Key History
Solids or liquids vs. both solids and liquids, ± progression, occurring at the 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; history of anxiety, smoking, Raynaud’s phenomenon.
Key Physical Exam
Vital signs; head and neck exam; heart, lung, and abdominal exams; skin exam (for signs of scleroderma/CREST).
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Presentation |
Differential |
Workup |
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■ 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. |
Esophageal cancer Achalasia Esophagitis Systemic sclerosis Esophageal stricture Amyotrophic lateral sclerosis |
CBC CXR Upper endoscopy with biopsy Barium swallow CT—chest |
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■ 45 yo F presents with dysphagia for 2 weeks accompanied by mouth and throat pain, fatigue, and a craving for ice and clay. |
Plummer-Vinson syndrome Esophageal cancer Esophagitis Achalasia Systemic sclerosis Mitral valve stenosis |
CBC Serum iron, ferritin, TIBC Barium swallow Upper endoscopy Video fluoroscopy |
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■ 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 belching and regurgitation of undigested food, especially at night. She has lost 5.5 lbs (2.5 kg) in the past 2 months. |
Achalasia Plummer-V inson syndrome Esophageal cancer Esophagitis Systemic sclerosis Mitral valve stenosis Esophageal stricture Zenker’s diverticulum |
CXR Upper endoscopy Barium swallow Esophageal manometry XR—neck |
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■ 38 yo M presents with dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush. |
Esophagitis (CMV, HSV, HIV, pill-induced) Systemic sclerosis GERD Esophageal stricture Zenker’s diverticulum |
CBC Upper endoscopy Barium swallow HIV antibody and viral load CD4 count |
Key History
Onset, size, location, mobility, pain, movement with swallowing; obstructive symptoms (dysphagia, shortness of breath); other masses; associated symptoms (constitutional, hematologic, GI, endocrine, pulmonary); ill contacts.
Key Physical Exam
Vital signs; HEENT exam; exam of lymph nodes, spleen, and tonsils; heart, lung, and abdominal exams.