OME - Day 12

Question 1

Colicky right upper quadrant abdominal pain: what’s the diagnosis and next step?

Answer 1

Gallstones, cholelithiasis, get an ultrasound

Question 2

Gallstones and dilated common bile duct on ultrasound, diagnosis?

Answer 2

Choledocholithiasis

Question 3

Inspiratory arrest on palpation of the gallbladder shows what?

Answer 3

Murphy’s sign, positive for cholecystitis

Question 4

Right upper quadrant pain, jaundice, and fever is what diagnosis?

Answer 4

Ascending Cholangitis, Charcot’s Triad

Question 5

Right upper quadrant pain, jaundice, fever, altered mental status and hypotension; what do you do?

Answer 5

ERCP (first) and antibiotics (at the same time), Ascending Cholangitis (Reynold’s pentad)

Question 6

What antibiotics for Ascending Cholangitis?

Answer 6

Cipro + Metronidazole or Ampicillin + Gentamycin + Metronidazole

Question 7

What are the risk factors for gallstones?

Answer 7

Female, Fat, Forty, Fertile, and Native American

Question 8

What are the ultrasound findings for a cholecystitis?

Answer 8

Pericholecystic fluid, thickening of gallbladder wall, gallstones

Question 9

You get an ultrasound and you aren’t sure if it is cholecystitis - what do you get?

Answer 9

HIDA scan

Question 10

Biopsy of esophagus reveals 30 eosinophils per high power field, what is the next step?

Answer 10

PPI (not oral steroids? treat eosinophilic esophagitis as GERD first)

Question 11

Guy tries to kill himself by drinking battery acid. What do you do?

Answer 11

Protect airway, EGD, maintain NPO

Question 12

How do you treat candida esophagitis?

Answer 12

Oral fluconazole

Question 13

How do you treat HSV esophagitis?

Answer 13

Valaciclovir or Acyclovir

Question 14

Odynophagia and a white cottage cheese on the mouth that can be removed, what’s the diagnosis?

Answer 14

Candida esophagitis

Question 15

Old lady on oral antibiotics in a nursing home complains of odynophagia, what’s the diagnosis?

Answer 15

Pill-induced esophagitis

Question 16

Oral lesions, vesicles on an erythematous base and odynophagia in an AIDS patient, what’s the diagnosis?

Answer 16

HSV esophagitis

Question 17

Biopsy of Achalasia will show what?

Answer 17

Absence of Auerbach Plexus

Question 18

Bird’s peak on barium swallow, diagnosis?

Answer 18

Achalasia

Question 19

Corkscrew esophagus on barium swallow, diagnosis?

Answer 19

Diffuse Esophageal Spasm

Question 20

Dysphagia, Webs, and Iron Deficiency Anemia, diagnosis?

Answer 20

Plummer-Vinson Syndrome

Question 21

Esophageal cancer of the lower esophagus with risk factors?

Answer 21

GERD, Adenocarcinoma

Question 22

Esophageal cancer of the upper esophagus with risk factors?

Answer 22

Squamous Cell Carcinoma, smoking and alcohol

Question 23

GERD and scleroderma - tx?

Answer 23

PPIs

Question 24

Halitosis, old man, regurgitates undigested food - what’s the diagnosis?

Answer 24

Zenker’s Diverticulum (do a Barium Swallow)

Question 25

How do you treat Diffuse Esophageal Spasm?

Answer 25

Nitro spray or calcium channel blockers.

Question 26

Paroxysmal dysphagia to large caliber food, diagnosis?

Answer 26

Schatzki's Ring

Question 27

What is the best next step after Achalasia on the esophagram, and why?

Answer 27

EGD with biopsy to rule out pseudoachalasia (aka cancer)

Question 28

What is the best treatment for Achalasia?

Answer 28

Myotomy

Question 29

Burning retrosternal chest pain better with sitting up and antacids, diagnosis?

Answer 29

GERD

Question 30

Nocturnal asthma without daytime Asthma, diagnosis?

Answer 30

GERD

Question 31

Salmon colored lesion on endoscopy of the esophagus - diagnosis?

Answer 31

Barrett's Esophagus

Question 32

Treatment for Barrett's Metaplasia?

Answer 32

High dose PPI

Question 33

Treatment for Esophageal Dysplasia?

Answer 33

Ablative therapy (you won't have to chose which)

Question 34

Treatment for Esophageal Adenocarcinoma?

Answer 34

Resection

Question 35

What is the first step in management of GERD?

Answer 35

PPIs

Question 36

What is the biopsy of Barrett's Esophagus going to look like?

Answer 36

Intestinal Metaplasia

Question 37

When do you go straight to EGD for GERD without treating?

Answer 37

Nausea, Vomiting, Weight Loss, Anemia

Question 38

When do you go to EGD for GERD without alarm symptoms?

Answer 38

After 6 weeks of PPI