Question 1.
A 38-year-old woman, gravida 3, para 2, comes to the office at 20 weeks’ gestation for a routine obstetrical appointment. Her pregnancy has been uncomplicated thus far. She does not report taking any medications other than her prenatal vitamins and denies any tobacco, alcohol, or illicit drug use. During her scheduled ultrasound, visualization of the fetus is difficult due to a decrease in amniotic fluid volume. Which of the following is the most likely condition affecting the fetus?
Macrosomia
Macrosomia is more commonly seen with polyhydramnios. Polyhydramnios is characterized by elevated amniotic fluid either due to impaired fetal swallowing of fluid or an increased production of fetal urine.
Duodenal atresia
Duodenal atresia is more commonly seen with polyhydramnios. Polyhydramnios is characterized by elevated amniotic fluid either due to impaired fetal swallowing of fluid or an increased production of fetal urine.
Bilateral renal agenesis
Major takeaway
Oligohydramnios is a condition in which there is a decreased amount of amniotic fluid. It can either be due to premature rupture of membranes or impaired fetal urine output.
Main explanation
This patient comes to a routine obstetrics appointment during her second trimester of pregnancy and is found to have insufficient amount of amniotic fluid, a condition called oligohydramnios. Oligohydramnios can either be due to premature rupture of the membranes or from conditions that impair fetal renal secretion of urine because fetal urine makes up a large proportion of the amniotic fluid in the latter half of pregnancy. Bilateral renal agenesis is one condition that can lead to decreased fetal urine production. Bilateral renal agenesis is not compatible with extrauterine life because the prolonged absence of amniotic fluid causes pulmonary hypoplasia, leading to respiratory insufficiency at birth.
Esophageal atresia
Esophageal atresia is more commonly seen with polyhydramnios. Polyhydramnios is characterized by elevated amniotic fluid either due to impaired fetal swallowing of fluid or an increased production of fetal urine.
Trisomy 21
Trisomy 21 is more commonly seen with polyhydramnios. Polyhydramnios is characterized by elevated amniotic fluid either due to impaired fetal swallowing of fluid or an increased production of fetal urine.
Question 2.
A 72-year-old male patient presents to his primary care physician with sensory ataxia and episodic lower back pain that began two months earlier and has degenerated quickly. The patient’s wife also says that he has become more forgetful over the past month and has “not been himself.” Gait inspection shows that the patient raises his knees abnormally high while walking and then slaps his feet down. Physical examination reveals absent lower limb reflexes and is significant for pupils that constrict during accommodation but not when exposed to bright light.
Based on the patient’s history and symptoms, which of the following is the most likely diagnosis?
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Lyme disease
Lyme disease is caused by an infection with Borrelia-type bacteria and most commonly presents with an expanding area of redness, or erythema migrans. Other common symptoms include fever, headache, fatigue, neck stiffness, and heart palpitations.
Vitamin B12 deficiency
Vitamin B12 deficiency can present with changes in personality, neurological damage, and anemia. Severe cases can lead to degeneration of the spinal cord, and could account for the lower limb reflex abnormalities. However, B12 deficiency would not explain the pupillarydefects, and there is no history that could explain a vitamin deficiency.
Friedreich's ataxia
Friedreich’s ataxia is an autosomal recessive disease that causes progressive damage to the nervous system, leading to gait disturbances and occasionally scoliosis, diabetes, heart disorders, and slurred speech. Symptoms normal begin presenting between 5 and 15 years of age.
Spinocerebellar ataxia
Spinocerebellar ataxia is a progressive, neurodegenerative genetic disorder with over 60 different types identified so far. Onset can begin at any age and symptoms generally include slowly progressing incoordination of gait as well as hands, speech, and eye movements.
Late neurosyphilis
Major takeaway
Neurosyphilis is an infection of the brain or spinal cord caused by the spirochete bacterium Treponema pallidum. One of the most common symptoms of late neurosyphilis is tabes dorsalis, a specific type of ataxia that results from degeneration of the dorsal roots and dorsal columns of the spinal cord.
Main explanation
This patient most likely has late neurosyphilis, an infection of the brain or spinal cord caused by the spirochete bacterium Treponema pallidum. Late neurosyphilis normally occurs in patients who have had untreated syphilis for over ten years, while early neurosyphilis generally occurs in patients who are immunocompromised within 1-2 years of primary infection.
One of the most common symptoms of late neurosyphilis is tabes dorsalis–a specific type of ataxia that results from degeneration of the dorsal roots and dorsal columns of the spinal cord. Due to a lack of proprioception, patients tend to lift their knees too high and then slap their feet down. To compensate for the lack of positional sense, tabetic patients often need visual cues to stand and often lose balance in the dark. Lower limb reflexes are typically diminished or absent. The presence of Argyll Robertson that accommodate but do not constrict to light is also characteristic of late neurosyphilisand is thought to be caused by damage to the pretectal nuclei in the midbrain.
Question 3.
A 28-year-old woman comes to the clinic because of left abdominal pain and a burning with urination over the past four days. She says the pain was just a nuisance at first, but now it has grown to be unbearable. She has also experienced several episodes of nauseaand vomiting within the past two days. Medical history is negative for similar symptoms in the past. Her temperature is 38.9°C (102.0°F), pulse is 86/min, respirations are 18/min, and blood pressure is 108/62 mm Hg. Physical examination shows left-sided costovertebral angle tenderness. The spleen is not palpable. Complete blood count is significant for a leukocyte count of 16,000/mm³. Her urine shows gross hematuria and contains leukocyte castson urinalysis. A computed tomography scan of her abdomen shows multiple wedge-shaped, low-attenuation areas in the left kidney. Which of the following is the most likely causative organism for this woman’s pathology?
Campylobacter jejuni
Campylobacter jejuni is most commonly associated with the development of Guillan-Barre syndrome after being ingested in undercooked poultry or unpasteurized milk.
Enterobacter spp
Enterobacter is a family of lactose-fermenting gram-negative bacteria that can also cause urinary tract infections but does so much less often than E. coli.
Escherichia coli
Major takeaway
The most common organism causing pyelonephritis is E. coli. This bacterium has multiple virulence factors, such as bacterial adhesinP, that allows it to adhere to the urothelium and begin the cascade of infection and inflammation.
Main explanation
The patient has acute bacterial pyelonephritis. The most commonly implicated organisms are from the gastrointestinal tract. The most common pathogen being uropathogenic Escherichia coli(UPEC), which is responsible for 90% of infections. Acute bacterialpyelonephritis is an infection of the kidney usually due to ascending infection. The infection gains access to the upper urinary tract by passing retrogradely up the ureter from the bladder. This is facilitated by virulence factors such as bacterial adhesin P which allow bacteria to adhere to the urothelium. The infection then passes into the collecting tubulesand results in an interstitial nephritis. This results in renal filtrationand blood flow alterations. Localized ischemia and inflammatory changes result in necrosis and scarring. The multiple wedge-shaped, low-attenuation areas in the left kidney may reflect acute bacterial pyelonephritis or multiple renal infarcts. Location of the wedges in line with the calyces suggests pyelonephritis, whereas wedges located between calyces suggest infarcts. Acute bacterial pyelonephritis usually presents with fever, flank pain, leukocyte casts, and leukocytosis in addition to symptoms of cystitis. Inflammation results in sensitization of nerves in the capsule of the kidney. Leukocyte casts are made when inflammation ascends into tubule.
Klebsiella pneumoniae
Klebsiella pneumoniae is a lactose-fermenting gram-negative enteric bacteria that can also cause urinary tract infections (3rd leading cause) but does so less often than E. coli. It is known for causing lobar pneumonia after being aspirated by patients with alcoholism.
Proteus mirabilis
Proteus mirabilis is a gram-negative bacteria that can also cause urinary tract infections but does so much less often than E. coli. It is known to show swarming motility on agar plating. It also produces urease, thus raising urinary pH and making more favorable growth conditions for itself.
Question 4.
A 33-year-old woman, gravida 1, para 1, comes to the office for her 6-week postpartum visit. She had a spontaneous vaginal delivery complicated by significant postpartum hemorrhageand required a blood transfusion. She reports difficulty with lactation since her delivery as well as recent hair loss, weight gain, amenorrhea, and loss of libido. Which of the following is the most likely diagnosis?
Post-natal depression
Post-natal depression (PND) is an important condition to screen for at the 6-week postnatalcheck. The symptoms described suggest abnormal endocrine function not accounted for by PND.
Pituitary adenoma
Symptoms and signs of pituitary adenoma depend on the hormones secreted (if any) and the size of the tumour. Headache is a common symptom. Hypopituitarism can occur secondary to a pituitary adenoma but given the recent history of delivery and PPH this is not the most likely diagnosis.
Sheehan's syndrome
Major takeaway
Sheehan syndrome is due to necrosis of the pituitary due to hypovolemia during postpartum hemorrhage. Symptoms vary but difficulty with lactation is a common symptom.
Main explanation
Sheehan syndrome is due to pituitary necrosis following postpartum hemorrhage.
During pregnancy the pituitary gland is normally enlarged and therefore is particularly sensitive to changes in blood flow. The hypovolemia that can occur with postpartum hemorrhage can be enough to cause ischaemia and infarction of the pituitary glandwith the anterior part being more vulnerable than the posterior part.
The anterior pituitary produces FSH, LH, GH, prolactin, TSH, ACTH and sheehan syndrome causes varying degrees of hypopituitarism depending on the amount of tissue destroyed. Adrenal insufficiency, hypothyroidism, amenorrhea, and an inability to breast-feed are classic features of the syndrome.
Empty sella syndrome
Empty sella syndrome may be primary, with normal or abnormal hormone levels, or secondary due to radiation, surgery or a tumor, with hypopituitarism. Given the history of postpartum bleeding, this diagnosis is less likely.
Hypothyroidism
Although this patient has symptoms of hypothyroidism, the failure to lactate, amenorrhea, and loss of libido suggest involvement of other pituitary hormones including prolactin, FSH, and LH.
Question 5.
A 22-year old woman comes into the primary care office with a 1 week history of foul-smellingvaginal discharge. She reports being sexually active with multiple partners and inconsistent condom use. On pelvic exam, her vaginal mucosa is erythematous and friable, and her cervixshows erythema with pinpoint areas of exudation. A wet mount preparation of the discharge shows numerous multi-flagellated organisms. Which of the following is the next best step in management?
Treat with fluconazole
Fluconazole is a treatment for vaginal candidiasis. This patient has evidence of trichomonadson the wet mount without evidence of hyphae. Vulvovaginitis would present with itching, “cottage-cheese” discharge, and pseudohyphae on wet mount.
Reassurance
This patient has evidence of trichomoniasis, a sexually transmitted infection. Both she and her partner require treatment with metronidazole to avoid further spread of the disease and potential long-term consequences.
Treat with nitrofurantoin
Nitrofurantoin is a first line treatment for urinary tract infections caused by E. coli, S. aureus, and certain strains of Klebsiella. A urinary tract infection would more likely present with burning on urination, increased urinary frequency, and possible systemic symptoms.
Treat with ceftriaxone
This patient does require treatment but ceftriaxone is not an appropriate treatment for trichomoniasis. Ceftriaxone may be used to treat pelvic inflammatory disease secondary to gonorrhea or chlamydia. It is also used to treat complicated urinary tract infections.
Treat with metronidazole
Major takeaway
Vaginitis, “strawberry cervix” on examination, and motileflagellated organisms suggest an infection with Trichomonas vaginalis. Trichomoniasis requires treatment with metronidazole.
Main explanation
This patient should receive metronidazole for her vaginitis. Vaginaldischarge and odor point to a diagnosis of vagnitis, as opposed to a urinary tract infection, which would present with dysuria and increased urinary frequency.
When approaching a patient with vaginitis the differential includescandidiasis, Trichomonas infection, and bacterial vaginosis. The patient has a “strawberry cervix” on exam and motile flagellated organisms suggestive of vaginitis secondary to Trichomonas. Trichomonas vaginitis requires treatment with metronidazole. Both the patient and her sexual partners should be treated.
NB: A relatively small proportion of women with trichomonas vaginalis will have ‘”strawberry cervix”. It is so named because of the erythematous appearance and pinpoint areas of exudation – strawberry-like.
Question 6.
A 23-year-old woman presents to her primary care physician with the complaint of episodic dizziness. The dizziness began three days ago and occurs when she rose up from her bed and when she turns her head fast. The episodes are associated with nausea and are unlike anything she has ever experienced. She denies any recent trauma, fevers, headaches, or sore throat. Her past medical history is insignificant and she takes no medications. Vital signsreveal a blood pressure of 135/90 mmHg, and pulse of 75/min. Cardiac and neurologicalexaminations are unremarkable. Which of the following is the most appropriate treatment in this patient?
Intravenous glucose
Intravenous glucose is used to treat hypoglycemia, which can also cause dizziness and nausea. However, these patient’s episodes appear to be related to body movement, particularly of the head, and not to changes in the patient’s glucose levels.
Temazepam
Temazepam is a short acting benzodiazepine used to treat acute episodes of anxiety. It works by increasing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor. In this case, the patient’s dizziness seems to be related to head movement rather than anxiety.
Atorvastatin
Atorvastatin is used to treat hyperlipidemia by inhibiting HMG-CoA reductase, an enzymefound in the liver that plays a role in cholesterol synthesis. While hyperlipidemia could cause plaques in the carotid arteries leading to dizziness, this would not necessarily occur when turning the patient’s head, as in this case.
Epley maneuver
Major takeaway
Benign paroxysmal positional vertigo (BPPV) is caused by the displacement of otoliths in the semicircular canals of the labyrinth of the inner ear. The Epley maneuver is a common repositioning technique used to treat BPPV and consists of hanging the patient’s head off the exam table and slowly turning it towards the affected ear.
Main explanation
This patient most likely has benign paroxysmal positional vertigo(BPPV), which is caused by dislodged otoliths in one of the semicircular canals of the labyrinth of the inner ear. When the head is turned rapidly to one side (often the side of the otolith dislodging), dizziness may occur until equilibrium is regained. The classical presentation of BPPV is the onset of vertigo when changing position of the head.
The Epley maneuver is a common repositioning maneuver used to treat BPPV. It can easily be performed in the office, by hanging the patient’s head off the exam table and slowly turning the patient’s head towards the affected ear and waiting for symptoms of vertigo to abate. Next, the head should be slowly turned to the unaffected side and held there for any symptoms of vertigo to cease. The goal of the Epley maneuver is to reposition the otoliths outside of the semicircular canals, thus relieving the patient’s symptoms. In addition to the Epley maneuver, medications such as meclizine, an anti-histamine, can be used for symptomatic relief from BPPV.
Midodrine
Midodrine is an alpha-agonist used to treat orthostatic hypotension. Dizziness from orthostatic hypotension is precipitated by going from supine or sitting to standing. Midodrinecan reduce dizzy spells and faints by about a third, although the quality of the evidence underlying this finding is limited.
Question 7.
A 17-year old boy comes to the emergency department because of bilateral tinnitus, and difficulty with balance. A magnetic resonance image of the patient’s brain shows several round, well-circumscribed, enhancing lesions. The lesions have dural tails along the convexity of his cranium. Which of the following is the likely diagnosis?
Tuberous sclerosis
Tuberous sclerosis is a rare multisystem genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.
Neurofibromatosis 2
Major takeaway
When a patient presents with bilateral acoustic neuroma, always think of the possibility of neurofibromatosis type 2. This may help anticipate future tumor growth, such as ependymoma and meningioma. The neurofibromatosis type 2 gene encodes a tumor suppressor protein called merlin, and is inherited in an autosomal dominant manner.
Main explanation
Bilateral vestibular schwannomas and multiple meningiomas in this patient raise concern for the diagnosis of neurofibromatosis type 2.
Neurofibromatosis type 2 is an autosomal dominant disorder that has a much lower prevalence than neurofibromatosis type 1 (1 in 50,000) and accounts for only 10% of all neurofibromatosis cases. The neurofibromatosis type 2 gene, at chromosome 22q12, encodes a tumor suppressor protein called merlin (or schwannomin).
Cutaneous features of neurofibromatosis type 2 are rarer than in neurofibromatosis type 1, including intracutaneous plaque-like lesions and occasional café-au-lait spots. Ophthalmologic features are also prominent in neurofibromatosis type 2 (particularly cataracts).
The predominant central nervous system tumors in neurofibromatosis type 2 are vestibular schwannomas, which often occur bilaterally, and with cranial meningiomas. Peripheral tumors in neurofibromatosis type 2 include spinal schwannomasand neurofibromas.
A good mnemonic is MISME.
Multiple
Inherited
Schwannoma
Meningioma
Ependymoma
The following are the diagnostic criteria for neurofibromatosis type 2:
1. Bilateral vestibular schwannomas; or
2. A first-degree relative with neurofibromatosis type 2, andeither
a) A unilateral vestibular schwannoma or
b) Two of the following: meningioma, posterior subcapsular lens opacity, or cerebral schwannoma, glioma, neurofibroma, cerebral calcifications; or
3. Two of the following:
a) Unilateral vestibular schwannoma
b) Multiple meningioma
c) Either schwannoma, glioma, neurofibroma, posterior subcapsular lens opacity, or cerebral calcification
Proteus syndrome
Proteus syndrome is a rare congenital disorder that causes skin overgrowth and atypical bone development. It is often accompanied by tumors over half the body. It can sometimes be confused with neurofibromatosis 1.
Li-Fraumeni syndrome
Li-Fraumeni syndrome is a rare cancer predisposition hereditary disorder characterized as autosomal dominant. The syndrome is linked to germline mutations of the p53 tumor suppressor gene.
Neurofibromatosis 1
Neurofibromatosis 1 is a tumor disorder that is caused by the mutation of a gene on chromosome 17 that is responsible for control of cell division.
Question 8.
A 20-year-old woman comes to the clinic because of neck swelling, irregular periods, weight gain, and fatigue. The patient’s family history is positive for autoimmune disorders, including diabetes mellitus type 1, and an ultrasound shows an enlarged thyroid gland. Based on the patient’s symptoms, family history, and ultrasound, what is the best next step in the management of this patient?
Adrenocorticotropin hormone (ACTH) stimulation test
The adrenocorticotropin hormone (ACTH) stimulation test measures how well the adrenal glands respond to ACTH by measuring cortisol levels before and after an injection of synthetic ACTH. It is normally used to diagnose acute adrenal crisis, Addison’s disease, or hypopituitarism, which are not indicated in this patient.
Glucose tolerance test
A glucose tolerance test is a medical test that assesses the body’s ability to remove glucosefrom the blood and is usually used to test for diabetes mellitus. While the patient does have a family history of diabetes mellitus type 1, the patient’s symptoms are inconsistent with this diagnosis.
Glycated hemoglobin (hemoglobin A1C) test
The hemoglobin A1C test is used to measure the three-month average plasma glucoseconcentration and is often performed to diagnose diabetes mellitus. While the patient does have a family history of diabetes mellitus type 1, the patient’s symptoms are inconsistent with this diagnosis.
Parathyroid hormone (PTH) and blood calcium levels tests
Parathyroid hormone (PTH) and blood calcium levels are often measured to assess parathyroid function. Although the patient does have an enlarged thyroid gland, the patient’s symptoms are inconsistent with an impairment to parathyroid function.
Thyroid-stimulating hormone (TSH) test
Major takeaway
Hashimoto’s thyroiditis is an autoimmune disease in which the thyroid gland is attacked by a variety of cell- and antibody-mediated immune processes, leading to hypothyroidism. Diagnosis of Hashimoto’s thyroiditis often includes testing for thyroid-stimulating hormone (TSH), free T3/T4, anti-thyroglobulinantibodies (anti-Tg), anti-thyroid peroxidase antibodies (anti-TPO, or TPOAb) and anti-microsomal antibodies.
Main explanation
This patient has Hashimoto’s thyroiditis, an autoimmune disease in which the thyroid gland is attacked by a variety of cell- and antibody-mediated immune processes, leading to hypothyroidism. Common symptoms of Hashimoto’s thyroiditis include weight gain, pale or puffy face, heavy menstrual flow or irregular periods, depression, and fatigue. The thyroid gland may also become firm and enlarged, which is caused by lymphocytic infiltration and fibrosis rather than tissue hypertrophy.
Hashimoto’s thyroiditis is approximately seven times more common in women than men. Diagnosis of Hashimoto’s thyroiditisoften includes testing for thyroid-stimulating hormone (TSH), free T3, free T4, anti-thyroglobulin antibodies (anti-Tg), anti-thyroid peroxidase antibodies (anti-TPO, or TPOAb) and anti-microsomal antibodies. Due to the autoimmune destruction of the thyroid follicles, TSH levels are normally elevated in an effort to increase free T3 and T4. Patients with Hashimoto’s thyroiditis also often have family members with thyroid or other autoimmune disorders.
Question 9.
A 40-year-old man comes to the office because of shortness of breath, increasing fatigue, lack of appetite and subsequent weight loss for the past 3 months, during which time he has lost 15-kg (33.1-lb). His temperature is 37.6°C (99.6°F), pulse is 80/min and respiratory rate is 16/min. Laboratory studies show a hemoglobin concentration of 10.7 g/dL. He has had lobar pneumonia 4 years ago, and he has been working as a ship builder for the past 10 years. Chest CT is obtained. Which of the following is the most likely diagnosis?
Lung cancer
Even though lung cancer is the most common complication of asbestos exposure, this CT shows that the medial surface of the left pleura is thickened. This pathological process does not involve the parenchyma, such as in lung cancer.
Mesothelioma
Major takeaway
Mesothelioma is most commonly encountered in patients with occupational or geographic exposure to talc powder or asbestos, and those with exposure and general symptoms of neoplastic proliferation (fever of unknown origin, anorexia, unintentional weight loss, anemia, fatigue) should be further investigated for this condition.
Main explanation
Mesothelioma is an aggressive malignant tumor derived from the mesothelium. Its forms include pleural mesothelioma (such as in this case), peritoneal and pericardial mesothelioma, and mesothelioma of the tunica vaginalis testis. Exposure to asbestos(e.g. ship-building) is a risk factor for pleural mesothelioma. Symptoms include dyspnea, cough, hemoptysis, fever of unknown origin, non-pleuritic chest wall pain, unexplained weight loss, and anemia. Chest radiographs are nonspecific, demonstrating only pleural opacity, whereas chest CT is more accurate, and can usually also be used in staging the disease. The appearance on CT is of nodular thickening which spreads along the pleural surfaces. Pleural thickening and the presence of a pleural mass should raise concern in a patient with exposure. A biopsy or a pleural fluid aspiration with cytology in the case of associated pleural effusion is required for a positive diagnosis.
Pleural effusion
Pleural effusions appear dependently, have a smooth border at the lung-liquid interface, and a meniscus-like appearance. Here, the thickened pleura surrounds the left lung almost completely.
Pneumonia
Pulmonary consolidation cannot be assessed using a mediastinal window on the CT scan. This window (mediastinal) is used for diagnosis of pathologies involving the surrounding soft tissues.
Tuberculosis
Tuberculosis is characterized by a similar constellation of symptoms; however, the CT in this case depicts a pathological process in the pleura, not the lung tissue.
Question 10.
A 50-year-old woman comes to her primary care provider for progressive dysphagia and loss of 15 pounds over the past three months. Over the past three months, she has been finding it increasingly difficult to swallow solid foods and she is now complaining of difficulty swallowingfluids. She has a medical history of obesity, gastroesophageal reflux disease (GERD), and metaplasia of the lower esophagus involving replacement of stratified squamous epitheliumwith columnar epithelium and goblet cells. Which of the following is the most likely diagnosis?
Boerhaave syndrome
Boerhaave syndrome is esophageal rupture, usually of the distal esophagus, associated with repeated retching and vomiting. It is a surgical emergency and would not develop over the course of months.
CREST syndrome
CREST syndrome refers to the limited cutaneous form of scleroderma, characterized by calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangectasias. While dysphagia and weight loss are symptoms of CREST syndrome, these symptoms are usually preceded by Raynaud’s phenomenon by several years.
Esophageal cancer
Major takeaway
Esophageal cancer is characterized by progressive dysphagia and weight loss, and is associated with risk factors including consumption of alcohol, smoking, GERD, Barrett esophagus, obesity, and achalasia.
Main explanation
Esophageal cancers, including squamous cell carcinoma and adenocarcinoma, are characterized by progressive dysphagia and weight loss. Of the two types, adenocarcinoma of the lower third of the esophagus is particularly associated with obesity, GERD, and intestinal metaplasia of the lower esophagus (also known as Barrett esophagus). Other predisposing factors include smoking, alcohol usage, and achalasia (impaired relaxation of smooth muscle sphincters). Diagnosis is typically confirmed by endoscopy and biopsy. Surgery is the most common treatment, and can be combined with chemotherapy and radiation therapy.
Esophageal varices
Esophageal varices are dilated submucosal veins that may cause hematemesis and are not commonly associated with dysphagia.
Plummer-Vinson syndrome
Plummer-Vinson syndrome is characterized by a triad of dysphagia, iron deficiency anemia, and esophageal webs. It is associated with increased risk of squamous cell carcinoma.
