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dysphagia

Practice targeted AMC-style multiple-choice questions on dysphagia.

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 75-year-old male presents with worsening dysphagia. An X-ray is performed (shown). What is the most appropriate initial investigation?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with dysphagia and early satiety. His BMI is 21. A CT scan is performed. Based on the image, and assuming conservative measures have failed, what surgical approach is MOST appropriate?

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 75-year-old presents with a 4-month history of increasing dysphagia to solids, occasional regurgitation, and chronic cough, particularly at night. He denies significant weight loss or chest pain. Past medical history includes type 2 diabetes and hypertension. Medications are metformin and perindopril. Physical examination is unremarkable. A chest X-ray is performed as part of the initial assessment. Considering the clinical presentation and the radiographic findings, which of the following investigations is most appropriate at this stage?

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

An 82-year-old woman is admitted to the hospital with increasing shortness of breath and intermittent chest discomfort over the past week. She reports some difficulty swallowing larger food boluses recently but denies significant heartburn. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 18/min, SpO2 94% on room air, Temp 36.8°C. Auscultation of the chest reveals decreased breath sounds at the left base. A central venous catheter is noted in the right subclavian vein. Initial blood tests show a mild normocytic anaemia (Hb 105 g/L) and normal inflammatory markers. An urgent imaging study is performed. Considering the clinical presentation and the provided imaging study, what is the most appropriate next step in the management of this patient?

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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with dysphagia and weight loss. Gastroscopy and biopsy confirm gastric adenocarcinoma. Staging CT imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old male with a history of mild dysphagia and iron deficiency anemia presents for further evaluation. He denies any recent weight loss or hematemesis. An abdominal CT scan with contrast is performed, the axial view is shown. What is the MOST likely underlying cause of his anemia?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 68-year-old male presents to his general practitioner with a three-month history of progressive dysphagia to both solids and liquids, accompanied by postprandial regurgitation. He also reports experiencing early satiety and occasional episodes of nocturnal coughing. His past medical history is significant for well-controlled hypertension and a remote history of smoking (quit 20 years ago). Physical examination reveals mild epigastric fullness, but is otherwise unremarkable. His vital signs are within normal limits. An abdominal CT scan with contrast was performed, and a representative image is shown. Given the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in the management of this patient?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with dysphagia and epigastric discomfort. A CT scan is performed, as shown. What is the MOST likely long-term complication?

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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old man presents with a 3-month history of progressive dysphagia, early satiety, and unintentional weight loss of 8 kg. He has a background of well-controlled hypertension. Physical examination reveals mild epigastric tenderness. Initial blood tests show a normocytic anaemia. An urgent upper endoscopy identified a large, ulcerated mass in the gastric body, and biopsies were taken. A staging CT scan of the abdomen and pelvis was subsequently performed. Considering the clinical presentation and the findings demonstrated in the provided imaging, which of the following statements best reflects the likely prognosis and primary management strategy for this patient?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

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A 45-year-old man presents to the clinic with a 3-month history of progressive difficulty swallowing both solids and liquids. He also reports regurgitation of undigested food and occasional chest pain. He has lost 5 kg over this period. On examination, there are no abnormalities noted. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

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A 60-year-old man presents to the clinic with a 6-month history of progressive difficulty in swallowing both solids and liquids. He also reports unintentional weight loss and occasional regurgitation of undigested food. On examination, there is no lymphadenopathy or abdominal masses. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 78-year-old male presents to the emergency department with a 2-day history of intermittent upper abdominal pain radiating to the chest and mild dysphagia. He denies shortness of breath or fever. Vital signs are stable. A chest X-ray is obtained. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate immediate management plan?

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

An 82-year-old woman is admitted to the hospital with increasing shortness of breath and intermittent chest discomfort over the past week. She reports some difficulty swallowing larger food boluses recently but denies significant heartburn. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 18/min, SpO2 94% on room air, Temp 36.8°C. Auscultation of the chest reveals decreased breath sounds at the left base. A central venous catheter is noted in the right subclavian vein. Initial blood tests show a mild normocytic anaemia (Hb 105 g/L) and normal inflammatory markers. An urgent imaging study is performed. Considering the clinical presentation and the findings on the imaging study, which of the following is the most likely underlying cause of the patient's anaemia?

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X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 68-year-old male with a history of GERD presents with worsening dysphagia and nocturnal cough. An X-ray is performed. Which of the following is the MOST likely underlying mechanism contributing to the patient's dysphagia?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

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