Week 3 review session

Question 1

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

Answer 1

a. scleroderma - LES weakened

Achalasia is when LES fails to relax

Question 2

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

Answer 2

a. esophageal stricture

Question 3

What are the triad of symptoms for Zenker’s diverticulum?

Answer 3

Dysphagia
Halitosis
Aspiration

Question 4

Of the following esophageal obstructive
conditions, which is most likely to present with only intermittent dysphagia?

a. stricture
b. rings
c. tumor

Answer 4

b. rings

Strictures do get bigger.
Rings typically don’t get bigger in size.

Question 5

True or False. Stroke is the most common
cause of oropharyngeal dysphagia.

a. True
b. False

Answer 5

a. True

Question 6

What are the 4 most common issues that cause difficulty initiating swallowing

Answer 6

Stroke
Neurologic disease
Pharyngitis
SOL of neck/throat

Separately, neck issues: cervical arthritis/DISH* or whiplash

*diffuse idiopathic skeletal hyperostosis

Question 7

Which of the following is NOT a main symptom of uncomplicated GERD?

a. regurgitation
b. nausea
c. heartburn

Answer 7

b. nausea

Question 8

Which of these conditions is NOT associated with globus hystericus?

a. neck mass
b. anxiety disorder
c. GERD

Answer 8

a. neck mass

Question 9

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

Answer 9

a. excessive LES relaxation - up to 90% of cases

Question 10

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

Answer 10

b. refer to a GI specialist for an endoscopy

Question 11

What are the atypical GERD symptoms?

Answer 11

Chest pain
Chronic cough
Dysphagia
Chronic sore/burning throat
Hoarseness
Globes sensation
Belching

Question 12

What is the first line medication
recommended to treat GERD?

a. H2 blockers
b. Proton Pump Inhibitors (PPIs)
c. Beta-blockers

Answer 12

b. Proton Pump Inhibitors (PPIs)

Question 13

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

Answer 13

b. once daily 8 weeks

Question 14

When should a PPI be given ideally?

a. before eating
b. after eating
c. it doesn’t matter

Answer 14

a. before eating - 30-60 minutes

Question 15

Functional dyspepsia is considered a(n):

a. Organic disease
b. Non-organic condition

Answer 15

b. Non-organic condition

Non-organic or “functional” disorder = no physical abnormality found to explain the condition

Question 16

What percentage of cases of dyspepsia are due to functional dyspepsia?

a. 10-20%
b. 30-40%
c. 50-60%
d. 70-80%

Answer 16

c. 50-60%

Most people have no physical abnormality

Question 17

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

Answer 17

d. at least 3 months

Question 18

What is the Rome III criteria?

Answer 18

1. One or more of the following symptoms: 
• Epigastric abdominal pain
• Epigastric burning 
• Early satiety 
• Bothersome post-prandial fullness 

AND

2. Symptoms present for ≥ 3 months

AND

3. No evidence of organic disease

Question 19

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

Answer 19

c. EGD

Question 20

Which of the following is true of a peptic ulcer?

a. diameter must be greater >5mm
b. diameter must be smaller <5mm

Answer 20

a. diameter must be greater >5mm

Question 21

Which are more common, gastric or duodenal ulcers?

a. gastric
b. duodenal

Answer 21

b. duodenal

> 95% duodenal ulcers occur in the first portion of the duodenum

Question 22

Which is more common, gastric cancer or duodenal cancer?

a. gastric
b. duodenal

Answer 22

a. gastric ?????

Question 23

When a patient reports increased pain with eating, which is more likely?

a. gastric ulcer
b. duodenal ulcer

Answer 23

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.

Question 24

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

Answer 24

b. peptic ulcer perforation