Guptashutosh
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D
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| sarika
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A. Barium esophagram first to visualize and orient urself and make sure doing Esophagoscopy wont rupture any webs.
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| robin082006
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A
Dysphagia--> barium first
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| Mahwish Mushtaq
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A
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| drashishmahajan
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A
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| fox
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Another kaplan q which is controversial.....answer given as esophagoscopy. In medical school I have been trained to pick Barium first for the same reason mentioned by Sarika but the justification given is that esophagoscopy will be needed eventually & also esophagoscopy affords an oppurtunity to take biopsies & is also therepeutic at times. I think its better to pick barium as we have a general consensus here.
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| Dr.Luck
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Choice A b/c we don't know whether there's a stricture,obstruction or simply increased tone at LES that's causing dysphagia...so we need to see it by ba esophagogram & then put endoscope inside othewrise there r more chances of iatragonic rupture of oesophagus by blindly putting endoscop in it.
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| Guptashutosh
Forum Elite
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esophagoscopy is NOT a blind procedure and iatrogenic rupture of esophgus is very very rare so D becomes 1st choice
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| young_doc
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Kaplan is not the all-mighty. They do make mistakes.
I think Barium is a better 1st step to take. Not so much because risk of rupture etc, but because we should start always with the least invasive procedure.
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| Data297
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They asked for the next step, it should be A. The one thing I remember from kaplan lectures is that scope is never first.
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| prod
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I agree with Ba swallow first..Kaplan Int Med page -2 esophageal carcinoma case..diagnosis "although Ba-swallow can be done first..endoscopy is mandatory". Now although the patient is old (62 years), still she denies weight loss and family H/o of GI malignancy..so I would pick choice A as next best step in Mx
best diagnostic procedure..would be esophagoscopy I guess 
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| hypochondriac
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I emailed Dr. Fisher about this question, he said D is the answer because the most likely diagnosis is esophageal Ca. There is increasing difficulty with swallowing, and difficulty is only for solids. In other types like achalasia it's dysphagia to solids and liquids at the same time.
Not sure I agree with him, but I think he has a point
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