Cm 3 Gerd & Infectious Esophagitis

36 Questions | Total Attempts: 295

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Cm 3 Gerd & Infectious Esophagitis

Questions and Answers
  • 1. 
    GERD: Reflux esophagitis is the recurrent reflux of gastric contents into the distal esophagus because of mechanical functional abnormality of the ____________________
    • A. 

      Pyloric sphincter

    • B. 

      Lower esophageal sphincter

    • C. 

      Pylorus

    • D. 

      Upper esophageal sphincter

  • 2. 
    Most times GERD presents as _________.  You must rule out everything else before you diagnose GERD.
    • A. 

      Cough

    • B. 

      Cold

    • C. 

      Gnawing burning pain

    • D. 

      Chest pain

  • 3. 
    GERD is a common problem occuring in 10-20? of people in the west (5% in Asia) for people with weekly symptoms. Up to 60% of the population experiences "heartburn" at some point.  In infants, about 50% have reflux, but less than 10% have evidence of esophagitis.
    • A. 

      True

    • B. 

      False

  • 4. 
    What is not a factor that protects the esophagus?
    • A. 

      Mucus

    • B. 

      Gravity

    • C. 

      Lower esophageal sphincter tone

    • D. 

      Esophageal motility

    • E. 

      Salivary flow

    • F. 

      Gastric emptying

    • G. 

      Tissue resistance

  • 5. 
    In a minority of patients: Reflux causes erosion of the esophagus that leads to ________________.  Which is replacement of normal squamous epithelium with metaplastic columnar epithelium and can predispose to malignancy.
  • 6. 
    Check all that exacerbate GERD
    • A. 

      Obesity

    • B. 

      Caffeine

    • C. 

      Alcohol

    • D. 

      Smoking

    • E. 

      IV drug use

    • F. 

      Fatty meals

    • G. 

      Medications

    • H. 

      Pregnancy

  • 7. 
    The etiology/Pathophysiology of GERD is Weekly heartburn and mucosal damage that develops produced by ________ of gastric contents into the esophagus.  Can be caused by problems with LES pressure or Hiatal Hernia.
    • A. 

      Heartburn

    • B. 

      Undigested

    • C. 

      Stalled portions

    • D. 

      Abnormal reflux

  • 8. 
    GERD has the most common presenting feature (of CP):
    • A. 

      Tightness

    • B. 

      Squeezing

    • C. 

      Feeling of impending doom

    • D. 

      Heartburn

  • 9. 
    Check all the symptoms of GERD
    • A. 

      Increases at nighttime and when laying down

    • B. 

      Often relieved with antacids

    • C. 

      Worse before meals

    • D. 

      Worse after meals

    • E. 

      Regurgitation or dysphagia may occur.

    • F. 

      Hematemisis may occur.

    • G. 

      Hoarseness, halitosis, cough, hiccupping and atypical CP are less common symptoms of reflux.

    • H. 

      More severe disease is generally caused by severe impairment of the lower esophageal sphincter tone: occurs spontaneously when supine.

    • I. 

      Less severe GERD is associated with a pattern of heartburn following meals, but not associated with nighttime Sx's.

    • J. 

      Can have asymptomatic "silent reflux" that is typically noticed by a dentist due to dental decay

    • K. 

      May cause loss of hair if nutritional needs are not adequate

    • L. 

      Main symptom is heartburn approx 30-60 min. after meals.

    • M. 

      Patients may also present with asthma, globus sensation, recurrent laryngitis, sore throat, acid brash, waterbrash. Reterosternal CP

  • 10. 
    What is a long term symptom of GERD?
    • A. 

      Diffuse esophageal spasm

    • B. 

      Neurogenic dysphagia

    • C. 

      Zenker's diverticulum

    • D. 

      Dysphagia

  • 11. 
    Check all of the below possible mechanisms that result in GERD:
    • A. 

      Sphincter incompetence

    • B. 

      Poor digestion

    • C. 

      Malabsorption

    • D. 

      Transient LES relaxation (common GERD)

    • E. 

      Hypotensive LES (More severe GERD)

    • F. 

      Anatomical Disturbance of LES (Hiatal Hernia)

    • G. 

      Obesity

  • 12. 
    In GERD, what is typically chosen to monitor the extent of tissue damage?
    • A. 

      The lower GI

    • B. 

      The Upper GI

    • C. 

      The lower esophageal sphincter

    • D. 

      The entire esophagus via endoscopy

  • 13. 
    A clinical diagnosis can typically be made based on:
    • A. 

      Family history

    • B. 

      Undigested food remniants on pillow

    • C. 

      A history of heartburn, regurgitation of gastric contents... especially if relieved by antacids.

    • D. 

      A person's affinity for spicy foods

  • 14. 
    A more severe disease warrants endoscopy to confirm the Dx and to assess for epithealial damage.
    • A. 

      True

    • B. 

      False

  • 15. 
    ___________________ i warranted in patients older than 45 years with a new onset of symptoms, long-standing or frequently recurring symptoms and failure to respond to therapy or symptoms, indicating more severe conditions such as anemia, dysphagia, or recurrent vomiting.
  • 16. 
    Medical Management for GERD:
    • A. 

      Suggest lifestyle modifications: stop smoking, avoidance of eating at bedtime (6pm), avoidance of large meals, avoidance of alcohol, avoidance of irritating foods, raise the head of the bed, lose weight, posture changes.

    • B. 

      Mild Symptomatic Tx: Anatacids or alginic acid

    • C. 

      Mild GERD Tx: Histamine (H2 Blockers): may be used but in larger doses than for PUD. H2-blockers are the first-line treatment for mild GERD.

    • D. 

      An Acid-suppressant proton pump inhibitor (PPI). The most powerful anti-GERD medication. PPIs are first-line Tx in moderate to severe disease or in patients who are unresponsive to H2-blockers or have evidence of erosive gastritis.

    • E. 

      A combination of an H2 blocker at bedtime and a PPI in the daytime may be helpful in patients with significant nighttime symptoms.

  • 17. 
    What should be avoided with GERD?
    • A. 

      B-agonists

    • B. 

      A-adrenergic antagonist

    • C. 

      Nitrates

    • D. 

      Calcium channel blockers

    • E. 

      All of the above

  • 18. 
    As a Tx for GERD weight loss has been shown to be as effective as a PPI.
    • A. 

      True

    • B. 

      False

  • 19. 
    When taking a PPI what may not be absorbed by the body?
    • A. 

      Salts

    • B. 

      Electrolytes

    • C. 

      Magnesium

    • D. 

      Calcium

    • E. 

      A & b

    • F. 

      C & d

  • 20. 
    Surgical & Endoscopic Techniques are available for ____________ but have NOT been shown to prevent complications of the disease.  Surgical Treatment for resolution of GERD is useful when the causative mechanism is a Hiatal Hernia.
    • A. 

      Refractory cases

    • B. 

      Active cases

    • C. 

      Latent cases

  • 21. 
    Patient education to give to patients should include:
    • A. 

      Avoid acidic foods

    • B. 

      Avoid alcohol

    • C. 

      Avoid caffeine

    • D. 

      Avoid chocolate

    • E. 

      Avoid sleeping

    • F. 

      Avoid garlic

    • G. 

      Avoid onions

    • H. 

      Avoid salt

    • I. 

      Avoid peppermint

    • J. 

      Avoid illegal drugs

    • K. 

      Avoid smoking

    • L. 

      Lose weight

    • M. 

      Raise the head of the bed

    • N. 

      Decrease fat intake

    • O. 

      Drink moonshine

  • 22. 
    What is not a complication of GERD
    • A. 

      Peptic ulcer disease

    • B. 

      Barrett's Esophagitis/Malignancy

    • C. 

      Ulcers/Strictures

    • D. 

      Vocal Cord Errosion

  • 23. 
    Check ALL of the warning Sx's suggesting that complications have occurred in GERD:
    • A. 

      Dysphagia

    • B. 

      Rhinorrhea

    • C. 

      Bleeding

    • D. 

      Weight loss

    • E. 

      Chest pain

    • F. 

      Weight gain

    • G. 

      Choking

    • H. 

      Coughing, SOB, Hoarseness (caused by acid)

    • I. 

      Lesions in the mouth

    • J. 

      Longstanding symptoms requiring continuous treatment

  • 24. 
    What is the "big culprit" causing Pill-induced esophagitis?
    • A. 

      NSAIDS

    • B. 

      Steriods

    • C. 

      Doxycylcine

    • D. 

      Acids

  • 25. 
    Corrosive Esophagitis is caused by:
    • A. 

      E. coli

    • B. 

      S. pyogenes

    • C. 

      Low pH

    • D. 

      Alkalis or acids

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