Archive:Dysphagia examination: Difference between revisions
wikademia>JWSchmidt {{OSCE2}} |
wikademia>Koppertone No edit summary |
||
| Line 1: | Line 1: | ||
Dysphagia: Difficulty swallowing with a sensation of food sticking | Dysphagia: Difficulty swallowing with a sensation of food sticking | ||
ID | ==ID== | ||
Specifically note the age of the patient as cancer risk increases with age | |||
Questions to ask | ==Questions to ask== | ||
1. Do you have difficulty moving food from your mouth to your throat? (oropharyngeal dysphagia) | 1. Do you have difficulty moving food from your mouth to your throat? (oropharyngeal dysphagia) | ||
| Line 29: | Line 30: | ||
Review of Systems | ==Review of Systems== | ||
General | ===General=== | ||
*weight loss | *weight loss | ||
*appetite | *appetite | ||
| Line 38: | Line 39: | ||
*fatigue | *fatigue | ||
Respiratory | ===Respiratory=== | ||
*coughing | *coughing | ||
*aspiration - suggests oropharyngeal dysphagia | *aspiration - suggests oropharyngeal dysphagia | ||
*halitosis - suggests Zenker's diverticulum | *halitosis - suggests Zenker's diverticulum | ||
Cardiovascular | ===Cardiovascular=== | ||
* Chest pain - suggests esophageal spasm or esophageal cancer | * Chest pain - suggests esophageal spasm or esophageal cancer | ||
**chest pain in esophageal spasm mimics angina as it radiates to back ears neck and jaw | **chest pain in esophageal spasm mimics angina as it radiates to back ears neck and jaw | ||
GI | ===GI=== | ||
*coughing or choking | *coughing or choking | ||
**suggests oropharyngeal dysphagia | **suggests oropharyngeal dysphagia | ||
| Line 62: | Line 63: | ||
*hiccups - lower esophageal lesion | *hiccups - lower esophageal lesion | ||
PMHx | ==PMHx== | ||
*Any previous dysphagia | *Any previous dysphagia | ||
*Are you Japanese? | *Are you Japanese? | ||
| Line 69: | Line 70: | ||
*radiation treatemnt | *radiation treatemnt | ||
Family history | ==Family history== | ||
*Japanese | *Japanese | ||
*cancer | *cancer | ||
| Line 75: | Line 76: | ||
*achalasia | *achalasia | ||
Social | ==Social== | ||
*alcohol | *alcohol | ||
*smoking | *smoking | ||
PSHx | ==PSHx== | ||
Meds | ==Meds== | ||
Allergies | ==Allergies== | ||
Physical exam | ==Physical exam== | ||
*oral cavity | *oral cavity | ||
**dentition, lesions, masses | **dentition, lesions, masses | ||
| Line 94: | Line 95: | ||
*skin changes - evidence of connective tissue disease | *skin changes - evidence of connective tissue disease | ||
Tests | ==Tests== | ||
*barium swallow | *barium swallow | ||
*videofluoroscopy | *videofluoroscopy | ||
| Line 100: | Line 101: | ||
*fiberoptic nasopharyngeal laryngoscopy | *fiberoptic nasopharyngeal laryngoscopy | ||
*esophageal manometry | *esophageal manometry | ||
==Other OSCE modules== | ==Other OSCE modules== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category:OSCE]] | [[Category:OSCE]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
Revision as of 23:13, 17 May 2007
Dysphagia: Difficulty swallowing with a sensation of food sticking
ID
Specifically note the age of the patient as cancer risk increases with age
Questions to ask
1. Do you have difficulty moving food from your mouth to your throat? (oropharyngeal dysphagia) OR does food get stuck in your throat(known as globus hystericus)? (esophageal dysphagia?)
2. Does food stick immediately (oropharyngeal dysphagia) OR does food stick after swallowing (esophageal dysphagia)?
3. Do you have difficulty with solid foods only (mechanical obstruction) OR solids and liquid foods (neuromuscular disorder)?
4. IS your swallowing difficulty intermittent or has it been progressive?
- intermittent
- esophageal ring/web
- diffuse esophageal spasm
- Progressive
- esophageal stricture
- esophageal cancer
- scleroderma (excessive deposits of collagen)
- achalasia (absence of contraction in the lower half of the esophagus)
5. Any recent ingestion of caustic substances or foreign body?
6. Provoking factors?
7. Relieving factors?
Review of Systems
General
- weight loss
- appetite
- night sweats
- fever
- fatigue
Respiratory
- coughing
- aspiration - suggests oropharyngeal dysphagia
- halitosis - suggests Zenker's diverticulum
Cardiovascular
- Chest pain - suggests esophageal spasm or esophageal cancer
- chest pain in esophageal spasm mimics angina as it radiates to back ears neck and jaw
GI
- coughing or choking
- suggests oropharyngeal dysphagia
- regurgitation from nose
- suggests oropharyngeal dysphagia
- regurgitation suggests esophageal stricture or achalasia
- regurgitation is defined as the effortless return of small amounts of gastric or esophageal content into the mouth
- heartburn - suggests esophageal stricture or scleroderma
- odynophagia (pain on swallowing)
- hematemesis
- hoarseness - suggests recurrent laryngeal compression
- slurred speech - muscle incoordination
- dysarthria - soft palate weakness
- hiccups - lower esophageal lesion
PMHx
- Any previous dysphagia
- Are you Japanese?
- scleroderma
- cancer
- radiation treatemnt
Family history
- Japanese
- cancer
- scleroderma
- achalasia
Social
- alcohol
- smoking
PSHx
Meds
Allergies
Physical exam
- oral cavity
- dentition, lesions, masses
- cranial nerve exam
- look for evidence of bulmar/pseudobulbar palsy (dysarthria, dysphonia, ptosis, tongue atrophy)
- cervical lymph nodes
- masses palpable in neck area
- thyroid gland
- skin changes - evidence of connective tissue disease
Tests
- barium swallow
- videofluoroscopy
- upper endoscopy
- fiberoptic nasopharyngeal laryngoscopy
- esophageal manometry
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence