GER

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. After 2 months
2. After 6 months
3. After 1 year
4. After 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 reflux episodes under 5 minutes
3. Total time of pH under 4 under 2 hours
4. Longest reflux episode under 5 minutes
What percent of children will respond to medical therapy, and not require fundoplication?
1. 10 %
2. 30 %
3. 50 %
4. 80 %
T or F: A fundoplication generally should not be done in a healthy child under 6 mo without GER complications, 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. Less than 5%
2. 5 - 10 %
3. 10 - 15 %
4. 25 %
At what is the incidence of intestinal obstruction after fundoplication surgery?
1. Less than 5%
2. 5 - 10 %
3. 10 - 15 %
4. 25 %
In neurologically impaired children with a gastrostomy, what is the incidence of requiring later fundoplication?
1. Less than 5%
2. 10 %
3. 15 %
4. 25 %
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%
3. Dysphagia
4. Halitosis
What do the radiographic and manometric studies show in achalasia?
1. String sign
2. Bird's beak
3. Hyperperistalsis
4. Web-like obstruction in distal esophagus
How long it is a Heller myotomy?
1. Below GE junction to aortic arch
2. Below GE junction, 3 cm in length
3. Above GE junction to aortic arch
4. Above GE junction, 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 peristaltic contractions 2 std dev > 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 bead appearance
4. Bird's beak
What is the initial 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 %
2. 30 %
3. 50 %
4. 80 %
T or F: The treatment of esophageal scleroderma is longitudinal myotomy in refractory cases?
1. True
2. False

GER

Quiz