GI - Esophagus

Question 1

Risk factors for GERD

Answer 1

• smoking
• caffeine
• alcohol
• stress
• obesity
• pregnancy
• scleroderma
• gastric outlet tumor
• sliding hiatal hernia

Question 2

Retrosternal burning pain, regurgitation, dysphagia, odynophagia

Answer 2

GERD

Question 3

Epigastric pain associated with early satiety and postprandial discomfort

Answer 3

Dyspepsia

Question 4

Most appropriate initial step for the management of recent-onset GERD without red flag symptoms

Answer 4

Empiric PPI therapy

Question 5

Organic causes of dyspepsia

Answer 5

• gastritis
• peptic ulcer disease
• GERD
• biliary colic
• medications (NSAIDs, iron supplements)
• pancreatitis
• gastric malignancy

Question 6

Red flags of GERD

Answer 6

• dysphagia
• odynophagia
• anemia or signs of GI bleed
• unintentional weight loss
• vomiting
• any risk factor for Barrett esophagus

Question 7

Endoscopy shows white or yellow adherent plaques

Answer 7

Esophageal candidiasis

Question 8

Endoscopy shows superficial, punched out ulcers in the distal esophagus in the absence of plaques

Answer 8

Herpes esophagitis (HSV-1)

Question 9

Endoscopy shows mucosal erosions and linear ulcers in the middle of the lower esophagus and viral inclusion bodies in cell nuclei on biopsy.

Answer 9

CMV esophagitis

Question 10

Dysphagia, food bolus impaction, associated features of atophy (asthma, allergic rhinitis, atopic dermatitis, alimentary allergies)

Answer 10

Eosinophilic esophagitis

Question 11

Circumferential mucosal lesions (ring corrugations) with possible esophageal trachealization and longitudinal furrows on endoscopy

Answer 11

Eosinophilic esophagitis

Question 12

Medications that induce esophagitis

Answer 12

• ABX (tetracycline, doxycycline, clindamycin)
• NSAIDs
• Bisphosphonates

Question 13

Punched out ulcers, mild inflammatory changes of the surrounding mucosa

Answer 13

Esophagitis

Question 14

Indications for EGD

Answer 14

• 60+ years
• red flag symptoms
• suspected GERD without adequate response to empiric PPI therapy
• risk factors for Barrett esophagus

Question 15

Risk factors for Barrett esophagus

Answer 15

• chronic GERD
• male
• 50+ years old
• White
• smoking
• obesity
• family history of Barrett esophagus or esophageal adenocarcinoma in a 1st degree relative

Question 16

Most common complication of GERD

Answer 16

Reflux esophagitis

Question 17

Most common sequela of reflux esophagitis or ingestion of caustic substances

Answer 17

Esophageal stricture

Question 18

Red flags for dysphagia

Answer 18

• 50+ years at onset
• significant involuntary weight loss
• symptom progression over < 4 months
• GI bleeding
• recurrent vomiting
• Hx of cancer

Question 19

Next best step for a patient with dysphagia who is less than 50 years of age with no red flags

Answer 19

4 week trial of PPI

Question 20

Next best step for a patient with dysphagia who is over 50

Answer 20

EGD

Question 21

Difficulty initiating swallowing process

Answer 21

oropharyngeal dysphagia

Question 22

Preferred test for suspected oropharyngeal dysphagia

Answer 22

Modified barium swallow (Videofluoroscopy)

Question 23

Impaired passage of solid food and liquid through the esophagus towards the stomach

Answer 23

Esophageal dysphagia

Question 24

Preferred initial test for most patients with esophageal dysphagia

Answer 24

EGD

Question 25

Most common cause of esophageal dysphagia

Answer 25

Esophagitis

Question 26

Painful sensation triggered by swallowing

Answer 26

Odynophagia

Question 27

Diagnostic test for suspected esophageal cancer

Answer 27

EGD

Question 28

Intermittent dysphagia predominantly with solid food for a long duration

Answer 28

Esophageal web or esophageal ring

Question 29

Small (1-2mm) filling defect arising from the proximal esophageal wall on barium swallow study

Answer 29

Esophageal web

Question 30

Circumferential filling defect typically arising from the distal esophageal wall on barium swallow study

Answer 30

Esophageal ring (Schatzki ring)

Question 31

Contrast filled pouch protruding from the esophagus on barium swallow study

Answer 31

Esophageal diverticula

Question 32

Regurgitation of undigested food and halitosis

Answer 32

Esophageal diverticula

Question 33

Intermittent dysphagia predominately with liquids, episodic retrosternal chest pain, heartburn and regurgitation, corkscrew appearance or rosary bead appearance on barium swallow study

Answer 33

Distal esophageal spasm

Question 34

Premature contractions on esophageal manometry

Answer 34

Distal esophageal spasm

Question 35

Hypertensive esophageal contractions on esophageal manometry

Answer 35

Hypercontractile esophagus

Question 36

Dysphagia with liquid and solid food, slow onset, symptoms for months to years, retrosternal pain, regurgitation of undigested food, weight loss, halitosis

Answer 36

Achalasia

Question 37

Bird beak sign on barium swallow

Answer 37

Achalasia

Question 38

Impaired peristalsis in the lower 2/3 of the esophagus with increased LES pressure and decreased LES relaxation on esophageal manometry

Answer 38

Achalasia

Question 39

Condition characterized by triad of dysphagia, upper esophageal webs and iron deficiency anemia

Answer 39

Plummer-Vinson syndrome

Question 40

Plummer-Vinson syndrome increases risk of what condition?

Answer 40

Esophageal squamous cell carcinoma

Question 41

Slow onset of progressive dysphagia with symptoms of CREST syndrome

Answer 41

Scleroderma