Upper GI Complaints

Question 1

effortless return of esophageal or gastric contents to pharynx

Answer 1

regurgitation

Question 2

failure to relax the LES

Answer 2

achalasia

Question 3

pain w/ swallowing

Answer 3

odynophagia

Question 4

____ epithelium is in the esophagus, _____ epithelium in the gastric area.

Answer 4

Squamous

columnar

Question 5

Striated muscle is seen in (upper/lower) portion of esophagus.

Answer 5

upper

Question 6

Smooth muscle is seen in (upper/lower) portion of esophagus.

Answer 6

lower

Question 7

Oropharyngeal or esophageal dysphagia?

Difficulty initiating swallowing

Answer 7

Oropharyngeal

Question 8

Oropharyngeal or esophageal dysphagia?

suprasternal notch or substernally

Answer 8

Esophageal

Question 9

Oropharyngeal or esophageal dysphagia?

Onset after few seconds

Answer 9

Esophageal

Question 10

Oropharyngeal or esophageal dysphagia?

Worse with liquids

Answer 10

Oropharyngeal

Question 11

Oropharyngeal or esophageal dysphagia?

Worse with solids

Answer 11

Esophageal due to mechanical obstruction

Question 12

Oropharyngeal or esophageal dysphagia?

Symptoms about the same with solids and liquids

Answer 12

Esophageal due motility disorder

Question 13

Oropharyngeal or esophageal dysphagia?

Caused by poor dentition, reduced saliva production, or neuromuscular disorders, structural lesions.

Answer 13

Oropharyngeal

Question 14

Oropharyngeal or esophageal dysphagia?

Caused by esophagitis, mechanical obstruction or motility disorder (achalasia, scleroderma)

Answer 14

Esophageal

Question 15

Oropharyngeal or esophageal dysphagia?

Choking or nasal regurgitation

Answer 15

Oropharyngeal

Question 16

Which of the following is used to diagnosis oropharyngeal dysphagia?
A. Upper endoscopy
B. Barium radiography
C. Videofluroscopy
D. Esophageal manometry

Answer 16

B, C
Also Nasopharyngeal laryngoscopy for oropharyngeal

The others are used for esophageal dysphagia.

Question 17

Difficulty swallowing

Answer 17

dysphasia

Question 18

Name the two causes of odynophagia

Answer 18

Infectious esophagitis (Herpes, CMV)
Pill esophagitis

Question 19

Which of the following is TRUE about achlasia?
A. Male predominance
B. Young age 
C. Dysphagia for liquids
D. Slow progressive

Answer 19

D

A. No gender predominance
B. Middle age
C. Dysphagia for solids and liquids

Question 20

All of the following are ways to diagnosis achlasia EXCEPT:
A. Barium study
B. Upper endoscopy
C. Videofluroscopy
D. Esophageal manometry

Answer 20

C

All the others are the same techniques used for esophageal dysphagia.

Question 21

1st line diagnosis of GERD if confident in diagnosis

Answer 21

Therapeutic trial w/ acid suppressing medication

Question 22

T/F: Absence of reflux esophagitis upon endoscopy excludes diagnosis of GERD.

Answer 22

False. GERD can manifest solely as symptoms.

Question 23

Ambulatory pH monitoring for GERD indicated for _____

Answer 23

o Atypical symptoms and negative endoscopy

o Symptoms refractory to standard therapy

Question 24

All of the following are alarm symptoms of dyspepsia EXCEPT:
A. Early satiety, dysphagia
B. Nausea/vomiting
C. Hematemesis, anemia, occult blood in stool, melena
D. Unintentional weight loss
E. Onset > 45 y/o

Answer 24

B

Question 25

T/F: Majority of pts w/ cancer or significant ulcers initially present w/ alarm symptoms.

Answer 25

False. Majority do NOT present with alarm symptoms

Question 26

``` Which of the following is FALSE on peptic ulcer disease? A. Worse at night B. Stomach pain worsen by food C. Nausea/vomiting D. Relief more common w/ duodenal ulcer ```

Answer 26

B. Stomach pain reduced by food

Question 27

T/F: ~90% of pts w/ PUD that are not using NSAIDs are infected w/ H. pylori

Answer 27

True

Question 28

Malignancy associated w/ H. pylori (2)

Answer 28

``` Gastric adenocarcinoma MALT lymphoma (mucosa-associated lymphoid tissue) ```

Question 29

``` All of the following are used to diagnosis current peptic ulcer EXCEPT: A. Urease breath test B. Stool antigen C. Serology (IgG anti-HP antibody) D. Gastric biopsy with EGD ```

Answer 29

C. Does NOT distinguish b/w past and present infection. Remains positive long after eradication.

Question 30

1st line treatment of PUD

Answer 30

PPI + 2 antibiotics x 2 weeks Confirm eradications via urea breath test or stool antigen

Question 31

``` Which of the following is NOT a risk factor of PUD? A. Smoking B. Acetaminophen (Tylenol) C. Old age D. History of PUD ```

Answer 31

B. Acetaminophen is NOT a NSAID

Question 32

T/F: The main pathophysiology of PUD is direct damage to epithelial cells.

Answer 32

False. Not an important component of pathophysiology. Mainly due to inhibition of cyclooxygenase

Question 33

Zollinger-Ellison Syndrome =

Answer 33

Gastrin-producing neuroendocrine tumor

Question 34

Which of the following is NOT a symptom of gastroparesis? A. Postpardial bloating B. Early satiety C. Delayed vomiting partially digested contents D. Refractory GERD E. Watery diarrhea

Answer 34

E

Question 35

``` Which of the following is NOT a cause of gastroparesis? A. Diabetic gastropathy B. Nerve damage C. Post viral gastroenteritis D. Scleroderma E. Medication use ```

Answer 35

E

Question 36

Succussion splash is seen in ____

Answer 36

gastroparesis = sloshing sound from stomach

Question 37

Treatment for gastroparesis include ____

Answer 37

Promotility agents: Erythromycin (motilin antagonist) but rapidly diminishing response to successive doses Metoclopramide but not really used due to SE of dyskinesia

Question 38

Name the disease: | Trachealization, furrowing, strictures, diffuse narrowing, eosinophilic abscesses

Answer 38

Eosinophilic Esophagitis