Dysphagia

Question 1

Site

Answer 1

Where does the food get stuck?

Question 2

Quality

Answer 2

Are you finding it difficult to swallow?

Does the food get stuck after swallowing?

Question 3

Severity

Answer 3

What type of food usually gets stuck?

Is there any difference when the food is soft?

Question 4

Time course

Answer 4

Did it start suddenly?
How long have you had difficulty swallowing for?
Has it been getting worse?
Has this ever happened before?

Question 5

Context

Answer 5

What were you doing when you first had difficulty swallowing?

Question 6

Relieving

Answer 6

Normal

Question 7

Aggrevating

Answer 7

Normal

Question 8

Associated features

Answer 8

Have you lots any weight since this started?

Have you lost you appetite at all?

Question 9

Smoking

Answer 9

Normal

Question 10

Drinking

Answer 10

Normal

Question 11

Past hist

Answer 11

Normal

Question 12

Fam Hist

Answer 12

Normal

Question 13

Social hist

Answer 13

Normal

Question 14

Occupational hist

Answer 14

Normal

Question 15

What are some associated features we are looking for?

Answer 15

Past stroke 
Parkinson’s disease 
Multiple Sclerosis 
Coughing Choking/ Gaging (initiation problem) 
Reflux (causing stricture) 
Loss of appetite

Question 16

What are the reasons for the site and quality questions?

Answer 16

To determine if the problem is oropharayngeral or oesophageal

Question 17

What is the point of the severity question

Answer 17

To differentiate between a motility/mechanical problem

Question 18

Differential diagnosis

Answer 18

Stroke – family history, past history of cardiovascular problems, high cholesterol, hypertension, sensorimotor loss, sudden onset, other neurological problems

Parkinson’s Disease – short steps, tremors, loss of smell, rigid movements

Multiple Sclerosis – Muscle Weakness, Visual disturbances, Hearing disturbances, Dizziness

Reflux – past history, chest pain, pain with or after eating

Oesophageal Cancer – past history, family history, weight loss, chest pain, history of reflux, coeliac disease, fever, initially solids only

Achalasia (loss of peristalsis in oesophagus) – context, rule out cancer, liquids from onset