American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial test of choice for evaluating oropharyngeal dysphagia?

1. Upper endoscopy

2. Videofluoroscopy

3. Esophageal manometry

4. Barium swallow study

The correct answer is: Videofluoroscopy

Videofluoroscopy is the initial test of choice for evaluating oropharyngeal dysphagia because it directly assesses the swallowing process in real-time. This test allows for the observation of the various phases of swallowing and helps identify any abnormalities in the oropharyngeal area that may contribute to swallowing difficulties. It provides dynamic imaging, which is crucial for evaluating the coordination of the oral and pharyngeal phases of swallowing, thereby allowing clinicians to visualize how food and liquids are managed by the pharynx and whether there are instances of aspiration. While other tests such as upper endoscopy and barium swallow studies also evaluate swallowing, they do not provide the same level of detail regarding the timing and mechanism involved in the act of swallowing itself. Upper endoscopy is more focused on visualizing the esophageal lining and any structural or mucosal abnormalities, rather than the functional aspects of swallowing. Esophageal manometry evaluates esophageal motility but does not assess oropharyngeal function, making it less suitable for dysphagia stemming from problems in the oropharynx. Therefore, videofluoroscopy stands out as the preferred initial assessment tool in this context.