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CME QUESTIONS

Continuing Medical Education Questions: December 2021

Bushyhead, Daniel MD

Author Information
The American Journal of Gastroenterology: December 2021 - Volume 116 - Issue 12 - p 2333
doi: 10.14309/ajg.0000000000001559
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Abstract

LEARNING OBJECTIVE

After this activity, the participant will be able to distinguish between the tests of gastric sensorimotor function.

QUESTION 1

A 25-year-old woman is referred by her primary care doctor for chronic vomiting. She reports the post-prandial sensation of food effortlessly traveling into her mouth. She sometimes rechews and swallows the food. She denies abdominal pain, nausea, hematochezia, melena, or unintentional weight loss. On physical exam, her vital signs are unremarkable, and her abdomen is soft, non-tender, and non-distended without scars. She has no history of prior gastrointestinal surgeries. Laboratory studies show a normal complete blood cell count and basic metabolic panel.

What is the best next step in management of this patient?

  • A. Upper endoscopy
  • B. Gastric emptying study
  • C. Antroduodenal manometry
  • D. Esophageal manometry with impedance

QUESTION 2

A 35-year-old woman who is 6 months post-partum presents with chronic nausea and vomiting. She reports daily nausea and retching. She also reports chronic epigastric pain and post-prandial fullness and bloating. She notes unintentional weight loss of 5 lbs. She denies diarrhea, constipation, hematochezia, and melena. She is breastfeeding and regularly pumps. She has a history of gestational diabetes but takes no medications excepting a prenatal vitamin. Vital signs are unremarkable. Physical exam is remarkable for mild epigastric tenderness to palpation. Laboratory studies including complete blood cell count, comprehensive metabolic panel, and thyroid stimulating hormone are unremarkable. Upper endoscopy with gastric biopsies is performed and is unremarkable.

Which of the following diagnostic tests is the most appropriate next step for this patient?

  • A. 2-hour gastric scintigraphy
  • B. 4-hour gastric scintigraphy
  • C. Breath test
  • D. Single photon emission CT

QUESTION 3

Which of the following diagnostic tests is best to assess gastric accommodation?

  • A. Gastric scintigraphy
  • B. Barostat
  • C. EndoFLIP
  • D. Wireless motility capsule

© 2021 by The American College of Gastroenterology