Disorders of the Stomach

Question 1

A patient presents with left supraclavicular lymphadenopathy and an umbilical lymph node. What do you suspect?

Answer 1

Gastric cancer or abdominal cancer (Left supraclavicular lymphadenopathy aka Virchow’s node)

Question 2

Refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen.

Answer 2

Sister Mary Joseph’s node (Umbilical)

Question 3

Gastrin secreting tumor

Answer 3

Zollinger-Ellison syndrome

Question 4

H. pylori Triple therapy

Answer 4

Clarithromycin + Amoxicillin + PPI (CAP)

Question 5

A patient describes abdominal discomfort that improves with meals and gets worse an hour or so later. What do you suspect?

Answer 5

Duodenal ulcer

Question 6

Projectile vomiting occurs shortly after feeding in an infant < 3 mo old, palpable “olive-like” mass

Answer 6

Pyloric stenosis

Question 7

The most common cause of GERD

Answer 7

H. pylori infection

Question 8

What is the gold standard for diagnosis of GERD?

Answer 8

pH monitoring with a intra-esophageal electrode

Question 9

What surgical procedure is indicated for refractory GERD?

Answer 9

Nissen Fundoplication

Question 10

What lifestyle change, in addition to smoking cessation, not eating before bedtime, and proper food choices, has the largest effect on GERD symptoms?

Answer 10

weight loss

Question 11

A patient describes abdominal discomfort that is worse with meals and gets better an hour or so later after eating? What do you suspect?

Answer 11

gastric ulcer

Question 12

Treatment for gastritis?

Answer 12

Proton pump inhibitor
Treat H. Pylori if present
Remove irritants

Question 13

What GI cancer is acanthosis nigricans associated with?

Answer 13

stomach cancer

Question 14

What medications may result in a false-negative urea breath test in a patient with H. pylori?

Answer 14

Proton pump inhibitors
H2 blockers
Bismuth
Antibiotics

Question 15

What symptoms of GERD may present as a pulmonary disease process?

Answer 15

hoarseness
cough
wheeze

Question 16

Syndrome with elevated gastrin levels?

Answer 16

Zollinger Ellison

Question 17

What type of GI ulcer has pain relief with food?

Answer 17

duodenal ulcer

Question 18

In addition to peptic stricture what is another complication of chronic GERD?

Answer 18

Barrett’s esophagus

Question 19

What disorder can cause heartburn hoarseness and atypical chest pain?

Answer 19

GERD

Question 20

A baby presents with vomiting and abdominal exam reveals an olive like mass in the RUQ. What do you suspect?

Answer 20

pyloric stenosis

Question 21

What exam finding would be possibly seen on radiologic work up for child with pyloric stenosis?

Answer 21

• US for identification shows a Double-track

- Follow up barium studies show String & Shoulder sign

Question 22

Use of what antibiotic is associated with increased risk of pyloric stenosis?

Answer 22

Clarithromycin (Note: erythromycin is also associated)

Question 23

What type of hernia can worsen GERD symptoms?

Answer 23

hiatal hernia

Question 24

What MEN I tumor causes excess gastric acid production?

Answer 24

Zollinger Ellison

Question 25

A patient describes abdominal discomfort that is worse with meals and gets better an hour or so later after eating? What do you suspect?

Answer 25

gastric ulcer

Question 26

A patient describes abdominal discomfort that improves with meals and gets worse an hour or so later. What do you suspect?

Answer 26

duodenal ulcer