Which is NOT one of the anatomic factors that prevent reflux?

1.   ?    Diaphragmatic hiatus
2.   ?    Diaphragmatic crura
3.   ?    Angle of His
4.   ?    Esophageal mucosa

Which is NOT one of the physiologic factors that prevent reflux?

1.   ?    Pressure differential in chest and abdomen
2.   ?    Length of intra-abdominal esophagus
3.   ?    Flap valve of LES
4.   ?    Lower esophageal sphincter

At what age does the lower esophageal sphincter mature?

1.   ?    2 months
2.   ?    6 months
3.   ?    1 year
4.   ?    2 years

What is one of the normal values for 24-hour pH monitoring in children?

1.   ?    Less than 30 reflux episodes
2.   ?    Less than 30 relfux episodes under 5 minutes
3.   ?    Total time of pH under 4 = 2 hours
4.   ?    Longest reflux episode of 5 minutes

What percent of children will respond to medical therapy, and not require fundoplication?

1.   ?    10 Percent
2.   ?    30 Percent
3.   ?    50 Percent
4.   ?    80 Percent

True or false: a fundoplication generally should not be done in any child under 6 months of age, since the potential for spontaneous resolution is quite high?

1.   ?    True
2.   ?    False

How long should medical therapy for GE reflux be attempted in older children?

1.   ?    About 2 months
2.   ?    6 months
3.   ?    1 year

Which is NOT an indication for operation in children with GE reflux?

1.   ?    pH score more than 3 std dev above normal
2.   ?    Barrett's esophagus
3.   ?    Medical therapy failure
4.   ?    Stricture

What is the incidence of failure of Nissen and Thal fundoplications?

1.   ?    Under 5%
2.   ?    5 - 10 Percent
3.   ?    10 - 15 Percent
4.   ?    25 Percent

At what is the incidence of intestinal obstruction after fundoplication surgery?

1.   ?    Under 5%
2.   ?    5 - 10 Percent
3.   ?    10 - 15 Percent
4.   ?    25 Percent

In neurologically impaired children who have a gastrostomy placed, what is the incidence of requiring later fundoplication?

1.   ?    Under 5%
2.   ?    10 Percent
3.   ?    15 Percent
4.   ?    25 Percent

What is the most common cause of esophageal achalasia in the United States?

1.   ?    Trypanosoma cruz
2.   ?    Scleroderma
3.   ?    Recurrent esophagitis
4.   ?    Unknown

What are the histologic findings in the distal esophagus of children with achalasia?

1.   ?    Absent/damaged ganglion cells, except in Chagas disease
2.   ?    Inflammatory changes
3.   ?    Giant cells
4.   ?    None of the above

Which is NOT one of the typical clinical findings of achalasia?

1.   ?    Recurrent pneumonia
2.   ?    Asthma in 50% of patients
3.   ?    Dysphagia
4.   ?    Halitosis

What do the radiographic and manometric studies show in achalasia?

1.   ?    String sign
2.   ?    Bird's beak
3.   ?    Hyperperistalsis
4.   ?    Weblike obstruction in distal esophagus

How long it is a Heller myotomy?

1.   ?    Below GE jxn to aortic arch
2.   ?    Below GE jxn , 3 cm in length
3.   ?    Above GE jxn to aortic arch
4.   ?    Above GE jxn , 5 cm in length

What is the cause of diffuse esophageal spasm?

1.   ?    Trypanosoma cruz
2.   ?    Scleroderma
3.   ?    Recurrent esophagitis
4.   ?    Unknown

Which is NOT one of the manometric findings of diffuse esophageal spasm?

1.   ?    Repetitive high amplitude pressure peaks
2.   ?    Synchronous pressure peaks
3.   ?    Orderly perstaltic contractions 2 std dev above normal
4.   ?    Uncoordinated contractions

Which is NOT one of the radiographic findings in diffuse esophageal spasm?

1.   ?    Corkscrew appearance
2.   ?    To and Fro motion of barium
3.   ?    Rosary beed appearance
4.   ?    Bird's beak

What is the intial treatment of diffuse esophageal spasm?

1.   ?    Myotomy
2.   ?    Resection and replacement
3.   ?    Nifedipine
4.   ?    Dilatation

What is the incidence of esophageal motor dysfunction in patients with scleroderma?

1.   ?    10 Percent
2.   ?    30 Percent
3.   ?    50 Percent
4.   ?    80 Percent

T or F: The treatment of esophageal scleroderma is lonigtudinal myotomy in refractory cases?

1.   ?    True
2.   ?    False