OUR LADY OF FATIMA UNIVERSITY

FATIMA COLLEGE OF MEDICINE

CLINICAL HISTORY

History # 1​
Name of Patient: Mark Pineda
Informant: Patient
Historian:
Reliability: 95%
Submitted to: Dr. Susan Lee
​
CLINICAL HISTORY

General Data:

M.P, 30-year old, male, single, Filipino, Roman Catholic, housekeeping assistant, born
on Aug 31, 1994 in Villasis, Pangasinan, presently residing in 325 Romy St., Pasay City
admitted for the first time at Pasay City General Hospital last February 02, 2025 at
8:00am.

Chief Complaint:

History of Present Illness:

Three weeks prior to admission the patient experienced sore throat graded as 6/10 pain
scale (PS), dysphagia rated 6/10 (PS), hoarseness, generalized body pain rated 8/10
(PS), and difficulty breathing described as “drowning” feeling and panting while walking
slower than other people of the same age lasting for an hour and relieved by deep
breathing. He claims that his symptoms were triggered by eating too much and drinking
half a glass of water. He took his hypertension medication, Losartan 100mg, and
claimed that the symptoms other than the difficulty breathing didn’t resolve. He denies
Headache, Dizziness, Nausea, Vomiting, Syncope, Fever, Cough, Chills, Oliguria, and
Polyuria. No consultation was done since the patient claims that there was no difficulty
performing his daily activities. Consult??
In the same week, Five days after the onset of symptoms, the patient went for a check
up for worsening of symptoms of sore throat graded as 7/10 (PS), dysphagia rated 7/10
in pain scale (PS), hoarseness, generalized body pain rated 8/10 (PS), and difficulty
breathing described as “drowning” feeling and panting while walking slower than other
people of the same age lasting for an hour and is relieved by deep breathing and
Level surface? Elevation?
appearance of change in taste describe as intense taste of food, generalized numbness
Huh?
and Edema in his neck with no laterality of the trachea and Vomiting everything he eats
Projectile?
described as expelling undigested food thrice a day and Diarrhea described as loose,
watery, brown stool twice a day. This prompted him to seek check up consultation Redundant
at
EC Torres Medical Clinic, he was diagnosed with sore throat and was prescribed
Acute tonsillopharyngitis
Amoxiclav 625 mg twice a day and Bactidol once every night time before sleeping.
There’s no associated Stomach pains, Chest pain, Headache, Dizziness, Nausea,
Syncope, Fever, Cough, Chills, Oliguria, and Polyuria. Inc? Dec?
Two weeks prior to admission, his symptoms of dysphagia rated 7/10 in pain scale (PS),
hoarseness, generalized body pain rated 8/10 (PS), and difficulty breathing described
REPHRASE
as “drowning” feeling and panting while walking slower than other people of the same
age lasting for an hour and is relieved by deep breathing, Change in taste, Vomiting
undigested food, Loose watery Diarrhea, Edema in his neck, and appearance of blurring
of his vision in his left eye. This prompted him to get another check up at RG Medical
Clinic, which diagnosed him with and prescribed Amoxiclav 625 mg thrice a day,
Bactidol every before going to bed and 2 unrecalled medications and dosages for
hyperacidity which he took once a day. He still denies Stomach pain, Chest pain,
Headache, Dizziness, Nausea, Vomiting, Syncope, Fever, Cough, Chills, Oliguria, and
Polyuria.
In the same week, a day after his second check up and three days prior to admission,
he claims to have lost his appetite and the edema on his neck spread to his face and
the rest of his symptoms persisted. He stopped his medications - Amoxiclav, Bactidol
and his hyperacidity medicines. He continued taking his hypertension medication -
Losartan. No consultation was done. He still denies Stomach pain, Chest pain,
Headache, Dizziness, Nausea, Vomiting, Syncope, Fever, Cough, Chills, Oliguria, and
Polyuria.
Opted??
One day prior to admission, the patient reported no resolution of any of the symptoms.
He was prompted to rest and to only tolerate the pain and no consultation was done and
only took his hypertension medicine - Losartan 100mg. He still denies Stomach pain,
Chest pain, Headache, Dizziness, Nausea, Vomiting, Syncope, Fever, Cough, Chills,
Oliguria, and Polyuria.
Two Hours prior to admission, his symptoms persisted and there’s progression of his
difficulty breathing described as he cannot climb flights of stairs but is still able to
change his own clothes. This prompted the patient to seek consultation and admission
to the institution.

Past Medical History:

He received complete childhood immunizations he reports having had chickenpox when
he was 6 years old. He has received two doses of the Synovac COVID-19 vaccine and
a Moderna booster but denies receiving flu or pneumonia vaccines. He has no known
allergies to food, medications, or pollen.
He was diagnosed with Hypertension in 2022, with a recorded peak blood pressure of
140/130 mmHg. He was prescribed Losartan 100 mg twice a day. He claims to be
compliant with his medication.
He had left elbow laceration due to falling in concrete in 2024 and received first aid and
4 stitches in the Emergency room.
He denies any history of psychiatric illnesses.

Family History:
Patient’s father, age of 50, is alive and is apparently healthy and his mother died due to
Asthma and Highblood at the age of 45 in 2014. He is the 2nd of 3 siblings - his 2
siblings are alive. His older sister has been diagnosed with Asthma and Allergic Rhinitis
at an unrecalled year and age while his younger sibling is apparently healthy. His
grandfather on his father’s side died in 2018 due to Colon Cancer while his grandmother
died due to Diabetes in 2013. His maternal grandparents died due to Kidney problems
but with an unrecalled specific disease, year and age of death. No heredo-familial
diseases like Arthritis, Gout, psychiatric problem, seizures disorders, thyroid disease,
renal disease and tuberculosis.

Personal & Social History:

The patient’s highest education attainment is Highschool and formerly employed as
loader in comelec for 3 months and now as Housekeeper and Janitor for 2 years. He
reports to have been exposed to cleaning chemicals like muriatic acid. He is single with
no children. He lives in a bungalow house with 3 rooms, 2 windows, 4 beds with 3 family
members - his father, and 2 siblings. Their drinking water is from Nawasa. The patient is
a smoker, using 1 pack a day since 2010. He switched to vape in 2018 and stopped in
2019. He is an alcoholic drinker, and claims to finish 1 bottle of Alfonso brandy (1750
mL) alone. He drinks coffee once a day and soda 2 bottles a day. He does not drink tea.
He eats thrice a day, prefers meat (mostly pork) and fried, oily foods with 3 to 4 cups of
rice. He gets 6-7 hours of uninterrupted sleep at night starting from 9/ 10 pm until
4:30-5:00 am with 2 pillows. Their garbage is collected twice a day, everyday. His hobby
is playing mobile games in his free time and does not engage in any other exercise and
sexual activity. He takes care of 7 dogs but is not responsible for bathing them. He
denies using illegal prohibited drugs, being exposed to any chemicals, or traveling
outside the Philippines.
Review of Systems:

General: (-) weakness, (+) fatigue, (-) weight loss, (-) fever, (-) chills, (-) increased
appetite
Integumentary: (-) alopecia, (-) itching, (-) dryness, (-) changes in color
Head: (-) headache, (-) dizziness
Eye: (-) redness, (-) excessive tearing, (-) blurring of vision, (-) pain, (-) use of glasses
Ears: (-) hearing loss, (-) tinnitus, (-) vertigo, (-) earaches, (-) discharge
Nose & Sinuses: (-) nasal stuffiness, (-) discharge, (-) itching, (-) nose bleeding
Throat: (-) itching, (-) hoarseness
Teeth & Gums: (-) dentures, (-) bleeding, (-) dental pain
Neck: (-) lump, (-) pain, (-) stiffness in the neck
Respiratory: (-) cough, (-) sputum, (-) hemoptysis, (-) dyspnea, (-) pain
Cardiovascular: (-) paroxysmal nocturnal dyspnea, (-) palpitation, (-) orthopnea, (-)
chest pain
Gastrointestinal: (-) loss of appetite, (-) nausea & vomiting, (-) change in bowel
movement, (-) abdominal fullness, (-) pain on defecation, (-) abdominal pain, (-)
hematemesis, (-) melena, (-) diarrhea, (-) regurgitation
GUT: (-) frequency, (-) polyuria, (-) nocturia, (-) urgency, (-) dysuria, (-) pain, (-)
incontinence, (-) discharge, (-) hematuria,
Musculoskeletal: (-) arthralgia, (-) stiffness, (-) arthritis, (-) edema, (-) numbness, (-)
limitation of movement
Psychiatric: (-) nervousness, (-) tension, (-) memory change, (-) suicide attempts
Neurologic: (-) changes in mood, (-) headache, (-) numbness, (-) changes or loss of
sensation, (-) paresthesia, (-) tremors, (-) seizures, (-) weakness, (-) fainting
Hematologic: (-) easy bruising, (-) bleeding
Endocrine: (-) heat or cold intolerance, (-) polydipsia, (-) polyphagia

Physical Examination
General Survey:
The patient is conscious, coherent, speech has good tone and volume, cooperative,
decently groomed, with adequate personal hygiene, appropriately dressed, he is fairly
nourished and well developed, with no deformities, no involuntary movements, no
tremor, ambulatory gait is not widened. Patient is not in cardiopulmonary distress.

Vital Signs:

●​ BP: 120/80 mmHg

●​ HR: 79 bpm
●​ RR: 16 cpm
●​ Temperature: 37.0°C axillary

Skin/Integumentary:

The skin is brown in color, moist, good elasticity, warm, no hyperpigmentation on the
anterior and posterior chest. There are no tattoos or scars. The hair is black, fine, and
evenly distributed. The fingernails are pale and clean. No swelling, signs of infection, or
clubbing. The diamond-shaped window is present, and capillary refill time is less than 2
seconds.

HEENT:

Head: Head held erect and midline, normocephalic, symmetric, no deformities, no

depression, no lumps, no tenderness. Hair is black, thick, well distributed, no alopecia.

Face: Negative facial asymmetry, no masses, no involuntary movements, temporal

artery not visible but palpable with strong pulsations and has good facial expressions.
Patient has mild non-pitting edema on bilateral cheeks.

Eyes: Eyebrows are evenly distributed, no active lesions, eyelashes of the upper
eyelids are directed outward and upward while those in the lower eyelids are directed
outward and downward. There are no signs of irritations, erythema or change in color
of the eyelids, palpebral conjunctiva appears pale, no dilated blood vessels, iris is brown
but with icteric sclera. No ptosis and no drooping of eyelids with blurring of vision in his
left eye. The pupils are round, equal and about 3mm, reactive to accommodation, direct
and indirect light stimulation, cornea is clear, negative for arcus senilis and intact
extraocular muscles.

Ears: Normal set ears, the upper border is at the level of the eyes, no abnormality of the
pinna, no tenderness, no discharges, no skin lesions seen, both right and left tympanic
membrane is shiny, pearly gray, and able to visualize the cone of light with clean
auditory canal.

Nose: Nasal septum is in midline, no perforation seen, no discharges, turbinates are

moist and pale. There are some vibrissae seen in the anterior nares, frontal and
maxillary sinuses are not tender, with normal trans-illumination test.
Mouth: Symmetrical lips, no lagging of the upper lip, are dry and pale but negative for
cheilosis, tongue is in midline upon protrusion, no lesion seen and mobile with normal
strength. Has a complete set of teeth, no apparent gum bleeding, uvula is midline,
tonsils not enlarged nor inflamed and posterior pharyngeal wall is smooth and pale.

Neck: No distended neck veins, trachea is at midline, thyroid gland not palpable, no
palpable lymph nodes including periauricular, posterior auricular, occipital,
jugulodigastric, superficial cervical, deep cervical chain, posterior cervical,
supraclavicular, submandibular and submental lymph nodes. The patient presented
mild, non-pitting cervical edema on anterior neck extending to the posterior neck.​
​ ​ ​ ​ ​ ​ ​

Chest & Lungs:

The chest wall is symmetric and without any gross deformities, it is elliptical in shape,
with symmetrical A:P ratio, no dilated superficial blood vessels, no widening or
narrowing of the intercostal spaces. Chest expansion was also symmetrical, no
retractions were observed. No masses, or lymph node enlargement was noted upon
palpation, no tenderness, the tactile fremitus in the areas of the chest and back are
equal, no lagging of the chest noted. The lung field was resonant on percussion. Lungs
are clear upon auscultation, noting vesicular breath sounds heard over most of the lung
field, no crackles or wheezing appreciated.

Cardiovascular:

Jugular veins are palpable but not visible and distended. The apex beat felt at the 5th
ICS left midclavicular line, no heaves, no thrills, no lifts. Has regular rhythm with loud S1
and S2. Carotid pulses are strong graded as 1+, equal, and bounding. Brachial, radial,
popliteal, pretibial and dorsalis pedis pulses are strong, equal and rhythm is regular.
Heart rate is 82 bpm with normal rate and regular rhythm. Has no S3, S4 and any extra
heart sounds. No appreciated friction rub as well as aortic and pulmonic murmur.

Abdomen:

The abdominal circumference measures 90 cm at the level of umbilicus. Upon

inspection, the abdomen is globular with inverted umbilicus, no dilated blood vessels
seen, no skin lesions, no visible peristalsis. Has a hypoactive bowel sounds on
auscultation of the 4 quadrants with 5 bowel sounds per minute, most heard in the RLQ.
Negative for bruits over the region of liver, abdominal aorta and renal arteries areas.
Upon palpation, the abdomen is soft, non tender and no palpable superficial masses.
The liver, spleen and kidneys are not palpable. Negative for the kidney punch test.

Spine and Extremities:

Hands and Wrist

The patient’s hands and wrist are brown in color, no bony deformities, no nodes
palpated on each side of each fingers, no bogginess, no masses, no tenderness and no
crepitus of the interphalangeal joints. The patient can fully perform the range of motion
of the hands and wrist.

Forearms are brown in color with bruises-like hyperpigmentation on both left and right,
symmetrical with a circumference of 27 cm. No tenderness, lesions, masses or nodules
and both forearms are within body temperature. There is a full range of motion as to
flexion, extension, pronation and supination.

Elbows are brown in color, symmetrical with no gross deformities. Different bony
landmarks such as olecranon bursa, olecranon process, lateral and medial epicondyle
are appreciated and have normal carrying angle. No tenderness, crepitus, lesions,
nodules or masses on both elbows. Upon standing, there is a full range of motion as to
flexion, extension, pronation and supination.

Upper arms are brown in color, symmetrical with a circumference of 31 cm on the right
and left. No tenderness, lesions, nodules and both upper arms are within the body
temperature.

Shoulders are brown in color, symmetrical with no gross deformities; different shoulder
landmarks such as sternum, sternoclavicular joint, acromio-clavicular joint, coracoid
process and greater tuberosity of humerus are properly appreciated and with no gross
deformities, no tenderness, crepitus, nodules, masses on both shoulders. There is a full
range of motion as to flexion, extension, abduction, adduction, internal rotation, and
external rotation.

Spine (cervical, thoraco-lumbar)

Cervical Spine is curved concave posteriorly and is at the midline position, Cervical
neck muscles are intact without deviation to the right or left, C7 is palpable on the
cervical spine without any nodules, masses, deformities, tenderness or crepitus upon
palpation. Cervical parasternal muscles are warm and soft to touch, without any
masses, nodules, tenderness upon palpation; there is full range of motion as to flexion,
extension, left and right rotation, and lateral flexion to the right and left.

Upon inspection of the Thoracolumbar spine, the thoracic spine is convex posteriorly
and lumbar spine is concave posteriorly. There is no gross deformity noted. Upon
palpation, there are no nodules, masses, tenderness or deformities on the thoracic
spine. The patient can do range of motion of the thoracolumbar spine as to extension,
lateral bending and spinal rotation without any difficulty.

Lower Extremities (hips, special tests, knee joints, ankle joints, foot)

Hips
Upon inspection, there are no visible lesions or gross deformities. On palpation, there
are no tenderness, swelling and masses or nodules noted. The range of motion is
bilaterally normal as to flexion, extension, adduction, abduction, internal rotation, and
external rotation.

Knee Joints
Upon inspection, no gross bony deformities were observed and the patella is intact. On
palpation, there are signs of knee effusion such as swelling, stiffness and warmth to
touch. Thigh circumference is 48 cm on the right, 49 cm on the left while calves
circumference is 41 cm on the right and 42 cm on the left. The patient was able to
perform the range of motion as to flexion and extension on both knees.

Ankle Joints and Foot

Upon inspection, no gross bony deformities were seen but hyperpigmentation and
dryness of the skin were noted on his both feet. On palpation, there is swelling,
stiffness, and warmth to touch on lateral and medial malleoli and calcaneus of both
ankles. The patient can slowly perform the range of motion as to dorsiflexion,
plantarflexion, inversion and eversion on both feet.

Neurological Examination:

I.​ Cerebrum

Patient is conscious, coherent, oriented to time, place, and person, shows good
recall of recent and remote memories, speaks fluently and with ease, shows
good judgment, calculation ability and was able to follow simple commands.

II.​ Cranial Nerves

Cranial Nerve I: Nostrils are patent and the patient was able to identify the smell
using both nostrils. Olfactory nerve is intact.

Cranial Nerve II: The patient has a vision of 20/40 on his right eye and 20/70 on
his left eye. The pupils of both left and right eyes are equally round (2-3mm) and
reactive to light. Both are reactive to light and accommodation. Positive for Direct
and Consensual Light Reflex. Optic nerve is intact.

Cranial Nerve III, IV, and VI: Extraocular muscles of the eye such as the
Superior, Inferior, Lateral, and Medial Rectus, and the Superior and Inferior
Oblique muscles are all intact with no ptosis of the eyelids. Patient is able to
follow the 6 cardinal gazes with ease. Patient’s Oculomotor, Trochlear, and
Abducens Nerves are intact.

Cranial Nerve V: The sensory part of the CN V was intact and was able to feel
sensation of the brush in ophthalmic nerve (V1) area, maxillary (V2) area and
mandibular nerve (V3) area. The motor part of CN V is intact and was able to
demonstrate normal tone and force in the muscle of mastication.

Cranial Nerve VII: Sensory part of the CN VII is intact and was able to
distinguish different kinds of taste sensations in the anterior ⅔ of the tongue. The
motor part of CN VII is intact and was able to demonstrate normal tone and force
in the muscles of facial expression.

Cranial Nerve VIII: Acoustic nerve is intact. In Rinne’s test, air conduction is
greater than bone conduction. In Weber's test, the patient heard the vibration
equally in both ears. There is no lateralization.

Cranial Nerve IX: Patient is negative for dysarthria and dysphagia; Uvula is in
the midline and muscles surrounding are moving symmetrically; Patient is
negative for hoarseness.

Cranial Nerve X: Patient has normal gag reflex.

Cranial Nerve XI: The patient is able to shrug his shoulder against pressure and
is able to turn head side to side against resistance.
Cranial Nerve XII: There is negative fasciculation of the tongue. The tongue is
midline on protrusion, with no atrophy or hypertrophy noted. The patient can
slowly perform the range of motion of the tongue.

III.​ Cerebellum

The patient can stand and sit without difficulty. He can maintain an upright
position with a balanced gait. He can perform finger to nose tests on his right and
left arm in full extension without any delay for 3 times.

IV.​ Motor Examination

Upon inspection, the patient has no visible fasciculations, atrophy, hypertrophy or

involuntary movements. His muscle tone is normal, no spasticity, rigidity or
hypotonicity. No muscle weakness noted and the muscle strength is 5/5
bilaterally.

V.​ Sensory System

The patient can feel pain sensation on forehead, maxilla, and portion above the
mandible symmetrically. He can feel light touch on proximal and distal parts of
the limbs symmetrically.

VI.​ Deep Tendon Reflexes

Upper Extremities: Reflex of left and right biceps and triceps are both normal,
graded as 2.
Lower Extremities: Reflex of left and right knee jerk are both normal, graded as
2.
Ankle: Reflex of left and right ankle of the patient are both normal, graded as 2.
Babinski Reflex: The patient is negative for Babinski Reflex.

VII. Meningeal Signs

Patient is negative for nuchal rigidity, brudzinski sign and kernig’s sign.
DISCUSSION
BASIS:
●​Sore throat 6/10 PS → 7/10 PS
●​Dysphagia 6/10 PS → 7/10 PS
●​Hoarseness
●​Generalized body pain rated 8/10 PS
●​Difficulty breathing “drowning”
●​Panting while walking slower than other people of same age lasting for an hour and relieved
by deep breathing
●​Triggered by eating and drinking water
●​Change in taste → Intense taste of food
●​Generalized numbness and Edema in his neck → Spread to his face
●​Vomiting everything he eats/ Expelling Undigested food - 3x a day
●​Diarrhea - loose watery brown stool - 2x a day
●​Blurring of the left eye vision
●​Loss of appetite
●​Progression of the DOB → Cannot climb flights of stairs but still able to change his clothes.
●​Hypertension → highest is 140/130 mmHg
●​In maintenance medication - Losartan 100 mg 2x a day
●​Smoker - 1 pack a day since 2010.
●​Vape user - from 2018-2019
●​Diet → Mostly pork and 3-4 cups of rice
●​Family History - Mother died due to Asthma and Highblood at the age of 45.
●​His grandparents on his mother’s side died due to Kidney problems but with an unrecalled
year and age

RISK FACTORS:
●​Hypertension → highest is 140/130 mmHg
●​In maintenance medication - Losartan 100 mg 2x a day
●​Smoker - 1 pack a day since 2010.
●​Vape user - from 2018-2019
●​Diet → Mostly pork and 3-4 cups of rice
●​
Chronic Nonrenal (Systemic) Disease ●​ Hypertension

Demographic, Anthropomorphic, Ancestry, ●​ Sex - The mean GFR is lower in women

Geographic than in men.
●​ Family History - Family History - Mother
died due to Asthma and Highblood at the
age of 45. His grandparents on his
mother’s side died due to Kidney
problems but with an unrecalled year
and age.
●​
Lifestyle ●​ Smoking - 1 pack a day since 2010
●​ Diet - High protein diet and 3-4 cups of
rice
●​ Physical Activity - no exercise

●​

PRIMARY IMPRESSION: —--

ETIOLOGY: HYPERTENSION-ASSOCIATED CKD

DIFFERENTIAL DIAGNOSIS:
CONDITIONS RULE IN RULE OUT

Chronic Kidney Disease +​Difficulty Breathing ー​ Check labs for: Anemia

+​Easy fatigability
+​Decreased appetite with
progressive malnutrition

ENT/ RESPIRATORY

Ludwig Angina +​Difficulty Breathing ー​ Drooling

+​Progressive neck and facial ー​ Tooth pain
edema, ー​ No floor-of-mouth elevation
+​Dysphagia, ー​ Trismus
+​Hoarseness, ー​ Superior and Posterior
+​Failed oral antibiotics - displacement of the tongue
Amoxiclav

Parapharyngeal Abscess +​Difficulty breathing (caused ー​ Fever

by airway compromise) ー​ Trismus,
+​Dysphagia,
+​Hoarseness,

Retropharyngeal Abscess +​Difficulty breathing (caused ー​ No neck stiffness

by airway compromise) ー​ Trismus,
+​Dysphagia,
+​Muffled voice ("hot potato
voice"),

Deep Neck Space Infection +​Neck edema, ー​ Fever

(DNSI) +​Sore throat, ー​ Trismus
+​Dysphagia,
+​Hoarseness,
+​Failure of oral antibiotics

Bacterial Pharyngitis/ +​Persistent sore throat, ー​ No exudates noted,

Tonsillitis with Cellulitis worsening symptoms, ー​ No cervical
+​No response to antibiotics lymphadenopathy

CARDIOVASCULAR

Superior Vena Cava (SVC) +​Facial and neck edema, ー​ No prominent venous
Syndrome +​Hoarseness, distension,
+​Venous congestion, ー​ no underlying malignancy
+​Dyspnea history

ALLERGIC/ IMMUNOLOGIC

Angioedema (Allergic or ACE +​Difficulty breathing (possible ー​ No clear history of allergen

induced) airway compromise) exposure or ACE inhibitor
+​Rapid facial/neck swelling, use
+​Hoarseness,
ー​ no fever

ENDOCRINE

Thyroiditis +​Difficulty breathing (possible ー​ No thyroid tenderness,

airway compromise) ー​ No systemic thyroid
+​Neck swelling, symptoms
+​Dysphagia,
+​Hoarseness,

Thyroid Cancer with +​Progressive dysphagia, ー​ No palpable thyroid mass

Compression hoarseness, neck swelling, ー​ Lymphadenopathy
airway symptoms

HEAD AND NECK

Laryngeal or Hypopharyngeal +​Difficulty breathing (possible ー​

Cancer airway compromise)
+​Progressive dysphagia,
+​Hoarseness,
+​Weight loss
+​Smoking History

NEUROMUSCULAR

Myasthenia Gravis +​Dysphagia, ー​ Symptoms are progressive,

+​Hoarseness, not fluctuating
+​Weakness,
+​Ptosis

Polymyositis/ +​Progressive dysphagia, ー​ No systemic muscle

Dermatomyositis +​Muscle weakness, weakness mentioned
+​Systemic symptoms

Sarcoidosis +​Difficulty breathing (possible ー​ No pulmonary or systemic

airway compromise) granulomatous symptoms
+​Hoarseness,
+​Dysphagia,
+​Systemic symptoms
GASTROINTESTINAL (Aspiration Risk/ Dysphagia)

Achalasia or Esophageal +​Dysphagia, ー​ No chronicity,

Stricture +​Regurgitation of undigested ー​ No heartburn or reflux
food, history
+​Weight loss

DIAGNOSIS:

PATHOPHYSIOLOGY:

DIAGNOSTICS:

MANAGEMENT
​ PHARMACOLOGIC
​ NON PHARMACOLOGIC