ROSH Gastrointestinal Practice Exam

For a 63-year-old man with dysphagia and weight loss, what is the most definitive diagnostic test?

1. Barium esophagram

2. Chest X-ray

3. CT Scan

4. Endoscopy

The correct answer is: Endoscopy

The most definitive diagnostic test for a 63-year-old man presenting with dysphagia and weight loss is endoscopy. In cases of dysphagia, especially when accompanied by notable weight loss, it is important to investigate potential obstructive or pathological changes in the esophagus directly. Endoscopy allows for direct visualization of the esophageal mucosa, enabling the identification of abnormalities such as tumors, strictures, or inflammatory lesions. Additionally, it provides the option for biopsies of suspicious areas, which can facilitate the diagnosis of malignancies or other conditions affecting the esophageal lining. While a barium esophagram might help to visualize structural abnormalities in the esophagus, it does not provide tissue characterization or the option for direct intervention. A chest X-ray can identify some gross abnormalities, like masses or significant mediastinal changes but lacks the specificity required for a detailed analysis of esophageal issues. Similarly, a CT scan can provide information about the surrounding tissues and may help assess masses or lymph nodes, but it still does not allow for direct examination of the esophagus itself or tissue sampling. Hence, endoscopy stands out as the most definitive and diagnostic tool in this clinical scenario, thus confirming its appropriateness as the answer.