Q1. All investigations are done to differentiate non cardiac chest pain from cardiac chest pain?
a)24 hr ph monitoring
b)Bernstein test
c)Manometry
d)Balloon distension
Q2) Treatment of choice for gastric volvulus
a)Ant Gastropexy
b)Posterior Gastropexy
c)Gastrectomy
d)
Q3) Esophagomyotomy is indicated in all except
a)Zenker Diverticulum
b) Epiphrenic diverticulum
c) Diffuse esophageal spasm
d) Nutcracker esophagus
Q4) All arteries supply thoracic esophagus except?
a)Superior thyroid artery
b) Bronchial artery
c) Descending thoracic artery
d) Inferior phrenic artery
Q5) In Achlasia all are present except
a) Aperistaltic esophagus
b) Failure of LES relaxation
c) Elevated LES pressure
d) Increased esophageal pressure than gastric pressure
Answers
1) c
All of these can be used in someway to distinguish non cardiac chest pain from cardiac but given the choices c is correct
24 hr ph test--measures exposure of esophagus to gastric juice, probe placed 5cm LES.
It tells time the esophageal mucosa is exposed to acid, ability of esophagus to clear refluxed acid and correlates acid exposure to pt's symptoms. The units to express esophageal exposure to gastric juice are ,(i) cumulative time esophageal ph is below a chosen threshold (ii) frequency of reflux episodes below a certain threshold (iii) duration of episodes longer than 5mins
Bernstein test measures whether the symptoms can be reproduced by infusion of acid, if positive esophagus is sensitive to acid.
Balloon distension--- If by distension of balloon symptoms are reproduced test is positive. this test was designed to distinguish cardiac pain from non cardiac.
Manometry - used to examine motor function of esophagus and its sphincters.
Schakelford 128
2)a
Organoaxial rotation is more common than mesenterioaxial and anterior is more common than posterior.
Management is laparotomy, hiatal hernia repair and fixing the antrum to ant abd wall, fundoplication may or may not be done, gastrectomy done if necrosis is present.
Schakelford 18
3)c
For both diverticula this is the treatment of choice, for DES no definite treatment is there and esophagomyotomy relieves dysphagia but not chest pain. in nutcracker eso indicated if no response tonifedipine.
Schakelford 285
4) d
sup thyroid, inferor thyroid, tracheobronchial, thoracic aorta,left gastric splenic
Scahkelford 12
5)c
may or may not be elevated
