Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is gastroesophageal reflux disease (GERD). While this may seem a odd practice, it is useful to see multiple examples of how GERD will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for GERD.
Chief Complaints:
- Chest pain or abdominal pain: often substernal/epigastric, burning in nature
- Occurs after eating or when lying down
- Pain might be relieved by sitting upright/walking around
- Bitter/sour taste in mouth often accompanies pain (i.e. acid reflux)
- Heartburn may also be the presenting symptom
Patient History:
- Chronic non-productive cough: patients may experience this for some time. Often associated with this condition.
Clinical Workup:
- No signs of cardiac issues: EKGs, tropnonins, and stress test should be negative in cases of this condition.
- Upper endoscopy can reveal erythematous esophagus and linear erosions of the esophagus.
QUESTION EXAMPLES
Question # 1
35-year-old man is being evaluated in the clinic for a four month history of chest pain. He explains that he has been experiencing frequent episodes of a sub sternal squeezing tight chest pain that radiates to his neck. These episodes do not seem to be related to any particular activity however they often occur at rest and sometimes at night. The episodes last for up to two hours. He denies having any shortness of breath, wheezing, palpitations, loss of consciousness, or leg swelling. The patient explains that he does not use tobacco or alcohol products. His family history is noncontributory. Currently his blood pressure is 125/70 mmHg, and pulse is 72 bpm. The patient’s BMI is 32 kg/m². An EKG is performed and is unremarkable.An exercise stress test is also performed and is within normal limits. What is the likely cause of the patient’s chest pain?
Explanation #1
Chest pain + occur when lying down (at night when sleeping) + long episodes of symptoms + no signs of cardiac issues (normal EKG and stress test) = GERD
Question # 2
A 60 year old male comes to the clinic because he has been having intermittent episodes of chest pain of the past 4 months. He explains that he has about 3 episodes weekly where he develops a burning pain between his chest and abdomen. This occurs when he lies down to watch TV after lunch and dinner. He has noticed that a bitter taste also seems to accompany the pain. He drinks about 4 alcoholic drinks daily and does not use tobacco products. His vitals are within normal limits and his BMI is 34 kg/m². A physical exam is unremarkable. What is the likely diagnosis in this patient?
Explanation #2
Chest/abdomen pain + burning sensation + occurs after eating and lying down + bitter taste in mouth with pain = GERD
Question # 3
A 42 year old male comes to the clinic because he has been experiencing progressive heartburn for the past year. He explains that he takes over the counter antacids daily, but they no longer seem to help relief his pain. He has tried to change his diet as well, but has not been able to control his symptoms. A physical exam is unremarkable. An upper endoscopy is performed, and shows that the distal esophagus is erythematous, and a few linear erosions are noted on the exam. Biopsies of the esophagus show inflammation of the epithelium. What condition likely explains the patient’s symptoms?
Explanation #3
Heartburn + erythematous esophagus and erosions on upper endoscopy = GERD
Question # 4
A 35 year old woman comes to the hospital because she has been experiencing intermittent burning chest pain for the past month. She explains that the pain is worse at night when she is sleeping, and can awake her at times. She has been able to resolve her symptoms by sitting upright in bed. When experiencing the pain she denies shortness of breath or palpitations. He past medical history is notable for her oral contraceptive prescription, and she has a 10 pack year history of smoking. Her vitals are currently within normal limits, and her physical exam is notable for mild abdominal tenderness in the upper abdomen. What is the likely diagnosis in this patient?
Explanation #4
Chest/abdomen pain + burning sensation + occurs when lying down +pain received by sitting upright = GERD
Question # 5
A 34 year old male comes to the clinic because he has been experiencing burning substernal chest pain for the past few months. He has also noticed a sour tasting liquid in his mouth during these episodes of pain at night when he wakes up from sleeping. He explains that he has had a non-productive cough for the past month. His past medical history is notable for a 15 pack year smoking history, and he drinks a six pack of beer every Sunday. His Vitals are within normal limits and his BMI is 36 kg/m². A physical exam is unremarkable. What is the likely diagnosis in this patient?
Explanation #5
Burning substernal chest pain + symptoms when lying down + acid in mouth (sour liquid) + history of chronic non-productive cough = GERD
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Treatment:
- H2-receptor blocking agents
- Proton pump inhibitors (such as omeprazole)
Page Updated: 02.15.2017