Dysphagia

Question 1

Key history in dysphagia

Answer 1

Solids or liquids vs. solids and liquids
Progression
Occurring at beginning or middle of swallow
Constitutional symptoms (especially weight loss)
Hoarseness
Drooling
Regurgitation of liquids vs. undigested food
Odynophagia
GERD symptoms
Medications
HIV risk factors
Hx of anxiety, smoking, Raynaud’s phenomenon

Question 2

Key physical exam in dysphagia

Answer 2

Vital signs
Head and neck exam
Heart, lung and abdominal exams
Skin exam (for signs of scleroderma/CREST syndrome)

Question 3

75 yo M with dysphagia that started with solids and progressed to liquids
+ alcoholic and heavy smoker
+ unintentional weight loss of 15 pounds over last four months

Answer 3

Esophageal cancer
Achalasia
Esophagitis

CBC, CXR, upper endoscopy with biopsy, barium swallow, CT - chest

Question 4

45 yo F with dysphagia over two weeks
+ mouth and throat pain
+ fatigue
+ picca

Answer 4

Plummer-Vinson syndrome (esophageal webs, glossitis and iron deficiency anemia)
Esophageal cancer
Esophagitis

CBC, serum iron, ferritin, TIBC, barium swallow, upper endoscopy, video fluoroscopy

Question 5

48 yo F with dysphagia for both solids and liquids that has slowly progressed over last year
+ difficulty belching
+ regurgitation of undigested food, especially at night
+ six pound weight loss over last two months

Answer 5

Achalasia
Plummer-Vinson syndrome
Esophageal cancer
Esophageal stricture

CXR, upper endoscopy, barium swallow, esophageal manometry, XR - neck

Question 6

38 yo M with dysphagia and pain on swallowing solids more than liquids
+ oral thrush

Answer 6

Esophagitis (CMV, HSV, HIV, pill-induced)
Systemic sclerosis
Esophageal stricture
GERD

CBC, upper endoscopy, barium swallow, HIV antibody and viral load, CD4 count