first on 2CK. They could by all means say patient has O2 sats of 50% and the answer would be give oxygen before fluids.

Answer 35

.

Question 36

Nesumaisyti!!. Achalasia = bird's beak Diffuse eso spams = corkscrew

Answer 36

Trachealization - in eosinophilis esophagitis.