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Thoracic 6

By David Blitzer / February 5, 2023

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Question 1 of 20

1. Question
The most crucial diagnostic test for any esophageal motility disorder is:
- Fluoroscopic esophagram
- Esophagogastroduodenoscopy
- Manometry
- 24-hour pH study
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Question 2 of 20

2. Question
Appropriate treatment of achalasia consists of:
- Laparoscopic myotomy
- Endoscopic myotomy
- Botox injection of LES
- Pneumatic balloon dilation of LES
- All of the choices
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Question 3 of 20

3. Question
What is the key manometry finding in achalasia?
- 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 4 of 20

4. Question
All of the following contribute to GERD, EXCEPT:
- Obesity
- Alcohol
- Carbonated beverages
- Fatty foods
- Eating more than 3 hours prior to sleep.
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Question 5 of 20

5. Question
Which of the following is an absolute indication for surgical intervention for GERD?
- Barrett’s esophagus
- Failure of medical therapy in the setting of demonstrated reflux and decreased LES tone
- Evidence of reflux esophagitis on endoscopy
- Asymptomatic sliding hiatal hernia
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Question 6 of 20

6. Question
Normal resting pressure of the lower esophageal sphincter:
- 0-5 mm Hg
- 10-30 mm Hg
- 60-80 mm Hg
- 100-120 mm Hg
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Question 7 of 20

7. Question
Which is true regarding surgical outcomes for GERD?
- Surgical therapy is successful for symptom relief in 80-90% of cases
- Fundoplication effectively reduces Barrett’s esophagus and the risk of cancer
- A tight fundoplication is optimal to prevent reflux
- Recurrence of symptoms is reduced if all patients undergo Collis gastroplasty
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Question 8 of 20

8. Question
All are true of GERD, EXCEPT:
- Intrinsic lower esophageal hypotension is a possible cause
- The most effective treatment for morbidly obese patients is a laparoscopic Nissen fundoplication
- GERD increases the risk of development of Barrett’s Esophagus
- A hiatal hernia, when present, should be repaired at the time of fundoplication
- Delayed gastric emptying may increase the risk of GERD
Correct

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Question 9 of 20

9. Question
Which is true regarding surgical intervention for GERD?
- The gastroesophageal junction should be restored to the level of the diaphragmatic hiatus
- In the setting of a sliding hiatal hernia, the defect should be repaired without need for a fundoplication
- A Collis gastroplasty may be useful in the setting of a foreshortened esophagus
- Preservation of the vagal nerves is not necessary during Nissen fundoplication
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Question 10 of 20

10. Question
Which of the following is true regarding the treatment of GERD?
- H2-blockers and PPIs are equally effective for symptom resolution
- PPIs have only a 20% chance at resolving GERD-associated esophagitis
- PPI treatment does not reduce the risk of cancer for patients with Barrett’s esophagus
- H2-blockers directly block the H+ pump in parietal cells
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Question 11 of 20

11. Question
A DeMeester Score greater than which value is consistent with significant GERD?
- 3
- 10
- 14
- 27
- 35
Correct

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Question 12 of 20

12. Question
Which of the following is true regarding the diagnosis of GERD?
- For patients with typical symptoms of heartburn who respond to initiation of PPI therapy, no additional diagnostic tests are needed
- The most important initial test is barium esophagogram
- Endoscopy is rarely helpful for preoperative planning
- Manometry and 24-hour pH monitoring add little to the workup if a good history is obtained along with an EGD
- If Barrett’s esophagus is identified, at least 2 biopsies should be performed
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Question 13 of 20

13. Question
The best initial diagnostic test in a patient with dysphagia and a history of aspiration pneumonia:
- Upper endoscopy
- Abdominal CT scan
- Gastrografin swallow
- Barium swallow
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Question 14 of 20

14. Question
Upper endoscopy is performed on a patient with worsening dysphagia. A 5cm intramural mass is identified on EUS. The next best step is:
- Fine needle aspiration biopsy
- Core biopsy
- Endoscopic resection
- Right thoracotomy
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Question 15 of 20

15. Question
Upper endoscopy reveals a darkly pigmented, polypoid, ulcerated mass 10 cm above the GE junction. The most likely diagnosis is:
- Metastatic melanoma
- Primary melanoma
- Carcinosarcoma
- Granular cell tumor
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Question 16 of 20

16. Question
The best approach for resection of a 6cm leiomyoma, located 5cm above the gastroesophageal junction is:
- Right thoracotomy, biopsy with frozen section confirmation, enucleation of tumor
- Ivor Lewis esophagectomy
- Thoracoabdominal esophagectomy
- 3-hole esophagectomy
Correct

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Question 17 of 20

17. Question
Which of the following most reliably predicts the behavior of GIST tumors?
- Tumor histology
- C-kit mutation status
- Mitotic activity
- Tumor location
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Question 18 of 20

18. Question
Leiomyomas typically involve which layer of the esophagus?
- Mucosa
- Submucosa
- Muscularis propria
- Lamina propria
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Question 19 of 20

19. Question
Which esophageal malignancy is associated with the best prognosis after resection?
- Adenocarcinoma
- Squamous cell carcinoma
- Small cell carcinoma
- Leiomyosarcoma
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Question 20 of 20

20. Question
Granular cell tumors of the esophagus originate from:
- Interstitial cells of Cajal
- Smooth muscle cells
- Schwann cells
- Neuroendocrine cells
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