AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 60-year-old male presents with a 6-month history of progressive difficulty swallowing solid foods, which has now progressed to liquids. He describes a sensation of food getting 'stuck' in his chest and occasionally regurgitates undigested food. He also reports a 10-pound weight loss. Endoscopy reveals a dilated esophagus with a 'bird's beak' appearance at the gastroesophageal junction. What is the most likely diagnosis?
- AEsophageal Cancer
- BGastroesophageal Reflux Disease (GERD)
- CAchalasia
- DEsophageal Stricture
Show answer & explanationAnswer & explanation
Correct answer: C. Achalasia
The progressive dysphagia to both solids and liquids, regurgitation of undigested food, weight loss, and the classic 'bird's beak' appearance on imaging (which endoscopy findings would correlate with) are highly indicative of Achalasia, a motility disorder of the esophagus.
Why the other options are wrong
- A. Esophageal cancer can cause progressive dysphagia and weight loss, but the 'bird's beak' appearance is not typical; endoscopy would usually show a mass or ulceration.
- B. GERD typically presents with heartburn and acid regurgitation, not progressive dysphagia to both solids and liquids or a 'bird's beak' appearance.
- D. Esophageal stricture causes progressive dysphagia, but usually primarily to solids, and would appear as a focal narrowing, not a 'bird's beak' dilation.
Achalasia
A rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of peristalsis in the distal esophagus.
- Leads to progressive dysphagia to both solids and liquids.
- Classic radiographic finding is a 'bird's beak' appearance on barium swallow.
- Can cause regurgitation of undigested food and weight loss.
Memory trick: STUCK: Solids & liquids, Tight LES, Undigested food, Classic 'bird's beak' on imaging, Kilos lost.