Esophageal Disorders — MCQs
Corkscrew esophagus is seen in which of the following conditions ?
Which of the following is the MOST common complication associated with GERD?
A 43-year-old patient presents to the emergency department with chest pain, has a history of chronic alcoholism, and had an episode of vomiting with bright red blood. Endoscopy reveals a partial-thickness tear in the distal oesophagus. What is the diagnosis?
False statement about Barrett esophagus is:
A 70 year old patient presented with history of fever, repeated aspiration and coughing in the night. On examination there is a swelling on left side of neck which produces gurgling sound on compression. Following is the barium swallow study of the patient. What is the most likely diagnosis?
The location of Schatzki's ring is
When a spontaneous perforation of the esophagus occurs as a result of severe barotrauma while a person vomits against a closed glottis, what is this condition known as?
Gold standard investigation for diagnosing GERD:
In which of the following conditions is uniform dilation of the esophagus seen?
The patient complains of intermittent dysphagia that is equal for both solids and liquids, which of the following is the most probable diagnosis?
Esophageal Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Corkscrew esophagus is seen in which of the following conditions ?
- A. Scleroderma
- B. Achalasia cardia
- C. Diffuse esophagus spasm (Correct Answer)
- D. Carcinoma esophagus
Explanation: ***Diffuse esophagus spasm*** - **Corkscrew esophagus** is a classic radiographic finding in **diffuse esophageal spasm (DES)**, indicating multiple simultaneous, non-peristaltic contractions. [1] - This condition is characterized by **uncoordinated esophageal contractions** that can lead to chest pain and dysphagia. [1] *Scleroderma* - Scleroderma typically causes **hypomotility** or aperistalsis in the esophagus, especially in the distal two-thirds, rather than a corkscrew appearance. [1] - It results from progressive **fibrosis and atrophy of the smooth muscle**, leading to esophageal dilation and reflux symptoms. [1] *Achalasia cardia* - Achalasia is defined by the **failure of the lower esophageal sphincter (LES) to relax** and loss of peristalsis in the esophageal body, leading to a "bird-beak" appearance on barium swallow. [2] - It features a **dilated esophagus** proximally to the tight LES, not multiple indentations. [2] *Carcinoma esophagus* - Esophageal carcinoma usually presents as a **focal stricture**, mass, or irregular lumen on imaging, often causing dysphagia that is progressive. - It does not typically cause the diffuse, segmental contractions characteristic of a corkscrew esophagus.
Question 2: Which of the following is the MOST common complication associated with GERD?
- A. Chronic cough
- B. Dental erosion
- C. None of the options
- D. Esophagitis (Correct Answer)
Explanation: ***Esophagitis*** - **Reflux of gastric acid** into the esophagus directly irritates the esophageal lining, leading to inflammation and cellular damage, commonly presenting as esophagitis [1]. - This recurrent irritation causes histological changes such as **basal cell hyperplasia** and **elongation of papillae**, which are hallmarks of reflux-induced injury [1]. *Chronic cough* - While chronic cough can be a symptom of GERD, it is considered an **extraesophageal manifestation** rather than a direct complication of esophageal mucosal damage. - Its prevalence is lower than esophagitis among GERD complications and it's less direct consequence of acid exposure to the esophagus itself. *Dental erosion* - **Acid reflux** can lead to dental erosion due to the direct contact of acidic gastric contents with tooth enamel. - However, this is less common than esophagitis, which is a direct and frequent consequence of **mucosal acid exposure** within the esophagus [1].
Question 3: A 43-year-old patient presents to the emergency department with chest pain, has a history of chronic alcoholism, and had an episode of vomiting with bright red blood. Endoscopy reveals a partial-thickness tear in the distal oesophagus. What is the diagnosis?
- A. None of the options
- B. Boerhaave syndrome
- C. Alcoholic liver disease
- D. Mallory-Weiss tears (Correct Answer)
Explanation: ***Mallory-Weiss tears*** - This condition involves a **partial-thickness tear** in the **distal oesophagus** due to forceful vomiting, often seen in association with **chronic alcoholism**. [1] - The presence of **bright red blood** in the vomitus after an episode of vomiting strongly suggests a Mallory-Weiss tear. [1] *Boerhaave syndrome* - This diagnosis typically presents with a **full-thickness oesophageal rupture**, leading to mediastinitis and sepsis, which is a more severe condition than a partial tear. - While also associated with forceful vomiting, the endoscopic finding of a **partial tear** rules out Boerhaave syndrome. *Alcoholic liver disease* - While the patient has a history of **chronic alcoholism**, liver disease itself does not directly cause an oesophageal tear or bleeding from vomiting. - Alcoholic liver disease can lead to **oesophageal varices**, but the endoscopy specifically found a tear, not variceal bleeding. *None of the options* - **Mallory-Weiss tears** perfectly match the clinical presentation of chronic alcoholism, forceful vomiting, bright red blood, and the endoscopic finding of a partial-thickness tear in the distal oesophagus.
Question 4: False statement about Barrett esophagus is:
- A. Chronic GERD is the predisposing factor
- B. May lead to malignancy after few years
- C. Goblet cells seen on histology
- D. Columnar to squamous metaplasia (Correct Answer)
Explanation: ***Columnar to squamous metaplasia*** - Barrett esophagus is characterized by the replacement of the normal **squamous epithelium** of the distal esophagus with **columnar epithelium** [1]. - Therefore, the statement "Columnar to squamous metaplasia" is incorrect as it describes the opposite process, making it the false statement. *Chronic GERD is the predisposing factor* - **Chronic gastroesophageal reflux disease (GERD)** causes repeated exposure of the esophageal lining to stomach acid, leading to cellular damage [1][2]. - This chronic irritation is the primary risk factor for the development of Barrett esophagus [1]. *May lead to malignancy after few years* - Barrett esophagus is a significant risk factor for the development of **esophageal adenocarcinoma** [1][3]. - The metaplastic columnar epithelium can undergo further dysplastic changes, which can progress to invasive cancer over time [2]. *Goblet cells seen on histology* - The distinctive histological feature of Barrett esophagus is the presence of **intestinal metaplasia**, which includes the identification of **goblet cells** within the columnar epithelium [1]. - These goblet cells are a key diagnostic marker for Barrett esophagus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 348-349. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 764-765. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-766.
Question 5: A 70 year old patient presented with history of fever, repeated aspiration and coughing in the night. On examination there is a swelling on left side of neck which produces gurgling sound on compression. Following is the barium swallow study of the patient. What is the most likely diagnosis?
- A. Plummer vinson syndrome
- B. Dysphagia Lusoria
- C. Laryngocoele
- D. Zenker's diverticulum (Correct Answer)
Explanation: ***Zenker's diverticulum*** - The patient's symptoms of **fever**, **repeated aspiration**, and **coughing at night** are classic for a Zenker's diverticulum, particularly in an older patient. - The presence of a **neck swelling** producing a **gurgling sound on compression** (Boyce's sign) is highly indicative of a Zenker's diverticulum, which is essentially a pharyngeal pouch. The barium swallow image likely shows contrast pooling in such a pouch. *Plummer Vinson syndrome* - Characterized by **dysphagia**, **iron-deficiency anemia**, and **esophageal webs**. - While it causes dysphagia, it does not typically present with a gurgling neck swelling or significant aspiration as described. *Dysphagia Lusoria* - This is a rare condition caused by an **aberrant right subclavian artery** compressing the esophagus. - It primarily causes dysphagia due to extrinsic compression, without the associated neck swelling, gurgling sound, or significant aspiration risk from food pooling within a diverticulum. *Laryngocoele* - A laryngocele is an **abnormal sac** or pouch that arises from the **laryngeal ventricle** and may extend externally, presenting as a neck swelling. - While it can cause a neck swelling, it is **air-filled**, not fluid or food-filled, and therefore would not typically produce a gurgling sound on compression or be clearly visible on a barium swallow as a contrast-filled pouch like in the image provided.
Question 6: The location of Schatzki's ring is
- A. Upper esophagus
- B. Pharyngoesophageal junction
- C. Lower end of esophagus (Correct Answer)
- D. Gastric antrum
Explanation: ***Lower end of esophagus*** - Schatzki's ring is a **circumferential, thin mucosal fold** typically found at the **esophagogastric junction**. [1][2] - It is associated with **hiatal hernia** and can cause **dysphagia** for solid foods. [1] *Upper esophagus* - This region is more commonly associated with conditions like **Zenker's diverticulum** or **esophageal webs**, not Schatzki's ring. - Strictures in the upper esophagus usually have different etiologies, such as caustic injury or radiation. *Pharyngoesophageal junction* - This area is the transition between the pharynx and esophagus, and while it can have strictures or webs (e.g., **Plummer-Vinson syndrome**), it is not the typical location for Schatzki's ring. - The cricopharyngeal muscle is located here and can be a source of dysphagia. *Gastric antrum* - The gastric antrum is part of the stomach, located distal to the esophagus, and is not where Schatzki's rings form. - Conditions affecting the gastric antrum include **gastric ulcers** or **pyloric stenosis**.
Question 7: When a spontaneous perforation of the esophagus occurs as a result of severe barotrauma while a person vomits against a closed glottis, what is this condition known as?
- A. Mallory-Weiss syndrome
- B. Plummer-Vinson syndrome
- C. Boerhaave's syndrome (Correct Answer)
- D. Kallmann syndrome
Explanation: ***Boerhaave's syndrome*** - This syndrome is characterized by a **spontaneous transmural esophageal rupture** due to a sudden increase in intraesophageal pressure, typically caused by **severe retching or vomiting** against a closed glottis. - It's a medical emergency often associated with **chest pain**, **dyspnea**, and in some cases, **subcutaneous emphysema**. *Mallory-Weiss syndrome* - This involves **longitudinal mucosal tears** at the gastroesophageal junction, also caused by severe vomiting or retching, but it does not involve a full-thickness rupture. - It usually presents with **hematemesis** (vomiting blood) and is less severe than Boerhaave's syndrome. *Plummer-Vinson syndrome* - This is a rare condition characterized by **dysphagia**, **iron-deficiency anemia**, and **esophageal webs**. - It is not directly related to esophageal perforation or vomiting. *Kallmann syndrome* - This is a genetic condition characterized by **anosmia** (inability to smell) and **hypogonadotropic hypogonadism**, leading to delayed or absent puberty. - It is an endocrine disorder and has no association with esophageal conditions.
Question 8: Gold standard investigation for diagnosing GERD:
- A. 24 hour pH monitoring (Correct Answer)
- B. USG
- C. HIDA
- D. Manometry
Explanation: ***24 hour pH monitoring*** - This is considered the **gold standard** for diagnosing GERD because it directly measures the frequency and duration of **acid reflux events** into the esophagus. - It helps correlate symptoms with reflux episodes, providing objective evidence for the diagnosis and guiding treatment. *USG* - **Ultrasound (USG)** is primarily used for imaging abdominal organs like the **gallbladder**, liver, and kidneys, not for directly assessing esophageal acid reflux. - While it can sometimes detect complications, it cannot diagnose the presence or severity of GERD itself. *HIDA* - **HIDA scan** (hepatobiliary iminodiacetic acid scan) is used to diagnose problems of the **gallbladder** and bile ducts, such as cholecystitis or biliary obstruction. - It is not relevant for the diagnosis of gastroesophageal reflux disease. *Manometry* - **Esophageal manometry** measures the **pressure and coordination of esophageal muscle contractions**, assessing motility disorders [1]. - While it can identify related conditions like achalasia or ineffective peristalsis, it does not directly measure acid reflux and therefore is not the gold standard for GERD diagnosis.
Question 9: In which of the following conditions is uniform dilation of the esophagus seen?
- A. Achalasia and Diffuse esophageal spasm (Correct Answer)
- B. Esophageal strictures and Nutcracker esophagus
- C. Nutcracker esophagus and Esophageal cancer
- D. Esophageal strictures and Esophageal cancer
Explanation: ***Achalasia and Diffuse esophageal spasm*** - In **achalasia**, there is a **loss of ganglion cells** in Auerbach's plexus [1], leading to **impaired relaxation of the lower esophageal sphincter** and a lack of peristalsis in the esophageal body, resulting in proximal dilation [1]. - **Diffuse esophageal spasm** involves **simultaneous, high-amplitude, non-peristaltic contractions** causing dysphagia and chest pain, which can lead to a "corkscrew" appearance on imaging but also generalized esophageal dilation due to inefficient bolus transit. *Esophageal strictures and Nutcracker esophagus* - **Esophageal strictures** typically cause **focal narrowing** of the esophagus, proximal to which there may be dilation [2], but not uniform dilation along the entire length. - **Nutcracker esophagus** is characterized by **high-amplitude peristaltic contractions** and does not typically involve uniform esophageal dilation [2]. *Nutcracker esophagus and Esophageal cancer* - As mentioned, **Nutcracker esophagus** features strong, coordinated contractions but **no structural dilation** [2]. - **Esophageal cancer** often presents as a **focal mass** or stricture, which can obstruct the lumen and cause proximal dilation, but not uniform dilation. *Esophageal strictures and Esophageal cancer* - Both **esophageal strictures** and **esophageal cancer** are typically associated with **localized narrowing** and obstruction, leading to focal or proximal dilation rather than a uniform dilation of the entire esophagus.
Question 10: 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.
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