USMLE Step 2 - General Surgery Verified Solution

USMLE Step 2 - General Surgery Verified Solutions Gold-standard for GERD diagnosis ️️pH-manometry Classic clinical scenario of GERD ️️Overweight + heartburn elicited by bending over, wearing tight clothes, or lying flat + symptom improvement with OTC antacids or H2 blockers Complications of long-standing GERD ️️Peptic esophagitis and Barret esophagus Evaluation of long-standing GERD ️️Endoscopy and biopsy Indications for laparoscopic Nissen fundoplication in GERD ️️Long-standing symptomatic disease that can't be controlled by medical means Development of complications: ulceration, stenosis Indication for resection in GERD ️️Severe dysplastic changes Clinical pattern of uncoordinated massive contraction ️️Crushing pain with swallowing Clinical pattern in achalasia ️️Dysphagia worse for liquids that is improved when the patient sits up straight and waits Diagnostic tests for motility problems ️️Barium swallow and manometry Therapy for achalasia ️️Balloon dilation by endoscopy Clinical manifestations of esophageal cancer ️️Progressive dysphagia + weight loss Esophageal squamous cell carcinoma risk factors ️️Black + men + smoking + drinking Esophageal adenocarcinoma risk factors ️️Long-standing GERD Diagnosis of esophageal cancer ️️Barium swallow Endoscopy and biopsies CT to assess operability Surgery for esophageal cancer ️️In most cases is palliative rather than curative Mallory-Weiss tear clinical picture ️️Bright red blood after prolonged, forceful vomiting Diagnosis of Mallory-Weiss tear ️️Endoscopy Treatment of Mallory-Weiss tear ️️Photocoagulation during endoscopy Boerhaave syndrome ️️Esophageal perforation following prolonged, forceful vomiting Boerhaave syndrome clinical picture ️️Continuous, severe, epigastric and low sternal pain of sudden onset Fever, leukocytosis, very sick-looking patient Diagnostic tests for Boerhaave syndrome ️️Contrast swallow: gastrografin first, barium if negative Treatment of Boerhaave syndrome ️️Emergency surgical repair Most common cause of esophageal perforation ️️Instrumental perforation during endoscopy Clinical picture of instrumental perforation of the esophagus ️️Boerhaave syndrome It may present with neck emphysema Gastric adenocarcinoma or lymphoma clinical scenario ️️Elderly + anorexia + weight loss + vague epigastric distress or early satiety It may present with hematemesis Diagnostic tests for gastric adenocarcinoma or lymphoma ️️Endoscopy and biopsies CT to assess operability Best treatment for gastric adenocarcinoma ️️Surgery Treatment for gastric lymphoma ️️Chemotherapy or radiotherapy Surgery only if perforation is feared Treatment of low-grade lymphomatoid transformation ️️H