Return to Diagnosis ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Anatomical Pathology, Digestive System, Gastroenterology & Hepatology, General Surgery, Neurology, Rheumatology, General Practice, Otorhinolaryngology
Progress Test Topic(s)
A 72 year old Māori man, who smokes, presents with difficulty swallowing. This has been getting worse for the past 3 months and he has lost 6 kg of weight.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the oropharynx, larynx, oesophagus, lungs and thorax
   - Physiology of swallowing
   - Pathophysiology of achalasia and gastro-oesophageal reflux disease (GORD)
   - Pathophysiology of and histological changes in Barrett's oesophagus
   - Histopathology of oesophageal cancer
   - Lymphatic vs haematogenous spread of cancer
   - Pharmacology of opiates
Clinical and Communication Skills 
   - History from someone with dysphagia; recognise red flag symptoms
   - Communicate with patient in distress who is choking
   - Perform an examination of the cranial nerves, neck and abdomen
   - Differential diagnosis of dysphagia
   - Indications for endoscopy, CT, videofluoroscopy, contrast swallow, oesophageal manometry
   - Assess nutritional state
   - Interpret FBC, electrolytes, creatinine, liver function tests, vitamin B12/folate
   - Indications for nasogastric and nasojejeunal tubes, enteral stent, percutaneous endoscopic gastrostomy (PEG) and parenteral feeding
   - Perform a nasogastric tube insertion
   - Stage oesophageal cancer using the TNM system
   - Outline the management of oesophageal cancer: surgery (including anaesthetic risks), radiation, oncology; role of palliative care
   - Clinical features of oesophageal perforation
   - Monitoring patients with Barrett's oesophagus for development of cancer
   - Management of stroke and systemic sclerosis
   - Roles of speech and language specialist, dietitian
   - Smoking cessation and nicotine replacement during hospitalisation
   - Pharmacological and non-pharmacological management of pain, conversion of opioids between oral and parenteral formulations; use of opioids in pallaitve care
Personal and Professional Skills 
   - Delivering life-changing news
   - Empathise with patient with cancer
   - Communicate with patient and family/whanau in relation to death and dying
   - Reflect on own attitudes to smoking-related illness and how it may affect patient interaction
Hauora Māori 
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ in people presenting with swallowing problems (e.g. higher cancer and stroke rates for Māori)
   - Understanding of inequities in access to health services and quality of medical care for Māori, including less likelihood for localised cancer or cancer staging and application of this to clinical decision making and management
   - Ensuring a culturally safe environment in life-changing scenarios such as palliative care
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing cancer inequalities
Population Health 
   - Epidemiology of dysphagia; risk factors and prevalence of underlying disorders
   - Smoking: risk/lifestyle factors and preventive strategies
Conditions to be considered relating to this scenario
oesophageal carcinoma, goitre, drug induced oesophagitis, foreign body, Parkinson's disease, Bell's palsy, GORD,benign oesophageal stricture, pharyngitis, bulbar/pseudobulbar palsy, achalasia
Less common but 'important not to miss'
oesophageal candidiasis
Barrett's oesophagus, eosinophilic oesphagitis, systemic sclerosis, oesophageal web, pharyngeal pouch, corkscrew oesophagus (oesphageal spasm), neurological disorders (multiple sclerosis, myasthenia gravis), muscular dystrophies, aortic arch dilatation