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Step III

Step III - GI 3

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