Monthly Test of Esophagus ; Stomach (17/1/24)

Which gut peptide stimulate gastric contraction and enhances stomach emptying?

A 44 year-old man was reviewed in outpatient clinic with bothersome symptoms of gastroesophageal reflux occurring at multiple time of day, for the last 2 years. He had a gastroscopy one year ago which was normal. He had taken omeprazole 40 mg twice daily and metoclopramide 10 mg TDS for last 12 months, with no benefit. He ensures lifestyle modifications for reflux.

A 58 year-old woman on surveillance endoscopy was found to have Barrett’s oesophagus, biopsies revealed high-grade dysplasia. The Barrett’s segment appeared circumferential and 5 cm in length (Prague C5M5). She was already taking a high-dose proton pump inhibitor. She has refused for any surgical intervention.

A 70 year-old man presented with history of dysphagia for the last 6 weeks due to oesophageal adenocarcinoma at 37 cm.

Which of the following is the most important factor in the pathogenesis of oesophageal adenocarcinoma?

A 31 year-old man who had history of chest pain was referred to the gastroenterology clinic by his cardiologist. He had history of episodic dysphagia and occasional regurgitation for which he is taking omeprazole 40 mg twice daily and metoclopramide 10 mg TDS. Gastroscopy, oesophageal manometry, and pH studies, are consistent with achalasia cardia. Protozoal serology is negative.

Which of the following is the most appropriate management plan?

A 52 year-old man presented with a 2 month history of intermittent vomiting. He had no significant past medical history, use to drink 8 units of alcohol a week, and is a non-smoker. Gastroscopy showed 4 cm antral tumour, histopathological examination of biopsies demonstrate diagnosis of well differentiated adenocarcinoma

Which is the most useful modality as an adjunct to CT scanning for the initial staging of gastric cancer?

A 75 year-old man with a coffee ground vomit was referred for an upper GI endoscopy, there is history of Billroth II procedure performed 20 years back.

Which of the following is most common long term complication of this surgery?

A 67 year-old woman with GERD symptoms of 20 years’ duration presents for endoscopy. She does not have unintentional weight loss. At upper endoscopy, he is found to have a 5-cm segment of Barrett’s esophagus with a 2-cm polypoid nodule present at the proximal aspect of the segment.

What is the most appropriate strategy for staging early lesion in Barret’s esophagus?

A62 year-old woman with intermittent chest pains and dysphagia underwent manometery. The report shows lower esophageal sphincter pressure was elevated at 52 mm Hg (normal 10-45) and, after wet swallows, there was a failure of complete relaxation to the gastric baseline.” Five of the 10 wet swallows were peristaltic and five wet swallows were simultaneous.

What is the most likely diagnosis?

A 65 year old male with underwent surveillance for 5cm Barret’s esophagus. Endoscopy reported Barret’s of Prague C2 and M5 with no nodularity. The biopsy reported to show low grade dysplasia. Patient has no family history of Barrets or esophageal carcinoma.

What is the next appropriate step in management?

A 45 year-old woman present with progressive dysphagia to solids and liquids. She has significant past history of retrosternal burning partial responding to proton pump inhibitors. She also states that her finger discolored on cold exposure. Her manometery findings showed resting LES pressure of 8 mmHg and mean amplitude of peristaltic wave was found to be 25 mmHg.

What is most likely diagnosis?

A 30 year-old woman presented with 2 year history of recurrent chest discomfort occurring several times a day. She has been unresponsive to treatment with nitroglycerine and high dose proton pump inhibitor. Her ECG and cardiac evaluation by cardiologist was normal 6 months back. Upper GI endoscopy was reported to be normal.

What is the most appropriate next step?

What is the main inhibitory neuropeptide for relaxation of Lower esophageal sphincter?

A 29 year-old man was evaluated for dysphagia for past 2 months. He lost 3 kg during this period. On examination he appeared emaciated and pale. Oral examination appeared normal. Abdominal examination revealed no tenderness or visceromegaly. Axillary and inguinal lymph nodes were palpable. His laboratory parameter showed

Hemoglobin 8 13- 18 g/ dl MCV 76 80 – 90 fl White blood Cell 3 4 – 11 x 109/L platelet 110 150- 400 x 109/L

Upper Gastrointestinal endoscopy showed multiple whitish exudate throughout the extent of esophagus.

What is the most appropriate treatment?

A 42 year-old man gave an 8 months history of chest pain and burning sensation behind sternum that was usually brought on by eating heavy meals. He has no dysphagia, melena, vomiting and weight loss. He is an ex smoker with history of 10 packs per year. He left smoking due to his symptoms. His abdominal examination is unremarkable. What is the next appropriate management?

A 24 year-old man presented with complaints of intermittent dysphagia for 9 months. His past medical history has been significant for asthma. He has been on proton pump inhibitors for past 2 months with no response. EGD showed concentric circular rings with no luminal narrowing and overlying normal mucosa.

What is the next most appropriate step?

A 24 year-old man presented with complaints of intermittent dysphagia for 9 months. His past medical history has been significant for asthma. He has been on proton pump inhibitors for past 2 months with no response. EGD showed concentric circular rings with no luminal narrowing and overlying normal mucosa.

What is the most appropriate management?

Which is the most recognized risk factor for esophageal squamous carcinoma?

Which is the most recognized risk factor for esophageal adenocarcinoma?

What is the per year incidence of esophageal malignancy in patient with Barret’s esophagus?

A 29‐years male presented in with complaint intermittent epigastric discomfort for 1 month. He denies dysphagia, weight loss or hematemesis. He denies use of aspirin or pain killers. Abdominal examination reveals epigastric tenderness.

On examination

Heart rate 85 per min, regular Respiratory rate 18 per min Hemoglobulin 14 13 – 18 g/dl MCV 85 80–96 fL Ultrasound abdomen normal liver, spleen and pancreas

A 46-year old man was reviewed in clinic with troublesome symptoms of reflux occurring at any time of day, for the last 2 years. He had an upper GI endoscopy six months ago which was normal. He had taken omeprazole 40 mg twice daily and metoclopramide 10 mg three times daily for eight months. He had previously tried an H2-receptor antagonist in addition to this, with no benefit. He had no lifestyle risk factors for reflux. On examination he has BMI 20 kg/m2 and abdominal examination is normal.

Hemoglobulin 14 13 – 18 g/dl MCV 85 80–96 fL Serum Gastrin 400 < 55 pmol/ L

What is the next most appropriate management step?

A 45 years–old male presented with complaint of epigastric pain for past two weeks. The non –radiating pain is burning in nature and increases in intensity after meals. One month back, for similar complaints he recieved H.pylori eradication. Ultrasound abdomen showed fatty liver.

Which of the following diagnostic test is most useful for diagnosis of H pylori recurrence?

Which of the following factor is most likely associated with the pathogenesis of H Pylori gastritis?

A 37 year-old man presented with complaints of recurrent upper abdominal pain for the last 15 days. The pain is burning in character, occurs when the stomach is empty, and is relieved within minutes by food intake or antacids. He does not take non steroidal anti inflammatory drugs. He was found to have serological evidence of H. pylori infection.

Which of the following has association with this infection?

A 35 year-old female presented with complaints of increasing epigastric pain for the last 2 months associated with nausea, vomiting and weight loss. She had a significant past surgical history of living related renal transplantation 8 months back. She was given Injection ATG in the immediate post transplant period due to delay graft functioning. Her currently medication includes Tab Deltacortil 10 mg OD and Tab Azathioprine 50 mg OD. On physical examination her abdomen was tender specifically in epigastric region. Laboratory investigation showed

Hemoglobin 7.5 12-15.5 g/dl White Blood Cells 2.2 4000-11000/ cm3 Platelets 125000 150000-450000/uL

Antral biopsy on GI endoscopy showed Intranuclear inclusions

What is the most likely diagnosis?

A patient with antral growth was found to have gastrointestinal stromal tumour (GIST)

What is the cell of origin of GISTs?

What is the highly sensitive test for the diagnosis of H.pylori?

A 43- years old male presented with complaints of crampy abdominal pain, lightheadedness and palpitation for past 2 weeks. There is also associated postprandial fullness. He also stated that his symptoms usually occurred after 25 to 30 minutes of meal intake. His medical history is significant for diabetes and hypertension. He also undergone surgery for his weight loss 3 months back.

HbA1C 4.5 < 6 % ECG Normal pattern

What is the most appropriate treatment?

A 43- years old male presented with complaints of crampy abdominal pain, lightheadedness and palpitation for past 2 weeks. There is also associated postprandial fullness. He also stated that his symptoms usually occurred after 25 to 30 minutes of meal intake. His medical history is significant for diabetes, hypertension. He also undergone surgery for his weight loss 3 months back

HbA1C 4.5 < 6 % ECG Normal pattern

What is the most like cause of his symptoms?

A 56 year-old man presented with a 3-month history of intermittent vomiting associated with abdominal fullness and weight loss. He had no past medical history or family history of any disease. He was a non-smoker. Patient underwent upper GI endoscopy which revealed an irregular friable 4 cm growth with overlying ulcerated mucosa in the antrum. Histopathology of the mass confirmed it as adenocarcinoma.

Which is the most useful modality in the initial staging of gastric cancer?

Which of the following gut peptide enhances gastric motility?

A 33 year-old woman presented in outpatient department complaining of dyspepsia for the last two months associated with belching. He has been taking proton pump inhibitor and prokinetics prescribed by GP for the last 1 month but the symptoms has not resolved. She was on no other medications. There is no past medical history or family history of significant disease.

Hemoglobin 8.5 13-18 g/dl White cell count 2.2 X 103 4000-11000/ cm3 Platelets 125 × 109 150–400 × 109 /L Sodium 138 137–144 mmol/L Potassium 1.9 3.5–4.9 mmol/L Creatinine 1.2 0.5–1.5 mg/dL C-reactive protein 8 < 10 mg/L
plasma gastrin 100 < 55 pmol/L

Patient underwent Upper GI endoscopy which showed antral erosions and two healed duodenal ulcers in first part of duodenum

Which of the following is the most likely diagnosis?

A 35 year-old woman presented in emergency services with hemetemesis for 3 hours associated with upper abdominal cramps. She had no past such episode. She had been diagnosed to have depressive disorder 2 months back for which she is regularly taking an SSRI. For the last 2 days she took high doses of ibuprofen for rheumatoid arthritis. Patient underwent an upper GI endoscopy. At endoscopy she had a bleeding gastric ulcer with an adherent clot

What is the appropriate step to obtain hemostatsis?

A 50 years old male presented with hematemesis and melena. He take 24 units of alcohol per week and confesses of binge drinking.

Blood pressure 92 / 74 mmHg Pulse 110 < 90 beats per minute Hemoglobin 7 13 -18 g/dl White cell count 2.2 X 103 4000-11000/ cm3 Platelets 175 × 109 150–400 × 109 /L I.N.R 1.2 < 1.5 Serum Albumin 4.0 3.7 – 4.9 g/dl

What is the most likely diagnosis ?

A 68 year-old man presented in outpatient department with complains of vomiting and abdominal pain for the last 15 days. There is no associated dysphagia, hemetemesis or weight loss. His current medication includes levodopa for Parkinson’s disease. On examination abdomen is soft and nontender. No visceromegaly was appreciated.

Which is the most appropriate treatment?

A 45 year-old woman presented in outpatient department with complains of recurrent nausea and vomiting associated with travel for the last 3 months. There is no associated weight loss or abdominal pain. There is no past medical or family history of similar illness. She was prescribed cyclizine therapy for 15 days but the symptoms persisted.

What is the most appropriate medication?

A 32 year-old woman have persistent bloating, nausea, and vomiting for the last 4 months. She denies dysphagia. She is a diagnosed case of type 1 diabetes mellitus and currently on insulin 70/30. Her family history is also significant for diabetes. She has lost 3 kg in 5 months. Abdominal examination revealed no tenderness or visceromegaly.

HbA1C 5.5 range 4.0–6.0%)

What is most next appropriate step for daignosis?