Dysphagia

DYSPHAGIA MNEMONIC (DIFFICULTY SWALLOWING):

Having trouble remembering all the important questions to ask during your patient encounter? Then try this Dysphagia Mnemonic (difficulty swallowing) for USMLE Step 2 CS.

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PHYSICAL EXAMINATION for Dysphagia Mnemonic

NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping(don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.

• HEENT: Check throat for erythema and exudate
• Neck exam: Check for lymphadenopathy, thyromegaly
• Cardiovascular exam: Auscultation
• Pulmonary exam: Auscultation
• Abdominal exam: Inspection, auscultation, palpation, percussion.
• Skin: check for signs of scleroderma/CREST.

DIFFERENTIAL DIAGNOSIS for Dysphagia Mnemonic

• Esophageal cancer (Dysphagia starts with Solids and progresses to liquids. Hx of chronic alcoholism, smoking & weight loss )
• Achalasia (Dysphasia for BOTH solid and liquids)
• Esophagitis (Pain on swallowing. Immunocompromised “e.g. HIV, Corticosteroids”)
• Systemic Sclerosis (Look for CREST syndrome)
• GERD (Cough at nights, Hoarseness, sore throat)
• Plummer-Vinson syndrome (Iron deficiency anemia, sore throat, craving ice, dirt, clay…)
• Zenker diverticulum (Halitosis, regurgitation)
• Pill-induced esophagitis (e.g. Bisphosphonates)
• Mitral Stenosis (look for an immigrant or a pregnant female)

DIAGNOSTIC WORKUP for Dysphagia Mnemonic

• CBC
• Serum iron, ferritin, TIBC
• Throat culture
• HIV antibody and viral load, CD4 count
• Chest X-ray
• Barium swallow
• Endoscopy
• Esophageal manometry 
• Chest CT

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