Dysphagia

Question 1

What key history would you obtain from a patient that complained of dysphagia?

Answer 1

Solids vs. solids & liquids 
Progressive?
Constitutional symptoms (esp. weight loss)
Drooling
Regurgitation
Odynophagia
GERD symptoms
Medications
HIV risk factors
History of smoking
History of Raynaud's phenomenon

Question 2

What key physical exams would you perform on a patient who complains of dysphagia?

Answer 2

Vital signs
Head and Neck exam
Heart, lung and abdominal exam
Skin exam (signs of scleroderma/CREST)

Question 3

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 7 kg over the past 4 months. Differentials?

Answer 3

Esophageal cancer
Achalasia
Esophagitis
Systemic sclerosis
Esophageal stricture
Amyotrophic lateral sclerosis

Question 4

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 7 kg over the past 4 months. Differentials: esophageal cancer, achalasia, esophagitis, systemic sclerosis, esophageal stricture, amyotrophic lateral sclerosis. Workup?

Answer 4

CBC
CXR
Endoscopy with biopsy
Barium swallow
CT - chest

Question 5

45 yo F presents with dysphagia for two weeks together with fatigue and a craving for ice and clay. Differentials?

Answer 5

Plummer-Vinson syndrome
Esophageal cancer
Esophagitis 
Achalasia
Systemic sclerosis
Mitral valve stenosis

Question 6

45 yo F presents with dysphagia for two weeks together with fatigues and a craving for ice and clay. Differentials: Plummer-Vinson syndrome, esophageal cancer, esophagitis, achalasia, systemic sclerosis, mitral valve stenosis. Workup?

Answer 6

CBC
Serum iron, ferritin, TIBC
Barium swallow
Endoscopy

Question 7

48 yo F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night. Differentials?

Answer 7

Achalasia
Plummer-Vinson syndrome
Esophageal cancer
Esophagitis
Systemic sclerosis
Mitral valve stenosis
Esophageal stricture
Zenker's diverticulum

Question 8

48 yo F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night. Differentials: achalasia, Plummer-Vinson syndrome, esophageal cancer, esophagitis, systemic sclerosis, mitral valve stenosis, esophageal stricture, Zenker’s diverticulum. Workup?

Answer 8

CXR
Endoscopy
Barium swallow
Esophageal manometry

Question 9

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

Answer 9

Esophagitis (CMV, HSV, pill-induced)
Systemic sclerosis
GERD
Esophageal stricture
Zenker's diverticulum

Question 10

38 yo M presents with dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush. Differentials: esophagitis (CMV, HSV, pill-induced), systemic sclerosis, GERD, esophageal stricture, Zenker’s diverticulum. Workup?

Answer 10

CBC
Endoscopy
Barium swallow
HIV antibody
CD4 count