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Self-Assessment Questions

Gastroenterology

Upper Gastrointestinal Tumors: Review Questions

Douglas G. Adler, MD, and Christopher J. Gostout, MD

Dr. Adler is an Advanced Endoscopy Fellow and Dr. Gostout is a Professor of Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.



Choose the single best answer for each question.

1. A 32-year-old woman with major depression attempts suicide by drinking a household cleaning product containing lye. After being brought to an emergency department for medical attention, the patient is found to have severe chemical burns to her esophagus and stomach. The patient is stabilized, but develops severe stricturing of her proximal and midesophagus over the next several months. What condition is this patient at high risk for developing in the future?
  1. Squamous cell carcinoma of the esophagus
  2. Adenocarcinoma of the esophagus
  3. Gastric lymphoma
  4. Gastric adenocarcinoma
  5. Duodenal adenocarcinoma
Click here to compare your answer.


2. A 58-year-old man with a longstanding history of severe gastroesophageal reflux disease (GERD) develops progressive dysphagia and experiences a 20-lb weight loss over a 6-month period. Upper endoscopy reveals a large mass in the distal esophagus proximal to the gastroesophageal junction. Biopsies are obtained. The pathology report is most likely to reveal:

  1. Squamous cell carcinoma of the esophagus
  2. Adenocarcinoma of the esophagus
  3. Gastrointestinal stromal tumor
  4. Reactive inflammation with tissue hypertrophy
  5. Metastatic melanoma
Click here to compare your answer.


3. All of the following are thought to be risk factors for the development of gastric adenocarcinoma EXCEPT:

  1. Helicobacter pylori infection
  2. High salt diet
  3. Diet high in smoked foods
  4. Cigarette smoking
  5. Alcohol consumption
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4. A 75-year-old man with a history of coronary artery disease and parkinsonism is evaluated via upper endoscopy for a sensation of persistent abdominal fullness. He continues to eat well and has not had other symptoms. An upper endoscopy is performed and a 2 x 5 cm submucosal mass is identified in the gastric fundus. Deep biopsies reveal the mass to be a leiomyoma, a type of gastrointestinal stromal tumor. Subsequent endoscopic ultrasound studies fail to demonstrate abnormal local or regional lymph nodes and show the tumor to be confined to the gastric muscle layer. What is the best option for this patient?
  1. Chemotherapy
  2. Radiation therapy
  3. Partial gastrectomy with curative intent
  4. Observation
  5. Palliative gastrojejunostomy
Click here to compare your answer.


5. A 62-year-old woman known to have squamous cell carcinoma of the esophagus with liver metastases presents with dysphagia and coughing fits while eating. An upper endoscopy shows a narrowed esophageal lumen in the mid esophagus due to the tumor, and a barium swallow demonstrates the presence of a tracheoesophageal fistula at the level of the mass. What is the best treatment option for this patient?

  1. Photodynamic therapy
  2. Endoscopic laser therapy
  3. Endoscopic alcohol injection
  4. Endoscopic stent placement
  5. Placement of a percutaneous endoscopic gastrostomy (PEG) tube
Click here to compare your answer.
 

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