Week 3 review session Flashcards
Which of the following is most likely if a
patient has GERD and dysphagia to both
liquids and solids?
a. scleroderma
b. achalasia
c. cancer
a. scleroderma - LES weakened
Achalasia is when LES fails to relax
Which of the following is most likely if a
patient has dysphagia to solids only and
reports a history of chronic GERD?
a. esophageal stricture
b. Zenker’s diverticulum
c. esophageal web
a. esophageal stricture
What are the triad of symptoms for Zenker’s diverticulum?
Dysphagia
Halitosis
Aspiration
Of the following esophageal obstructive
conditions, which is most likely to present with only intermittent dysphagia?
a. stricture
b. rings
c. tumor
b. rings
Strictures do get bigger.
Rings typically don’t get bigger in size.
True or False. Stroke is the most common
cause of oropharyngeal dysphagia.
a. True
b. False
a. True
What are the 4 most common issues that cause difficulty initiating swallowing
Stroke
Neurologic disease
Pharyngitis
SOL of neck/throat
Separately, neck issues: cervical arthritis/DISH* or whiplash
*diffuse idiopathic skeletal hyperostosis
Which of the following is NOT a main symptom of uncomplicated GERD?
a. regurgitation
b. nausea
c. heartburn
b. nausea
Which of these conditions is NOT associated with globus hystericus?
a. neck mass
b. anxiety disorder
c. GERD
a. neck mass
What is the most common cause of GERD?
a. excessive LES relaxation
b. hiatal hernia
c. gastric distinction
d. disruption of esophageal peristalsis
e. gastric hypersecretion
a. excessive LES relaxation - up to 90% of cases
Your patient complains of regurgitation of food, heartburn, and dysphagia. Which of the following is the recommended next step?
a. make the diagnosis of GERD clinically based on the classic symptoms being present
b. refer to a GI specialist for an endoscopy
c. order H. pylori testing
b. refer to a GI specialist for an endoscopy
What are the atypical GERD symptoms?
Chest pain Chronic cough Dysphagia Chronic sore/burning throat Hoarseness Globes sensation Belching
What is the first line medication
recommended to treat GERD?
a. H2 blockers
b. Proton Pump Inhibitors (PPIs)
c. Beta-blockers
b. Proton Pump Inhibitors (PPIs)
Which of the following fulfills the recommendations for an initial management plan using a PPI to treat GERD?
a. twice daily for 4 weeks
b. once daily 8 weeks
c. take as needed only for 12 weeks
d. once daily indefinitely
b. once daily 8 weeks
When should a PPI be given ideally?
a. before eating
b. after eating
c. it doesn’t matter
a. before eating - 30-60 minutes
Functional dyspepsia is considered a(n):
a. Organic disease
b. Non-organic condition
b. Non-organic condition
Non-organic or “functional” disorder = no physical abnormality found to explain the condition
What percentage of cases of dyspepsia are due to functional dyspepsia?
a. 10-20%
b. 30-40%
c. 50-60%
d. 70-80%
c. 50-60%
Most people have no physical abnormality
How long do symptoms need to be present for
a diagnosis of functional dyspepsia?
a. no specific length of time
b. at least 3 weeks
c. less than 3 months
d. at least 3 months
d. at least 3 months
What is the Rome III criteria?
1. One or more of the following symptoms: • Epigastric abdominal pain • Epigastric burning • Early satiety • Bothersome post-prandial fullness
AND
- Symptoms present for ≥ 3 months
AND
- No evidence of organic disease
If a patient with dyspepsia is over 45-years-
old, has a family history of gastrointestinal
malignancy, or reports alarm symptoms, what
test should be ordered?
a. abdominal x-ray
b. abdominal ultrasound
c. EGD
d. manometry
c. EGD
Which of the following is true of a peptic ulcer?
a. diameter must be greater >5mm
b. diameter must be smaller <5mm
a. diameter must be greater >5mm
Which are more common, gastric or duodenal ulcers?
a. gastric
b. duodenal
b. duodenal
> 95% duodenal ulcers occur in the first portion of the duodenum
Which is more common, gastric cancer or duodenal cancer?
a. gastric
b. duodenal
a. gastric ?????
When a patient reports increased pain with eating, which is more likely?
a. gastric ulcer
b. duodenal ulcer
a. gastric ulcer
Gastric ulcers pain made worse with eating.
Duodenal ulcers frequently relieved by antacids or food. Pain occurs 1.5-3 hours after a meal and pain may wake the patient from sleep.
If free air is found under the diaphragm on chest or abdominal x-ray, what condition does this suggest?
a. functional dyspepsia
b. peptic ulcer perforation
c. gastric cancer
b. peptic ulcer perforation
