Examination component	Physical findings	Potential diagnosis or consideration
General
Mental status	Obtunded or intoxicated	Transient and self-limited dysco-ordination of swallow; address underlying causes
Nutritional state	Cachexia	Neoplasia
Overall fitness	Sarcopenia	Chronic disease
Strength	Weakness/fatigability	Myasthenia gravis
Integumentary
Skin inspection	Needle tracks or sores; cold, clammy skin	Substance use or opioid-induced esophageal dysfunction
	Sausage digits or Raynaud phenomenon	Connective tissue disease (e.g., scleroderma)
Head, eyes, ears, nose, and throat
Eyes	Ptosis (fatigable), diplopia	ALS
Mouth	Cervical or supraclavicular lymphadenopathy	Infectious esophagitis or malignancy
	Dry mouth (xerostomia)	Connective tissue disease, medication adverse effect, or tobacco use
	Poor dentition, poorly fitting dentures	Inability to comfortably or effectively form a food bolus precludes safe deglutition
	Thyromegaly or goiter	Extrinsic esophageal compression
	Tongue deviates, tongue fasciculations	ALS or cranial nerve defects
Observe a swallow	Coughing, choking, or drooling	Drooling and nasopharyngeal regurgitation suggest oropharyngeal localization; coughing confirms an aspiration risk
Speech	Weak or breathy voice, dysarthria	Vocal cord pathology or ALS
	“Wet” voice	Laryngeal aspiration (likely chronic)
Abdominal
Inspection	Signs of portal hypertension (e.g., varicosities, jaundice, distension)	Esophageal varices causing dysphagia by mass effect and peristalsis disruption
Palpation and percussion	Organomegaly	Malignancy
Neurologic
Cranial nerves	Absent gag reflex	Cranial nerves IX and X affected
	Asymmetric facial motor findings	Cranial nerves V, VII, and XII share sensory and motor control over the muscles of expression and the tongue
Gait	Abnormal gait	Weakness generalizes to swallowing