Repeated USMLE Questions Step 2 CK- 332

A 48 year-old woman presents to the clinic for a complaint of difficult swallowing solid food for the last 2 months. After seconds of swallowing, she feels the food getting stuck at the suprasternal notch. She has no history of food or acid regurgitation. She has not lost weight. She does not smoke or drink alcohol. Her medical, surgical and family histories are unremarkable. Her physical examination and laboratory investigations are normal.

What is the best next step of management?

A- Barium swallow

B- CT body screening

C- Esophageal manometry

D- Trial of proton pump inhibitor

E- Upper endoscopy

Answer






Dysphagia after seconds of swallowing suggests esophageal reason. The most common cause of esophageal dysphagia is esophageal reflux disease, motility disorder or stricture formation. Esophageal cancer can cause the same type of dysphagia so; it should be excluded by upper endoscopy. Barium swallow should follow if there is any stricture or gross lesion. Manometry is recommended is cases of achalasia which is not expected for this case as it eventually leads to dysphagia of solids and liquids.

The correct answer is E