Clinical Lectures

Question 1

Dysphagia

Answer 1

• Difficulty swallowing
• Patient complains of:
• Food sticking in throat
• Difficulty swallowing
• Food sticking then may choke

Question 2

Odynophagia

Answer 2

• Pain associated with swallowing
• May or may not accompany dysphagia
• Generally caused by painful lesions in mouth

Question 3

Most common causes of odynophagia

Answer 3

Herpes simplex

Candida stomatitis

Question 4

Globus sensation

Answer 4

The sensation of a lump in the throat

-Patient complains of sensation of something in the back of the throat “all of the time”

Question 5

Globus sensation effect on swallowing

Answer 5

• Swallowing is normal

- Sense of the “lump” disappears transiently with swallowing

Question 6

Primary cause of globus sensation

Answer 6

Tightening of upper esophageal sphincter

Question 7

Achalasia

Answer 7

• Lower esophageal sphincter fails to relax
• Results in dilation of the upper esophagus
• True cause of dysphagia

Question 8

Diffuse esophageal spasm

Answer 8

• Synchronous contraction of esophagus
• Lack of orderly peristalsis
• There may be normal periods of peristalsis
• May cause chest pain similar to angina (also relieved by nitro)
• True cause of dysphagia

Question 9

Dysarthria

Answer 9

• Unclear articulation of speech

- Due to difficulty controlling or coordinating the muscles used in speech

Question 10

Vomiting (emesis)

Answer 10

The voluntary or involuntary forceful emptying of the stomach contents

Question 11

Regurgitation

Answer 11

The passive flow of material back up the esophagus

Question 12

Dysphagia history

Answer 12

Step 1: Is dysphagia present?
Step 2: is this esophageal or oropharyngeal in location?
Step 3: is this a structural abnormality of a motor disorder?

Question 13

What would be suggestive of a progressive lesion (i.e. carcinoma)?

Answer 13

Swallowing difficulty progresses over time

Question 14

When would you suspect stricture?

Answer 14

Swallowing difficulty remains fixed with certain sized quantity of food

Question 15

When would you suspect a motility disorder?

Answer 15

Dysphagia with both solids and liquids

Question 16

What suggests problems in distal esophagus?

Answer 16

Dysphagia associated with hiccups

Question 17

Oropharyngeal dysfunction

Answer 17

Difficulty initiating swallowing or repetitive swallowing

Question 18

Esophageal dysfunction

Answer 18

Restrosternal “hanging up” sensation

Question 19

Mechanical obstruction

Answer 19

Difficulty with solids not liquids

Question 20

Esophageal dysmotility

Answer 20

Difficulty with both solids and liquids

Question 21

Zenker diverticulum

Answer 21

Regurgitation of undigested food or halitosis

Question 22

Blumberg test

Answer 22

Rebound tenderness; peritoneal irritation, appendicitis

Question 23

Markle (heel jar) test

Answer 23

Patient stands, raises up on toes, allows heels to hit floor > sharp pain hits abdomen; peritoneal irritation

Question 24

McBurney test

Answer 24

Sharp pain when McBurney point is palpated; appendicitis

Question 25

Murphy test

Answer 25

Abrupt cessation of inspiration on palpation of gall bladder; cholecystitis

Question 26

Rovsing test

Answer 26

RLQ pain intensified by LLQ palpation; peritoneal irritatoin, appendicitis

Question 27

Iliopsoas muscle test

Answer 27

Patient lies supine, resist their hip flexion > worsened RLQ pain; appendicitis

Question 28

Obturator muscle test

Answer 28

Right leg flexed at hip and knee, rotate leg internally and externally > worsened RLQ pain with internal; ruptured appendix or pelvic abscess