Rosh Internal Medicine Boost Practice Exam

For a patient with a history of radiation therapy experiencing difficulty swallowing solids, what is the best initial treatment?

1. Initiate H-2 antagonist therapy

2. Initiate proton pump inhibitor therapy

3. Refer for surgical resection

4. Schedule mechanical dilation

The correct answer is: Schedule mechanical dilation

In the context of a patient who has undergone radiation therapy and is now experiencing difficulty swallowing solids, mechanical dilation is typically considered the best initial treatment approach. Radiation therapy can cause changes in the esophagus, leading to conditions such as esophageal stricture or dysmotility, which contribute to swallowing difficulties. Mechanical dilation involves the use of a balloon or bougie to expand the esophageal lumen and can provide immediate relief of the obstruction or narrowing experienced by the patient. This approach is often favored as it addresses the mechanical aspect of the swallowing difficulty directly and can be performed relatively quickly, improving the patient's quality of life. Other options, such as pharmacologic therapies including H-2 antagonists or proton pump inhibitors, are generally more suitable for addressing acid-related disorders like gastroesophageal reflux disease (GERD) rather than directly treating structural issues caused by radiation. Surgical resection is a more invasive measure and usually reserved for severe cases or when malignancy is suspected, making it less appropriate as an initial treatment. Thus, scheduling mechanical dilation effectively targets the root of the problem in this scenario.