AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 62-year-old female presents with a 4-month history of progressive difficulty swallowing solids, initially, and now liquids. She reports regurgitation of undigested food and occasional nocturnal cough. She denies heartburn or significant weight loss. Barium swallow shows a 'bird's beak' appearance at the gastroesophageal junction. What is the most likely diagnosis?
- AGastroesophageal reflux disease (GERD)
- BAchalasia
- CEsophageal spasm
- DEsophageal cancer
Show answer & explanationAnswer & explanation
Correct answer: B. Achalasia
The patient's progressive dysphagia to both solids and liquids, regurgitation of undigested food, nocturnal cough, and the classic 'bird's beak' appearance on barium swallow are highly indicative of achalasia, a motility disorder of the esophagus.
Why the other options are wrong
- A. GERD primarily causes heartburn and acid regurgitation, usually without progressive dysphagia to both solids and liquids, and would not show a 'bird's beak' on barium swallow.
- C. Esophageal spasm causes intermittent, non-progressive chest pain and dysphagia, often described as 'corkscrew' esophagus on barium swallow, not a 'bird's beak' appearance or progressive dysphagia to liquids.
- D. Esophageal cancer typically causes progressive dysphagia, but usually more pronounced with solids initially, significant weight loss, and would appear as a mass or stricture on barium swallow, not a 'bird's beak.'
Achalasia
A primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of peristalsis in the distal esophagus.
- Progressive dysphagia (solids then liquids).
- Regurgitation of undigested food, nocturnal cough.
- Barium swallow: 'bird's beak' appearance of the distal esophagus.
- Diagnosis confirmed by esophageal manometry (high LES pressure, absent peristalsis).
Memory trick: Achalasia is 'Always' a 'Bird's Beak' that 'Blocks' food from going down.