Dysphagia — MCQs
Neurogenic cause of dysphagia includes following except:
Second swallowing in barium meal studies is found in-
Which of the following is the most common cause of esophageal dysphagia?
A 60-year-old male presents with progressive dysphagia to solids and liquids, significant weight loss, and chest discomfort. Barium swallow shows a 'bird-beak' appearance. What is the most likely diagnosis?
A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?
The patient complains of intermittent dysphagia that is equal for both solids and liquids, which of the following is the most probable diagnosis?
A 16-year-old patient complains of difficulty in swallowing, difficulty in talking and sometimes difficulty in breathing. On physical examination the presentation is similar to that shown in the picture. What would be the probable diagnosis?
A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?
All of the following are true regarding Zenker's diverticulum EXCEPT?
X-ray showing an air column between a soft tissue mass and the posterior wall of the nasopharynx is suggestive of which of the following conditions?
Dysphagia Indian Medical PG Practice Questions and MCQs
Question 1: Neurogenic cause of dysphagia includes following except:
- A. Tetany (Correct Answer)
- B. Multiple sclerosis
- C. Tetanus
- D. Parkinson's disease
Explanation: ***Tetany*** - **Tetany** is characterized by **involuntary muscle contractions** due to electrolyte imbalances (e.g., hypocalcemia) or toxins, primarily affecting peripheral nerves and muscles, not typically considered a neurogenic cause of dysphagia in the context of central nervous system disorders. - While severe muscle spasms can impair swallowing, the underlying pathophysiology of tetany is distinct from the neurological deficits seen in conditions like MS or Parkinson's regarding direct innervation of swallowing muscles. *Multiple sclerosis* - **Multiple sclerosis** is a demyelinating disease of the central nervous system that can affect cranial nerves and brainstem pathways involved in swallowing, leading to **neurogenic dysphagia**. - Lesions in areas controlling **pharyngeal muscles** or **motor planning** for swallowing directly impair the neurological control of this process. *Tetanus* - **Tetanus** is caused by a neurotoxin (tetanospasmin) that blocks inhibitory neurotransmitters, leading to **severe muscle spasms** and rigidity, including those of the jaw (trismus) and pharynx. - The resulting **spastic paralysis** directly interferes with the coordinated muscle movements required for swallowing, making it a neurogenic cause of dysphagia. *Parkinson's disease* - **Parkinson's disease** is a progressive neurodegenerative disorder affecting the basal ganglia, leading to motor symptoms including **bradykinesia**, rigidity, and tremor [1]. - It commonly causes **neurogenic dysphagia** due to impaired coordination, reduced pharyngeal motility, and delayed swallow reflex, impacting all phases of swallowing [2].
Question 2: Second swallowing in barium meal studies is found in-
- A. Scleroderma
- B. Reflux esophagitis
- C. Pharyngeal pouch (Correct Answer)
- D. Achalasia cardia
Explanation: ***Pharyngeal pouch*** - A pharyngeal pouch, specifically a **Zenker's diverticulum**, can lead to food or barium pooling within the pouch. - This pooling can cause a sensation of retained material, prompting a **second swallow** to clear the pharynx and esophagus. *Scleroderma* - Leads to **esophageal dysmotility** due to smooth muscle atrophy and fibrosis, primarily affecting the lower two-thirds of the esophagus. - This manifests as difficulty moving food down the esophagus, but not typically as the need for a second swallow to clear a pouch. *Reflux esophagitis* - Characterized by **inflammation of the esophagus** due to gastric acid reflux. - Symptoms include heartburn and dysphagia, but it does not cause the pooling of barium requiring a second swallow as seen with a pharyngeal pouch. *Achalasia cardia* - Involves the **failure of the lower esophageal sphincter to relax** and loss of peristalsis in the esophageal body. - This results in significant delayed emptying and a "bird's beak" appearance on barium swallow, but not the specific finding of a second swallow to clear a localized pouch.
Question 3: Which of the following is the most common cause of esophageal dysphagia?
- A. Gastroesophageal reflux disease (GERD)
- B. Peptic stricture (Correct Answer)
- C. Esophageal cancer
- D. Achalasia
Explanation: ***Peptic stricture*** - **Peptic strictures** are fibrous bands that narrow the esophageal lumen, most commonly resulting from chronic **gastroesophageal reflux disease (GERD)** [1]. - They lead to dysphagia by physically obstructing the passage of food, making it the most frequent cause of mechanical esophageal dysphagia [2]. *Gastroesophageal reflux disease (GERD)* - While **GERD** is the underlying cause for many peptic strictures, it primarily presents with **pyrosis (heartburn)** and **regurgitation** [1]. - Without a stricture or severe inflammation, GERD itself causes dysphagia less commonly than a resultant peptic stricture would. *Esophageal cancer* - **Esophageal cancer** can cause significant dysphagia, especially for solids, and is a serious concern, but it is less common overall than dysphagia caused by peptic strictures [1]. - Often accompanied by other symptoms like **weight loss**, **anemia**, and **odynophagia**, which differentiate it. *Achalasia* - **Achalasia** is a motility disorder where the lower esophageal sphincter fails to relax, leading to pressure build-up and dysphagia for both solids and liquids [3]. - Though a significant cause of dysphagia, its prevalence is lower compared to peptic strictures resulting from widespread GERD.
Question 4: A 60-year-old male presents with progressive dysphagia to solids and liquids, significant weight loss, and chest discomfort. Barium swallow shows a 'bird-beak' appearance. What is the most likely diagnosis?
- A. Achalasia (Correct Answer)
- B. GERD
- C. Esophageal stricture
- D. Esophageal cancer
Explanation: ***Achalasia*** - **Progressive dysphagia** to both solids and liquids, along with a **barium swallow** showing a "**bird-beak**" appearance, is highly characteristic of achalasia. [1] - This condition involves the **loss of peristalsis in the distal esophagus** and **impaired relaxation of the lower esophageal sphincter**. [1] *GERD* - Patients with **GERD** primarily experience **heartburn** and **regurgitation**, with dysphagia typically less prominent and usually only for solids initially. - A **barium swallow** would not typically show a "**bird-beak**" appearance, rather potential strictures or hiatal hernia. *Esophageal stricture* - **Esophageal stricture** typically presents with **progressive dysphagia to solids only** at first, later progressing to liquids. [2] - The **barium swallow** would show a **narrowed segment**, not the characteristic "**bird-beak**" seen in achalasia. *Esophageal cancer* - **Esophageal cancer** often causes **progressive dysphagia to solids**, significant **weight loss**, and sometimes pain, but the dysphagia for liquids typically develops much later. [2] - A **barium swallow** in cancer would show an **irregular, often asymmetric narrowing** with shelf-like borders, not the classic "**bird-beak**" of achalasia.
Question 5: A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?
- A. Plummer-Vinson syndrome (Correct Answer)
- B. Pill-induced esophageal stricture due to medication use
- C. Heterotopic gastric mucosa causing esophageal narrowing
- D. Achalasia cardia with progressive dysphagia for solids and liquids
Explanation: ***Plummer-Vinson syndrome*** - This syndrome is characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **esophageal webs**. - The patient's symptoms of intermittent dysphagia for solids, angular cheilitis, glossitis, koilonychia, and pallor are all consistent with chronic **iron deficiency**. *Pill-induced esophageal stricture due to medication use* - This usually presents with a history of taking certain medications (e.g., NSAIDs, bisphosphonates, antibiotics) causing esophageal irritation and inflammation. - While it can cause dysphagia, it typically doesn't present with the systemic signs of iron deficiency such as angular cheilitis or koilonychia. *Heterotopic gastric mucosa causing esophageal narrowing* - This congenital condition ("inlet patch") is usually asymptomatic but can cause symptoms like dysphagia or heartburn if it becomes inflamed or causes stricture. - It does not explain the associated **iron deficiency anemia** and its systemic manifestations. *Achalasia cardia with progressive dysphagia for solids and liquids* - **Achalasia** features dysphagia for both solids and liquids due to impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax [1]. - While it causes dysphagia, it is not directly linked to **iron deficiency anemia** or its mucocutaneous manifestations like glossitis and koilonychia [2].
Question 6: The patient complains of intermittent dysphagia that is equal for both solids and liquids, which of the following is the most probable diagnosis?
- A. Achalasia cardia
- B. Esophageal stricture
- C. Carcinoma esophagus
- D. Diffuse esophageal spasm (Correct Answer)
Explanation: Diffuse esophageal spasm - **Intermittent dysphagia** for **both solids and liquids** is a classic presentation, as the uncoordinated spasms affect the rapid transit of both food types [2]. - The contractions are **non-peristaltic** and often painful, but the key differentiating factor from achalasia is the intermittent nature and equal difficulty with both solids and liquids. *Achalasia cardia* - Characterized by **dysphagia for both solids and liquids**, but it is typically **progressive** and constant, not intermittent [1]. - The underlying pathology is failure of the **lower esophageal sphincter to relax** and loss of esophageal peristalsis [1]. *Esophageal stricture* - Causes **dysphagia predominantly for solids** due to mechanical narrowing, with liquids usually passing more easily until the stricture is very severe [3]. - The dysphagia is typically **progressive**, rather than intermittent, as the lumen narrows over time [3]. *Carcinoma esophagus* - Presents with **progressive dysphagia primarily for solids**, which then advances to liquids as the tumor grows and obstructs the lumen. - It would not typically manifest as **intermittent dysphagia** for both solids and liquids equally.
Question 7: A 16-year-old patient complains of difficulty in swallowing, difficulty in talking and sometimes difficulty in breathing. On physical examination the presentation is similar to that shown in the picture. What would be the probable diagnosis?
- A. Ranula
- B. Lingual thyroid (Correct Answer)
- C. Enlarged adenoids
- D. Vallecular cyst
Explanation: ***Lingual thyroid*** - The image shows a **mass at the base of the tongue**, which is typical of a lingual thyroid, an ectopic thyroid tissue. - Symptoms like **difficulty swallowing (dysphagia)**, **difficulty talking (dysphonia)**, and **difficulty breathing (dyspnea)** are common with a lingual thyroid due to its obstructive nature. - Lingual thyroid results from **failure of thyroid descent** during embryological development and is the most common ectopic thyroid location. *Ranula* - A ranula is a **mucus extravasation cyst** found on the **floor of the mouth**, usually unilateral and bluish. - While it can cause speech or swallowing difficulties, its location is distinct from the mass seen at the tongue base. *Vallecular cyst* - A vallecular cyst is a **mucus retention cyst** located in the **vallecula** (between the base of tongue and epiglottis). - Can present with dysphagia and respiratory symptoms, but typically appears more **cystic and translucent** rather than solid tissue mass. - Less common in adolescents compared to lingual thyroid. *Enlarged adenoids* - Enlarged adenoids are located in the **nasopharynx** and typically cause nasal obstruction, mouth breathing, and recurrent ear infections. - They would not present as a visible mass at the base of the tongue nor cause dysphagia or dysphonia to this extent.
Question 8: A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?
- A. Parapharyngeal abscess
- B. Retropharyngeal abscess
- C. Peritonsillar abscess (Correct Answer)
- D. Ludwig's angina
Explanation: ***Peritonsillar abscess*** - The image clearly shows **unilateral bulging** of the soft palate and displacement of the tonsil medially, consistent with a peritonsillar abscess. - Patients typically present with **fever**, **dysphagia**, severe sore throat, and a "hot potato" voice. *Parapharyngeal abscess* - A parapharyngeal abscess involves the **deep neck spaces** lateral to the pharynx, often presenting with neck swelling, trismus, and systemic symptoms. - While it can cause pharyngeal bulging, the classic **medial displacement of the tonsil** is more indicative of a peritonsillar abscess. *Retropharyngeal abscess* - This involves the space behind the posterior pharyngeal wall, usually presenting with **dysphagia**, **neck stiffness**, and fever. - Imaging would reveal a **prevertebral soft tissue swelling**, not primarily a medially displaced tonsil. *Ludwig's angina* - Ludwig's angina is a **rapidly spreading cellulitis** of the submandibular and sublingual spaces, typically arising from an odontogenic infection. - It presents with **woody induration** of the neck and floor of the mouth, elevation of the tongue, and potential airway compromise, but not primarily a medially displaced tonsil.
Question 9: All of the following are true regarding Zenker's diverticulum EXCEPT?
- A. It is a false diverticulum
- B. It occurs in children (Correct Answer)
- C. It is a posterior pharyngeal pulsion diverticulum
- D. The most common site for the diverticulum is Killian's dehiscence
Explanation: **Explanation:** Zenker’s diverticulum is a **pulsion diverticulum** caused by the herniation of the pharyngeal mucosa through a site of weakness in the muscular wall. 1. **Why Option B is the correct answer (False statement):** Zenker’s diverticulum is a disease of the **elderly**, typically occurring in the 7th or 8th decade of life. It is almost never seen in children because it is an acquired condition resulting from long-term incoordination of the cricopharyngeal muscle and increased intraluminal pressure. 2. **Why Option A is wrong (True statement):** It is a **false diverticulum** because it consists only of the mucosa and submucosa. A "true" diverticulum would involve all layers of the visceral wall, including the muscularis. 3. **Why Option C is wrong (True statement):** It is a **pulsion diverticulum** (pushed out by pressure) and it occurs **posteriorly** in the midline of the pharynx. 4. **Why Option D is wrong (True statement):** The anatomical site of herniation is **Killian’s dehiscence**, a triangular area of weakness between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Regurgitation of undigested food, halitosis (foul breath due to stagnant food), dysphagia, and a gurgling sound in the neck (Boyce’s sign). * **Diagnosis:** The investigation of choice is a **Barium Swallow**, which shows a pouch behind the esophagus. * **Management:** Endoscopic Dohlman’s procedure (stapling the party wall) or open diverticulectomy with cricopharyngeal myotomy. * **Complication:** Aspiration pneumonia is the most common serious complication.
Question 10: X-ray showing an air column between a soft tissue mass and the posterior wall of the nasopharynx is suggestive of which of the following conditions?
- A. Ethmoidal polyp
- B. Antrochoanal polyp (Correct Answer)
- C. Nasal myiasis
- D. None of the above
Explanation: ### Explanation **Correct Answer: B. Antrochoanal polyp** The characteristic radiological sign described—an **air column between the soft tissue mass and the posterior pharyngeal wall**—is a classic diagnostic feature of an **Antrochoanal Polyp (ACP)**. **Why it is correct:** An Antrochoanal polyp originates from the maxillary sinus mucosa, exits through the accessory ostium, and extends into the choana and nasopharynx. Because the polyp is pedunculated and hangs down from the choana into the oropharynx, it does not typically adhere to the posterior pharyngeal wall. On a lateral neck or skull X-ray, air can pass behind the mass, creating a visible radiolucent "air gap" or column. This distinguishes it from other fixed nasopharyngeal masses. **Why the other options are incorrect:** * **Ethmoidal Polyp:** These are usually multiple, bilateral, and originate from the ethmoid air cells. They rarely grow large enough to present as a solitary mass in the nasopharynx with a distinct posterior air column. * **Nasal Myiasis:** This is a parasitic infestation of the nose by maggots (*Chrysomya bezziana*). It presents with foul-smelling discharge, pain, and tissue destruction, not as a discrete nasopharyngeal soft tissue mass on X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** ACP most commonly arises from the **maxillary sinus** (specifically the lateral wall or floor). * **Clinical Presentation:** Usually **unilateral** nasal obstruction in children and young adults. * **Radiology:** On X-ray (Water’s view), you will see opacification of the involved maxillary sinus. On CT, it shows a "dumbbell-shaped" mass extending through the ostium. * **Treatment:** The treatment of choice is **Functional Endoscopic Sinus Surgery (FESS)** to remove the polyp and its base to prevent recurrence. Historically, the Caldwell-Luc operation was used.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free