Differential & Work-up: Dysphagia, Neck Mass

Question 1

75 yo M presents with dysphagia that started with solids and progressed to liquids. He is an alcoholic and a heavy smoker. He has had an unintentional weight loss of 15 lbs ( 6.8 kg) within the past 4 months.

Answer 1

1. Esophageal cancer
2. Achalasia
3. Esophagitis
4. Systemic sclerosis
5. Esophageal stricture

Question 2

WORK UP FOR:

1. Esophageal cancer
2. Achalasia
3. Esophagitis
4. Systemic sclerosis
5. Esophageal stricture

Answer 2

1. CBC
2. CXR
3. Upper endoscopy with biopsy
4. Barium swallow
5. CT-chest

Question 3

45 yo F presents with dysphagia for 2 weeks accompanied by mouth and throat pain, fatigue, and a craving for ice and clay.

Answer 3

1. Plummer·Vinson syndrome
2. Esophageal cancer
3. Diffuse esophageal spasm
4. Esophagitis
5. Achalasia
6. Systemic sclerosis

Question 4

WORK UP FOR:

1. Plummer·Vinson syndrome
2. Esophageal cancer
3. Diffuse esophageal spasm
4. Esophagitis
5. Achalasia
6. Systemic sclerosis

Answer 4

1. CBC
2. Serum iron, ferritin, TIBC
3. Barium swallow
4. Upper endoscopy
5. Esophageal manometry

Question 5

48 yo F presents with dysphagia for both solids and liquids that has slowly progressed in severity within the past year. It is associated with difficulty burping and regurgitation of undigested food, especially at night. She has lost 5.5 lbs (2.5 kg) in the past 2 months.

Answer 5

1. Achalasia
2. Plummer Vinson syndrome
3. Esophageal cancer
4. Esophagitis
5. Systemic sclerosis
6. Esophageal stricture
7. Zenker diverticulum

Question 6

WORK UP FOR:

1. Achalasia
2. Plummer Vinson syndrome
3. Esophageal cancer
4. Esophagitis
5. Systemic sclerosis
6. Esophageal stricture
7. Zenker diverticulum

Answer 6

1. CXR
2. Upper endoscopy
3. Barium swallow
4. Esophageal manometry

Question 7

38 yo M presents with dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush.

Answer 7

1. Esophagitis ( CMV, HSV, HIV, pill-induced)
2. Systemic sclerosis
3. GERD
4. Esophageal stricture

Question 8

WORK UP FOR:

1. Esophagitis ( CMV, HSV, HIV, pill-induced)
2. Systemic sclerosis
3. GERD
4. Esophageal stricture

Answer 8

1. CBC
2. Upper endoscopy
3. Barium swallow
4. HIV antibody and viral load
5. CD4 count

Question 9

39 yo F presents with a single 2-cm mass on the right side of her neck along with night sweats, fever, weight loss, loss of appetite, and early satiety. The mass is painless and movable and has not changed in size. She does not report heat intolerance, tremor, palpitations, hoarseness, cough, difficulty breathing, difficulty swallowing, or abdominal pain. Her husband was recently discharged from prison, and her mother has a history of gastric cancer.

Answer 9

1. Hodgkin/Non-Hodgkin lymphoma
2. Tuberculosis
3. HIV
4. Thyroid nodule
5. Metastatic GI or head and neck malignancy

Question 10

WORK UP FOR:

1. Hodgkin/Non-Hodgkin lymphoma
2. Tuberculosis
3. HIV
4. Thyroid nodule
5. Metastatic GI or head and neck malignancy

Answer 10

1. CBC with differential
2. BMP
3. ESR, CRP
4. Lymph node biopsy
5. PPD/QuanriFERON-TB Gold
6. CXR
7. TSH
8. HIV antibody/RNA
9. U/S-neck
10. Upper endoscopy
11. Fine needle aspiration