GERD Tutoring By Alaina Darby

AR has GERD due to increased LES relaxation and Decreased LES pressure AR has GERD due to increased LES relaxation and Decreased LES pressure. Which of the following would be the best recommendation? Avoid caffeine Stop smoking Avoid acidic foods Avoid fatty foods d

Which of the following pathophysiological causes of GERD is not caused by food choices? Decreased LES pressure Mucosal irritation Increased intraabdominal pressure Increased LES relaxation c

Which of the following pathophysiological causes of GERD would be most receptive to discontinuation of caffeine? Decreased LES pressure Mucosal irritation Increased intraabdominal pressure Increased LES relaxation a

Which of the following pathophysiological causes of GERD is primarily caused by food? Decreased LES pressure Mucosal irritation Increased intraabdominal pressure Increased LES relaxation d

Which of the following patients would likely be most at risk for Barrett’s esophagus? WM with poorly controlled GERD for 3 years, alcohol abuse, family history of BE AAF with poorly controlled GERD for 6 years, current smoker, no family history of BE AAM with well controlled GERD for 8 years, former smoker, family history of BE WF with poorly controlled GERD for 4 years, current smoker, family history of BE a

TR is a 45 yo wm who presents to you complaining of chest pain, cough, and belching. Which of the following would you recommend first? Endoscopy Empiric PPI trial Cardiac work-up pH monitoring c

TR is a 45 yo wm who presents to you complaining of chest pain, cough, and belching. Which of the following tests would you most likely use to diagnose? Endoscopy pH monitoring Efficacy of PPI trial Efficacy of antacid trial b

TR is a 45 yo wm who presents to you complaining of chest pain, cough, and belching. He has also had laryngitis frequently over the last year. Which of the following tests would you most likely use to diagnose now? Endoscopy pH monitoring Efficacy of PPI trial Efficacy of antacid trial b

TR is a 45 yo wm who presents to you complaining of chest pain, cough, and belching. He has also had laryngitis frequently over the last year and lost 30 pounds. Which of the following tests would you most likely use to diagnose now? Endoscopy pH monitoring Efficacy of PPI trial Efficacy of antacid trial a… be sure to clarify

jR is a 52 yo wf who presents with belching, heartburn, and regurgitation. How would you want to diagnose her? Endoscopy pH monitoring Efficacy of PPI trial Efficacy of antacid trial c… at least try it Confirm with pH monitoring

PC has been diagnosed with GERD PC has been diagnosed with GERD. Which of the following would be recommended to increase LES pressure? Avoidance of high fat meals Weight loss PPI therapy Sucralfate therapy a

PC has been diagnosed with GERD PC has been diagnosed with GERD. Which of the following would most directly prevent her from developing Barrett's esophagus? Metoclopramide PPI therapy Sucralfate therapy H2RA therapy c

PC has been diagnosed with GERD PC has been diagnosed with GERD. Which of the following increases LES pressure and promotes gastric emptying in this patient? Metoclopramide PPI therapy Sucralfate therapy H2RA therapy a

PC has been diagnosed with GERD PC has been diagnosed with GERD. Which of the following lifestyle modifications should not be recommended in this patient? Weight loss Avoid all confirmed trigger foods HOB elevation Avoidance of meals before bed b

RL is a 24 yo wf who is pregnant. She has developed heartburn RL is a 24 yo wf who is pregnant. She has developed heartburn. Which of the following would be preferred? Weight loss 8 week trial of PPI HOB elevation Sucralfate therapy c

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. How should you instruct him to take it? QAM with breakfast QAM 30 minutes before breakfast QPM 30 minutes before dinner QHS b

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. How long should he take it? 1 month 2 months 3 months Indefinitely b

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. After 4 weeks it seems to be helping but he is still having symptoms. especially at night. What should you do? Increase to BID Change to QHS dosing Addition of antacids at night Nothing… it hasn’t been 8 weeks a

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. He has completed the 8 week trial and his symptoms have returned and, as before, are worse at night. What should you prescribe first? H2RA QHS Metoclopramide Q day Sucralfate TID PPI QAM d

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. He is still having nightly symptoms on the PPI. What would be best to prescribe in addition to his QAM PPI? H2RA QHS Metoclopramide Q day Sucralfate TID PPI before each meal a

LA is a 67 yo wm who has been started on a PPI due to symptoms of heartburn and regurgitation. He is still having nightly symptoms on the PPI. Which of the following could be used if you decide to do a ph probe? H2RA QHS Metoclopramide Q day Sucralfate TID PPI before each meal b

JD has trouble swallowing. How should you advise him? Dexlansoprazole capsule taken 30 minutes prior to breakfast Esomeprazole capsule taken 30 minutes prior to breakfast Dexlansoprazole capsule sprinkled on breakfast items Esomeprazole capsule sprinkled on breakfast items c

RT takes clopidogrel and has recently been prescribed esomeprazole RT takes clopidogrel and has recently been prescribed esomeprazole. How should you advise him? Change to omeprazole Take them 4 hours apart Change to pantoprazole No change is needed d

Which of the following patients should receive long term PPI therapy? GERD with complications GERD without complications Asymptomatic BE Symptomatic BE 2 of the above 3 of the above e

Which of the following should be initiated in a patient who has already tried lifestyle modification unsuccessfully for 2 weeks without relief? Suggest OTC H2RA Suggest OTC PPI Suggest OTC antacids Refer for Rx PPI c

OL’s symptoms have gotten better but he is still having nighttime heartburn that wakes him up. Which of the following should be done for him if he has already tried several different OTC products over the course of several weeks? Refer for Rx H2RA x 8 weeks Refer for Rx PPI x 8 weeks Refer for Rx H2RA x 16 weeks Refer for Rx PPI x 16 weeks a

JD’s symptoms are fairly constant and he finds that he has little relief and An evaluation of his esophagus shows erosion. Which of the following would be best for him if he has already tried several different OTC products over several weeks? Refer for Rx H2RA x 8 weeks Refer for Rx PPI x 8 weeks Refer for Rx H2RA for life Refer for Rx PPI for life b

JD’s symptoms are fairly constant and he finds that he has little relief and An evaluation of his esophagus shows erosion. What should follow the initial 8 week course of PPI, if this was found to be effective? Continue the PPI for 8 more weeks Continue the PPI indefinitely Step down to OTC dose of PPI Step down to H2RA d

JD’s symptoms are fairly constant and he finds that he has little relief and An evaluation of his esophagus shows erosion. He cannot tolerate the step down to H2RA, what should you do? Increase the dose of H2RA Resume PPI at the high dose Resume PPI at a lower dose Add antacids to H2RA for breakthrough symptoms c

JD’s symptoms are fairly constant and he finds that he has little relief and An evaluation of his esophagus shows erosion. You decide to put him back on the PPI. What would not be a concern about using this as long term therapy? Osteoporosis Hypermagnesemia C diff infection Pneumonia b

JD’s symptoms are fairly constant and he finds that he has little relief and An evaluation of his esophagus shows erosion. You decide to put him back on the PPI. Which of the following should be monitored? BMD Creatinine B12 None of the above d

Which of the following is first line in a pregnant patient with GERD? Lifestyle changes Antacids H2RA’s PPI’s a

Which of the following should not be used in a pregnant patient with GERD? Lifestyle changes Antacids H2RA’s PPI’s d

Which of the following might be a reason to start an antacid and lifestyle changes as first line in a pregnant patient with GERD? Hypocalcemia Hypertension Constipation Urinary incontinence a

Which of the following is likely first line in pediatric patients? Lifestyle changes Antacids H2RA’s PPI’s d