A 42-year-old woman reports difficulty swallowing solid food, sore tongue, and brittle spoon-shaped nails. Hemoglobin is 9.4 g/dL, MCV 66 fL. Barium swallow shows a thin mucosal fold projecting into the lumen of the cervical esophagus. What is the most likely diagnosis?

• A Achalasia
• B Plummer-Vinson syndrome ✓
• C Esophageal candidiasis
• D Diffuse esophageal spasm

Explanation

Plummer-Vinson (Paterson-Kelly) syndrome is the triad of iron deficiency anemia, glossitis with koilonychia, and an upper esophageal web producing dysphagia. It matters clinically because it carries an increased risk of squamous cell carcinoma of the oral cavity and upper esophagus. Achalasia produces dilatation with a bird-beak appearance at the lower esophageal sphincter, not a proximal web, and is not linked to microcytic anemia, which excludes option A.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.