Im Gi Esophagus Usmle 2

Front 1

(3) causes of viral Esophagitis

Back 1

HSV

VZV

CMV

Front 2

(5)* causes of Bacterial Esophagitis

Back 2

My Pnew Strep Lacts Crypt:
Mycobacterium TB;
Pneumocystis Carnii;
Strep;
Lactobacillus;
Cryptospordium

Hint 2

My Pnew Strep Lacts Crypt

Front 3

*When is a Barium Esophagram the best initial test?

when is it the most accurate?
(3)

Back 3

Dysphasia

(that shows no signs of obstruction...for obstruction it would be Upper Endoscopy)

most accurate:
1. Esoph Webs
2. Esoph Rings
3. Esoph Diverticuli

Front 4

Dx:
Odynophagia (pain w/ swallowing), dysphagia, esophageal bleeding, N/V, chest pain, (or asymptomatic)

Back 4

Infectious Esophagitis

Front 5

Dx:
Infectious esophagitis w/ nodular filling defects on barium esophagram

Tx?

Back 5

Candida

Tx:
Fluconazole PO

Front 6

Causes:
Infectious esophagitis w/ vesicles and descrete erosions on endoscopy
(2)

Tx?

Back 6

HSV or VZV

Tx:
Acyclovir for HSV

Front 7

Dx:
Infectious esophagitis w/ intranuclear inclusions on bx via endoscopy

Tx?

Back 7

CMV

Tx:
Ganciclovir IV

Front 8

Who should upper endoscopy screening be offered to?
(2)

Back 8

1. Patients w/ GERD and Sx for > 5 years
(to check for Barrett's esophagus)

2. Patients w/ Esophageal varices

Front 9

Dx:
A Full-thickness tear usu in the weak left posterolateral wall of distal esophagus

(3) causes?

Back 9

Boerhaave's Syndrome

Causes:
Forceful vomiting;
Cough;
Trauma

Front 10

Dx:
A Partial-thickness tear usu in the right posterolateral wall of the distal esophagus and results in bleeding that resolves spontaneously

Cause?

Back 10

Mallory-Weiss syndrome

Cause:
Forceful vomiting

Front 11

medical Tx for non-bleeding Esophageal Varices

Back 11

Propranolol

Front 12

What is the next step in the Tx of a patient w/ GERD that has persistent Sx after 4 weeks of Tx w/ a PPI?

Back 12

24-hour Esophageal pH recording

Front 13

If patient has mediastinal and subcutaneous emphysema, what esophageal problem do they have?

Back 13

Full-thickness tear

(Boerhaave's syndrome)

Front 14

Dx sign:
"Crunching sound" heard w/ heartbeat

what is it due to?

Back 14

"Hammon's crunch"

(Mediastinal emphysema)

From:
Full-thickness esophageal tear
(Boerhaave's syndrome)

Front 15

*What is the Diagnostic test of choice for Boerhaave's syndrome or a partial esophageal perforation?

What is the most accurate test?

Back 15

Dx test: Gastrograffin
(water-soluble contrast)

most accurate: CT scan

Front 16

Tx for esophageal tear
(1 for each type)

Back 16

Partial-thickness (Mallory-Weiss):
may resolve spontaneously

Full-thickness (Boerhaave's):
Surgery

Front 17

Definition:
Pharyngeal or esophageal pouch due to a defect in the muscular wall of the posterior hypopharynx

Back 17

Zenker's Diverticulum

Front 18

Dx:
Halitosis, regurgitation of food after eating it, frequent aspiration, esophageal obstruction

Back 18

Zenker's Diverticulum

Front 19

Dx test for Zenker's Diverticulosis
(2 possible)

Tx (2 possible)

Back 19

Tests:
Barium swallow;
Endoscopy

Tx:
Surgical removal;
Cricopharyngeal myotomy

Front 20

Dx:
56-yo man complains of food feeling "stuck" on its way down and vomiting food he ate days ago

Back 20

Zenker's Diverticulum

Front 21

Definition:
Neurogenic disorder of esophageal motility w/ absence of normal peristalsis and impaired relaxation of the LES

Back 21

Achalasia

Front 22

Definition:
Esophageal motility disorder w/ frequent non-peristaltic contractions

Back 22

Diffuse Esophageal Spasms
(DES)

Front 23

What esophageal problem affects 70% of people with Scleroderma?

Back 23

Achalasia

Front 24

What type of problem does dysphagia to solids and liquids indicate?
(2 examples)

To just solids?
(3 examples)

Back 24

Solids + Liquids:
Motility problem
(Achalasia; DES)

Solids only:
Mechanical problem
(Tumor; Schatzki's ring; Plummer-Vinson syndrome)

Front 25

Dx:
weight loss, cough, dysphagia of both solids and liquids, "bird's beak" on CXR

Tx options?
(2 drugs and 2 procedures)

Back 25

Achalasia

Tx options:
Nitroglycerin;
Local Botulinum toxin;
Balloon Dialation;
Sphinctor Myotomy

Front 26

Dysphagia to both solids and liquids, diffuse chest pain, "corkscrew" appearance on CXR

DES Drug Tx options? (2 possible)

Back 26

Diffuse Esophageal Spasms (DES)

Tx options:

1. Nitroglycerin;

2. Anticholinergics

Front 27

When is an Esophageal Manometry the test of choice?
(2)

Back 27

1. an Inconclusive Barium or upper endoscopy

2. Description of a Motility problem
(Achalasia, DES, Nutcracker esophagus)

Front 28

Etiology of Achalasia
(2)

Back 28

Scarring of Auerbach's plexus from:

Chagas Dz
or
Ganglionic degeneration

Front 29

Definition:
Hypopharyngeal webs (thin mucosal structures protruding into lumen of the esophagus) associated w/ iron deficiency anemia

Back 29

Plummer-Vinson Syndrome

Front 30

Definition:
Narrow lower esophageal ringlike outgrowth associated w/ dysphagia

Back 30

Schatzki's Ring

Front 31

Etiology of GERD
(4)*

Back 31

HIDE:
Hiatal hernia;
Incompetent LES tone
Delayed Gastric emptying;
Esopageal motility decreased

Hint 31

HIDE

Front 32

(5)* causes of Delayed Gastric Emptying

Back 32

Delayed Food GAG:
DM;
Fatty foods;
Gastroparesis;
Anticholinergics;
Gastric outlet obstruction

Hint 32

Delayed Food GAG

Front 33

(8)* causes of a decreased LES tone

Back 33

Coffee CAN Cause Esophageal Sphinctor Problems:
Coffee;
Chocolate;
Alcohol;
Nitrates;
Calcium channel blockers;
Estrogen;
Smoking;
Progesterone

Hint 33

Coffee CAN Cause Esophageal Sphinctor Problems

Front 34

Differential of Chronic Cough
(3)*

Back 34

GAP in breathing:

GERD;

Asthma / Chronic Bronchitis;

Post-nasal drip

Hint 34

GAP in breathing

Front 35

Dx:
Substernal chest pain, dysphagia, hypersalivation, cough, wheezing

Back 35

GERD

Front 36

What (3) lifestyle modifications should be told to patients w/ GERD?

Back 36

Discontinue foods that lower LES tone;

Elevate head of bed;

No food < 3 hours before bed

Front 37

(2) drug Tx options for GERD

What can be done if medication doesn't work?

Back 37

Proton Pump Inhibitor (1st);

H-2 Blocker

Final solution:
Surgical fundoplication

Front 38

Definition:
Esophageal damage, bleeding and friability due to prolonged exposure to gastric contents

Back 38

Esophagitis

Front 39

(4)* complications of GERD

Back 39

BEEP:
Barrett's Esophagus;
Esophagitis;
Esophageal cancer;
Peptic stricture

Hint 39

BEEP

Front 40

(2) types of esophageal cancers and where each is formed in esophagus

Back 40

Squamous:
Upper 2/3 of esophagus

Adenocarcinoma:
Lower 1/3 of esophagus

Front 41

Risk factors for CA of the esophagus
(7)*

Back 41

ABCDEF:
Alcohol;
Barrett's esophagus;
Cigarettes;
Diverticuli (Zenker's);
Esophageal web (P-V synd), Esophagitis (reflux or irritants);
Familial

Hint 41

ABCDEF

Front 42

What causes Barrett's?

What can it become?

How often should a patient with Barrett's have an upper endoscopy?

Back 42

BARRett's:
Becomes Adenocarcinoma, Results from Reflux

UE:
Barrett's: every 2 - 3 years