NBME Form 15 Block 4 Q50
Question describes a man with progressive difficulty swallowing solids. Heavily implies esophageal cancer with his vignette, which I understand. Correct answer on NBME was EGD for most appropriate next step in evaluation. I selected video fluoroscopic barium swallow as the next step, however, because I was under the impression that even though EGD + biopsy is needed for diagnosis, you are supposed to obtain the swallow study first to identify location of lesions and potential safety issues with EGD.
Is this just a bad question, or can anyone explain? How should I approach something like this on the actual step exam?
Update:
I figured out that I learned this from like 3 different cards in the anking step 2 deck. Did some further digging into what algorithm they were using and apparently they meant barium swallow first in either oropharyngeal dysphagia or in mechanical esophageal dysphagia with history of prior radiation, caustic injury, complex stricture, or surgery for previous cancer. :|
mechanical esophageal dysphagia without any of that prior history is okay to go straight to EGD