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Thoracic 5

By David Blitzer / February 4, 2023

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Question 1 of 20

1. Question
Esophageal stents:
- Are rarely useful if perforation is present
- Are more likely to experience tumor ingrowth if an uncovered metal stent is deployed
- Should never be used in the diagnosis of cancer
- Are more likely to migrate if an uncovered metal stent is deployed
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Question 2 of 20

2. Question
Which statement is true regarding stenting for esophageal perforation?
- Successful occlusion of the perforation occurs in only 30-40% of cases.
- Stents should be left in place indefinitely
- Stenting is associated with a lower rate of esophageal stricture compared to open repair of perforation
- Drainage of the mediastinum or pleural space is not required after stenting even if contamination is present
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Question 3 of 20

3. Question
Mid-esophageal stents:
- Should never be used due to the high risk of aortoesophageal fistula
- Can lead to tracheal or bronchial obstruction
- Often need to be placed so that the proximal end extends above the upper esophageal sphincter to prevent migration.
- Are contraindicated
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Question 4 of 20

4. Question
What is the most common etiology of esophageal perforation?
- Iatrogenic
- Boerhaave’s syndrome
- Tumor
- Foreign body
- Corrosive ingestion
- Trauma
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Question 5 of 20

5. Question
A 39-year-old F with achalasia sustains an iatrogenic perforation during a pneumatic dilation procedure. She is tachycardic, but otherwise stable. Esophagram reveals a small amount of contrast extravasation into the left pleura. Which of the following is true regarding treatment?
- Observation is appropriate since the perforation is iatrogenic with minimal extravasation
- Left thoracotomy with washout and drainage will usually result in healing of the perforation
- Left thoracotomy and primary repair should be performed with a longitudinal myotomy 180 degrees from the repair
- Right thoracotomy and esophagectomy are required
- Stenting across the perforation has been shown to have superior outcomes in this patient population
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Question 6 of 20

6. Question
Regarding foreign body ingestion, which of the following is FALSE?
- The most common site of foreign body impaction is near Killian’s triangle
- Over 80% of patients presenting with a food impaction at the LES have a lesion of motility disorder
- Endoscopic extraction is successful approximately more than 75% of time. The other 25% require operative extraction.
- Sharp foreign bodies can be safely extracted endoscopically
- Disc batteries should be removed emergently
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Question 7 of 20

7. Question
A 19-year-old male presents to the ED after attempted suicide by ingesting bathroom cleaner. Which of the following is false regarding the initial management?
- Management begins with securing a safe airway
- Esophagogram and/or CT is required to r/o perforation
- Early endoscopy should be performed within 24hrs
- Endoscopy should be performed in the OR
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Question 8 of 20

8. Question
Which of the following is the most common cause of benign stricture?
- Peptic disease
- Caustic ingestion
- Esophageal webs
- Radiation injury
- Anastomotic stricture
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Question 9 of 20

9. Question
Which of the following statements regarding caustic esophageal injuries is correct?
- Approximately 50% of injuries are the result of accidental ingestions by small children
- The most common cause of corrosive injury in adults is suicide attempt
- Acids have a higher risk of perforation than alkalis
- Liquifactive necrosis is usually limited to the superficial mucosa
Correct

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Question 10 of 20

10. Question
Regarding the treatment of esophageal perforation, which of the following is true?
- Cervical perforations require urgent repair or resection to prevent mediastinitis
- All thoracic perforations should be approached with a left thoracotomy
- Longitudinal myotomy over the site of perforation should be performed before any primary repair
- Primary repair is contraindicated in perforations presenting late (> 48hrs)
- Pedicled muscle flaps should be avoided if there is any contamination in the chest
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Question 11 of 20

11. Question
What is the most common complication following caustic ingestion?
- Gastric outlet obstruction
- Perforation
- Stricture
- Cancer
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Question 12 of 20

12. Question
Which of the following is required for non-operative management of an esophageal perforation?
- Perforation is contained
- Contrast drains readily back into the esophageal lumen
- Asymptomatic patient
- Absence of cancer or distal obstruction
- All of the choices
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Question 13 of 20

13. Question
Which of the following has the highest sensitivity for diagnosing an esophageal perforation?
- Physical exam
- Chest x-ray
- Esophagram with water soluble contrast
- CT with oral contrast
- Esophagoscopy
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Question 14 of 20

14. Question
True or false: chest pain corresponding with high esophageal contraction amplitudes has a high correlation for etiology of pain in nutcracker esophagus.
- TRUE
- FALSE
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Question 15 of 20

15. Question
What is the key manometry finding to diagnose ineffective esophageal motility (IEM)?
- Complete aperistalsis
- Elevated LES pressure with failure to relax with swallow
- Simultaneous contractions in >20% of swallows
- Elevated distal esophageal pressures >180mmHg
- Failed distal propagation of contraction in >30% of swallows
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Question 16 of 20

16. Question
True or false: chest pain corresponding with high esophageal contraction amplitudes is typical for diffuse esophageal spasm.
- TRUE
- FALSE
Correct

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Question 17 of 20

17. Question
First-line treatment of diffuse esophageal spasm and nutcracker esophagus is
- Esophageal myotomy
- Medical therapy with nitrates
- Balloon dilation
- Botox injection of LES
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Question 18 of 20

18. Question
What is the key manometry finding in nutcracker esophagus?
- Complete aperistalsis
- Elevated LES pressure with failure to relax with swallow
- Simultaneous contractions in >20% of swallows
- Elevated distal esophageal pressures >180mmHg
- Failed distal propagation of contraction in >30% of swallows
Correct

Incorrect
Question 19 of 20

19. Question
What is the key manometry finding in diffuse esophageal spasm?
- Complete aperistalsis
- Elevated LES pressure with failure to relax with swallow
- Simultaneous contractions in >20% of swallows
- Elevated distal esophageal pressures >180mmHg
- Failed distal propagation of contraction in >30% of swallows
Correct

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Question 20 of 20

20. Question
The most common cause of secondary esophageal motility is
- Diabetes mellitus
- Scleroderma
- Gastroesophageal reflux
- Chagas disease
Correct

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