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Self-Assessment Questions

Gastroenterology

Esophageal Dysphagia: Review Questions

Douglas G. Adler, MD

Dr. Adler is an assistant professor of medicine and Director of Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, UT.



Choose the single best answer for each question.



Figure 1

Questions 1 and 2 refer to the following case.

A 30-year-old man presents to a gastroenterologist with intermittent dysphagia to solids. Over the past 5 years, he has had 2 episodes of food impaction requiring endoscopic treatment, which he attributed to taking very large bites. He has not followed-up with his physician as recommended. Past medical history reveals childhood asthma, which has resolved. Physical examination is unremarkable. Upper endoscopy shows an esophagus with a ringed appearance and vertical furrows throughout its length (Figure).


1. What is this patient’s most likely diagnosis

  1. Achalasia
  2. Eosinophilic esophagitis
  3. Esophageal candidiasis
  4. Schatzki’s rings
  5. Scleroderma
Click here to compare your answer.


2. What is the next step in this patient’s management?

  1. Esophageal biopsy
  2. Esophageal dilation
  3. Observation
  4. Oral fluconazole
  5. Oral proton pump inhibitor (PPI) therapy
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3. A 50-year-old man presents to the emergency department with progressive weight loss and dysphagia. Upper endoscopy reveals a large, fungating, friable mass at the esophagogastric junction, and biopsy reveals adenocarcinoma. Computed tomography shows no distant metastatic lesions. He has no other active medical issues. What is the next best step in this patient’s management?

  1. Referral for chemotherapy
  2. Referral for combined chemoradiotherapy
  3. Referral for endoscopic ultrasonography
  4. Referral for radiotherapy
  5. Referral for surgical evaluation
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4. A 65-year-old man is diagnosed with esophageal adenocarcinoma via upper endoscopy, which was performed for evaluation of dysphagia. Computed tomography demonstrates multiple hepatic lesions consistent with metastatic cancer. He has severe solid food dysphagia and can only swallow liquids, albeit with some difficulty. Given the patient’s advanced disease, he is not considered a candidate for surgery. What is the best treatment for this patient’s dysphagia?
  1. Endoscopic balloon dilation of the tumor
  2. Endoscopic laser therapy
  3. Placement of a gastrotomy tube for tube feeds and gastric venting
  4. Placement of a jejunostomy tube for tube feeds
  5. Placement of an esophageal stent
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Questions 5 and 6 refer to the following case.

A 32-year-old man presents to his primary care physician for evaluation of dysphagia to both solids and liquids. He reports that he has had this problem for several years, but symptoms have been worsening. He often leaves the table to regurgitate food that he cannot swallow. On several recent occasions, he has awakened at night to find undigested food on his pillow.


5. What is the most likely underlying diagnosis in this patient?

  1. Achalasia
  2. Esophageal adenocarcinoma
  3. Esophageal squamous cell carcinoma
  4. Schatzki’s ring
  5. Zenker’s diverticulum
Click here to compare your answer.


6. Given the underlying diagnosis, the patient is at increased risk for which of the following conditions?

  1. Esophageal gastrointestinal stromal tumor (GIST)
  2. Esophageal squamous cell carcinoma
  3. Gastric adenocarcinoma
  4. Gastric GIST
  5. Gastroesophageal reflux disease
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7. A 50-year-old woman with long-standing scleroderma presents to her primary care physician with dysphagia and chest pain after eating. A barium swallow demonstrates an atonic esophagus with a widely patent lower esophageal sphincter with free reflux of gastric contents into the esophagus. Upper endoscopy confirms these findings and reveals severe distal esophagitis. Based on findings from the barium swallow and upper endoscopy, scleroderma esophagus is suspected. What is the best treatment option for this patient?

  1. Aggressive antireflux regimen
  2. Daily calcium channel blockers
  3. Placement of a gastrostomy tube
  4. Surgical referral for a Nissen fundoplication
  5. Surgical referral for a Toupe fundoplication
Click here to compare your answer.
 

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