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Step III
Step III - GI 3
| Question | Answer |
|---|---|
| What are the names for spastic dx of the esophagus | Nutcracker esophagus aka diffuse esophageal spasm |
| Pt c/o severe chest pain but (-) cardiac hx. Happens when he drinks cold beverage and every now and then he has dysphagia. Dx | Nutcracker esophagus/diffuse spasm |
| Most accurate test for Nutcracker esophagus | Manometry |
| What does barium swallow show for Nutcracker esophagus | Corkscrew pattern (IF there is current spasm; else could show nothing) |
| Tx for Nutcracker esophagus | CCB + nitrates (same for Prinzmetal angina) |
| How does scleroderma present | S/S acid reflux (not helpful!) |
| Initial Tx for scleroderma | PPI |
| Pt is HIV (-) c/o odynophagia. What is next step | Endoscopy |
| Pt is HIV (+), c/o odynophagia and CD < 100. What is next step | Give Fluconazole |
| If initial tx fails then next step for HIV+ esophageal candidiasis | endoscopy |
| What are the other causes of esophagitis besides HIV esophageal candidiasis | Pills eg doxycycline, alendronate |
| Pt presents w/ violent vomiting and retching. Sudden upper GI bleed, hematemesis, black stool. Dx | Mallory Weiss tear |
| Initial Tx for Mallory Weiss tear | Should resolve on own but if still bleeding then shot of EPI |
| Pt c/o epigastric pain, substernal CP, metallic taste in mouth. Dx and first line of therapy | GERD; PPI (easiest and diagnostic c/w other tests/tx) |
| What other S/S can present in pt w/ GERD | Bitter taste, cough, wheezing, sore throat, hoarseness |
| What is both diagnostic and therapeutic for GERD | PPI |
| If initial tx w/ PPI for GERD fails then next step | 24hr pH monitor |
| Pt’s w/ GERD + thes S/S warrant an endoscopy | Weight loss, anemia, blood in stool, dysphagia |
| Initial Tx for mild GERD sx | Lifestyle modificx eg quit smoking, don’t eat w/I 3 hrs of sleeping, acoid caffeine, alcohol, peppermint, chocolate, weight loss, elevating HOB |
| If lifestyle modifications do not work for GERD then next tx | PPI (omeprazole) |
| Pt has GERD, tried lifestyle modification w/ no avail. Answer choice does not give PPI or pt can not obtain PPI (insurance or other reason) then what is tx | H2 (-) “-tidine” |
| If initial and secondary tx fails then next tx for GERD is | Nissen fundoplication OR endoscopically suturing LES tighter |
| What type of symptoms warrant endoscopic evaluation | Weight loss, anemia, FOBT(+), and pt w/ GERD x5+ yrs |
| What is Barrett’s esophagus | Pre-cancerous lesion |
| Endoscopy finds Barrett’s esophagus in pt. Tx | PPI + repeat endo 2-3yrs |
| Endoscopy finds low grade dysplasia. Tx | PPI + repeat endo 3-6 mos |
| Endoscopy finds high grade dysplasia. Tx | Distal esophagectomy |
| Non smoking young pt c/o Dyspagia solids + liquids together at onset but not getting worse. Dx | Achalasia |
| Initial diagnostic study for Achalasia | Barium swallow |
| Most accurate test for Achalasia | Manometry |
| What does Manometry show in achalasia | Low pressures (no peristalsis) throughout and norml/HIGH pressures at LES (can’t relax sphincter) |
| Initial Tx for Achalasia | Pneumatic dilation |
| If initial tx fails then next tx for Achalasia | Surgery |
| If pt refuses surgery or pneumatic dilation then tx for Achalasia is | Botox injx |
| What are two esophageal diseases where endoscopy is indispensable for diagnosis | Esophageal cancer (squamous cell) and Barrett’s esophagus (adenoCA) |
| Name some dz that present w/ dysphagia | Achalasia, scleroderma, zencker’s diverticulum, esophageal webs/rings, esophageal CA, spastic dz |
| Dysphagia + weight loss = | esophagus patho |
| Dysphagia + weight loss + FOBT(+)/anemia | CANCER |
Created by:
DrINFJ
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