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 EMQ 11

 

   

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EMQ: 11

Dysphagia

a)      Pharyngeal pouch

b)      Carcinoma of the oesophagus

c)      Benign stricture of the oesophagus

d)      Left atrial dilatation

e)      Aneurysm of the aorta

f)        Achalasia of the cardia

g)      Systemic sclerosis

h)      Bulbar palsy

i)        Impacted foreign body

j)        Schatzki ring

Match the description below to one of the conditions listed above

1) A 70-year-old female with difficulty in swallowing. She has not lost any weight. She has a history of rheumatic fever as a child and on examination she is in atrial fibrillation, has a tapping apex and a loud first heart sound with a rumbling mid-diastolic murmur best heard just medial to the apex beat.

2) A 63-year-old male has a long-standing history of gastro-oesophageal reflux disease. He does not use the medications prescribed but uses antacids as required. He complains of difficulty in swallowing but has not lost any weight.

3) A 67-year-old male with a history of ischaemic heart disease and stroke presents with a few months difficulty in swallowing. To begin with it affected solids more than liquids but he is now having difficulty with liquids as well. He has lost weight.

4) A 35-year-old male has long standing difficulty in swallowing. He has difficulty with both solids and liquids. He has not lost weight. Endoscopy shows a dilated oesophagus with food debris in it.

5) A 54-year-old male presents as an emergency with sudden onset of pain in his chest and difficulty in swallowing. This came on whilst he was having a meal in a restaurant.  There is complete dysphagia with inability to swallow saliva.

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