ABSITE Focused on Esophagus Problem Solving Exam Questions and With Distinction level Marking scheme updated 2024/2025
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ABSITE
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ABSITE
ABSITE Focused on Esophagus Problem Solving Exam Questions and With Distinction level Marking scheme updated 2024/2025
A 65-year-old male with an extensive history of GERD with Barrett's esophagus is referred to you with 4 months of worsening dysphagia to both solids and liquids in addition to o...
ABSITE Focused on Esophagus Problem
Solving Exam Questions and With Distinction
level Marking scheme updated 2024/2025
A 65-year-old male with an extensive history of GERD with
Barrett's esophagus is referred to you with 4 months of
worsening dysphagia to both solids and liquids in addition to
odynophagia. He has noted a 20-pound weight loss over 4
months. A barium swallow shows an irregular mass in the lower
portion of the esophagus. Esophagogastroduodenoscopy with
biopsy reveals esophageal adenocarcinoma. The best test to
define the extent of the local tumor is:
A. Endoscopic mucosal resection
B. Endoscopic ultrasound
C. Positron emission tomography (PET)
D. CT scan of the chest
E. Combined PET/CT scanning - Correct answer Endoscopic
ultrasound
Correct.
The evaluation of a patient with esophageal cancer involves
affirming the diagnosis, clinical staging, and determining the
resectability. The most important diagnostic tools include a
barium swallow and esophagoscopy. Endoscopic ultrasound
(EUS) is the single most valuable test in determining tumor size
and depth of penetration. Only after evaluation with EUS should
further workup follow, including CT of chest and abdomen and
PET, which are more accurate in determining distant metastases
rather than staging the extent of the local tumor. Resection of
the lesion is determined by both depth of invasion and lymph
node status.
,A 67-year-old male is diagnosed with a 2-cm squamous cell
carcinoma in the mid-esophagus. The best test to assess for
paraesophageal nodal involvement is
A. Computed tomography (CT) scan of the chest
B. Positron emission tomography (PET)
C. Endoscopic ultrasound
D. Mediastinoscopy
E. Thoracoscopy - Correct answer Endoscopic ultrasound
Correct.
CT scanning is useful for evaluating visceral metastatic disease
to the liver and lung, but is not as accurate as EUS for
determination of tumor and lymph node staging. The uptake of
fluorodeoxyglucose (FDG) by the primary tumor often obscures
demarcation of regional nodes on PET scan. Endoscopic
ultrasound detects about 85% of regional node involvement.
When combined with fine needle aspiration (FNA), the accuracy
approaches 95%. Mediastinoscopy and thoracoscopy are invasive
and are not very sensitive.
A 60-year-old man has heartburn and dysphagia. Esophagoscopy
shows a soft, firm, partially obstructing tumor in the mid
esophagus. Biopsy shows adenocarcinoma. His computed
tomographic (CT) scan discloses several 2-cm mediastinal lymph
nodes adjacent to the tumor. Endoscopic ultrasonography notes a
tumor extending through all layers of the esophagus with
extramural inflammatory changes. Which of the following would
be optimal treatment?
A. Transhiatal esophagectomy
B. Radiation therapy followed by transhiatal esophagectomy
, C. Laparotomy, right thoracotomy, esophagectomy, and gastric
interposition (Ivor- Lewis procedure)
D. Neoadjuvant chemo- and radiation therapy followed by
esophagectomy
E. Chemo- and radiation therapy only - Correct answer
Neoadjuvant chemo- and radiation therapy followed by
esophagectomy
Correct.
Recent studies comparing preoperative radiation therapy or
chemotherapy alone followed by esophagectomy fail to show an
advantage compared to esophagectomy alone. There is good data
from meta-analyses demonstrating improved survival with
neoadjuvant chemo- and radiation therapy followed by operation,
particularly for T3 or N1 lesions.
A 67-year-old male undergoes Ivor-Lewis esophagectomy for
adenocarcinoma of the mid- esophagus. On post-operative day 5
he is started on a diet. The right chest tube drainage, which was
serosanguinous to this time, increases and turns milky white. The
patient is afebrile and clinically stable. Which of the following is
appropriate to order at this time?
A. Chest tube fluid for culture
B. Chest tube fluid for triglyceride level
C. CT scan of the chest
D. Thin barium swallow
E. Lymphangiogram - Correct answer Chest tube fluid for
triglyceride level
Correct.
This scenario is highly suggestive of a chylothorax. This
condition can be confirmed by an elevated triglyceride level in
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