Dysphagia and oesophageal disorders — branching viva

Opening — framing the problem

The examiner begins: a 14-year-old with asthma and eczema arrives drooling, unable to swallow after steak lodged in his chest, and admits to a year of slow, careful eating. Talk me through your reasoning. ^[1]

I would treat this as a food bolus impaction that needs urgent endoscopic disimpaction, and I would frame the impaction as the first presentation of eosinophilic oesophagitis until biopsy proves otherwise, because impaction with atopy and adaptive eating in a teenager is the classic story. I would take oesophageal biopsies at the same endoscopy. ^{[16] [1]}