[MCQ] Diseases of the Esophagus- Part 3

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Diseases of the Esophagus- Part 2

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Congratulations - you have completed Diseases of the Esophagus- Part 2. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Esophageal peristalsis is best studied in ?

A	Upright position
B	Recumbent position
C	Lateral position
D	Head down position

Question 1 Explanation:

Esophageal peristalsis is best studied in the recumbent position, because in the upright position barium passage occurs largely by gravity alone.

Question 2

Motility pattern of esophagus showing reduced amplitude of contractions in lower esophagus, peristaltic or simultaneous in onset with hypotension of LES is suggestive of ?

A	Scleroderma
B	Achalasia
C	Diffuse esophageal spasm
D	None of the above

Question 2 Explanation:

In scleroderma, thoracic esophagus shows reduced amplitude of contractions, which may be peristaltic or simultaneous in onset & hypotension of LES

Question 3

Motility pattern of esophagus showing reduced amplitude of contractions in lower esophagus, simultaneous in onset with hypertensive LES nonrelaxing on swallowing is suggestive of ?

A	Scleroderma
B	Achalasia
C	Diffuse esophageal spasm
D	None of the above

Question 3 Explanation:

In achalasia, lower part of esophagus shows contractions that are reduced in amplitude & simultaneous in onset. In contrast to scleroderma, LES in achalasia is hypertensive and fails to relax in response to a swallow

Question 4

Motility pattern of esophagus showing large amplitude, prolonged and repetitive contractions in lower esophagus, simultaneous in onset is suggestive of ?

A	Scleroderma
B	Achalasia
C	Diffuse esophageal spasm
D	Diffuse esophageal spasm

Question 4 Explanation:

In diffuse esophageal spasm, lower part of esophagus shows simultaneous-onset, large-amplitude, prolonged, repetitive contractions.

Question 5

Esophageal motility studies are helpful in the diagnosis of all except ?

A	Achalasia
B	Diffuse esophageal spasm
C	Scleroderma
D	Mechanical dysphagia

Question 5 Explanation:

Esophageal motility studies are helpful in the diagnosis of esophageal motor disorders (achalasia, spasm, and scleroderma) but are of little value in the differential diagnosis of mechanical dysphagia.

Question 6

Which is the most common type of hiatal hernia ?

A	Type I
B	Type II
C	Type III
D	Type IV

Question 6 Explanation:

Type I or sliding hiatal hernia comprising ~95% of hiatus hernias

Question 7

When colon herniate into the mediastinum, the type of hiatus hernia is ?

A	Type I
B	Type II
C	Type III
D	Type IV

Question 7 Explanation:

With type IV hiatal hernias, viscera other than stomach herniate into mediastinum, most commonly the colon.

Question 8

Intersection of squamous epithelium of tubular oesophagus & columnar epithelium of stomach is termed ?

A	W line
B	W line
C	Y line
D	Z line

Question 8 Explanation:

The intersection of squamous epithelium of the tubular oesophagus & columnar epithelium of stomach is termed Z line, because of jagged appearance of the interface.

Question 9

A lower esophageal mucosal ring is also called ?

A	A ring
B	B ring
C	C ring
D	D ring

Question 9 Explanation:

A lower esophageal mucosal ring, also called B ring, is a thin membranous narrowing at the squamocolumnar mucosal junction

Question 10

Location of ‘Schatzki ring’ is ?

A	Hypopharyngeal
B	Mid esophageal
C	Lower esophageal
D	Lower esophageal

Question 10 Explanation:

Schatzki ring is a lower esophageal mucosal ring. It is a thin, weblike constriction located at the squamo-columnar mucosal junction at or near the border of the LES. It may result from GERD or be congenital in origin

Question 11

Schatzki ring invariably produces dysphagia when the lumen diameter is ?

A	< 1.3 cm
B	< 2.3 cm
C	< 3.3 cm
D	< 4.3 cm

Question 11 Explanation:

Schatzki ring invariably produces dysphagia when the lumen diameter is <1.3 cm.

Question 12

“Steakhouse syndrome” best relates to ?

A	Mouth
B	Oesophagus
C	Stomach
D	Colon

Question 12 Explanation:

Schatzki ring is one of the most common causes of intermittent food impaction, also called “steakhouse syndrome” as meat is a typical instigator.

Question 13

Which of the following is false about Plummer-Vinson syndrome ?

A	Young women
B	Symptomatic proximal esophageal web
C	Iron-deficiency anemia
D	All of the above

Question 13 Explanation:

Symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women constitutes Plummer-Vinson syndrome.

Question 14

Which of the following is false about Zenker’s diverticula ?

A	Hypopharyngeal
B	False diverticula
C	Associated with distal obstruction
D	None of the above

Question 15

Which of the following is false about Zenker’s diverticulum ?

A	Hypopharyngeal
B	False diverticula
C	Associated with distal obstruction
D	None of the above

Question 16

Which of the following is false about Zenker’s diverticulum ?

A	Occurs below the Killian’s triangle
B	Causes halitosis & regurgitation of saliva & food
C	Nasogastric intubation may cause perforation
D	Symptomatic pt’s treated by cricopharyngeal myotomy

Question 16 Explanation:

Zenker’s diverticulum appears in natural zone of weakness in posterior hypopharyngeal wall (Killian’s triangle).

Question 17

Esophageal inlet patch best relates to ?

A	Esophageal atresia
B	Benign esophageal tumor
C	Heterotopic gastric mucosa
D	Zenker’s diverticula

Question 17 Explanation:

Heterotopic gastric mucosa, also known as an esophageal inlet patch, is an area of gastric type epithelium in proximal cervical esophagus. The inlet patch is due to incomplete replacement of embryonic columnar epithelium with squamous epithelium.

Question 18

Which of the following statements about achalasia is false ?

A	Motor disorder of esophageal smooth muscle
B	UES & LES relax normally with swallowing
C	Nonperistaltic contractions in esophageal body
D	Underlying abnormality is loss of intramural neurons

Question 18 Explanation:

With a swallow, pressure in sphincters falls and a contraction wave starts in pharynx and progresses down the esophagus. In achalasia, esophageal body loses peristaltic contractions & are replaced by simultaneous contractions with elevated resting pressure & LES does not relax normally in response to swallowing. Prominent degeneration of nerve cell bodies seen in achalasia.

Question 19

Which of the following statements about achalasia is false ?

A	Underlying abnormality is loss of intramural neurons
B	Inhibitory neurons containing substance P are predominantly involved
C	Inhibitory neurons containing VIP are involved
D	Presence of GE reflux goes against achalasia

Question 19 Explanation:

Inhibitory neurons containing VIP and nitric oxide synthase are predominantly involved

Question 20

Which of the following is not a feature of achalasia ?

A	Dysphagia
B	Gastroesophageal reflux
C	Chest pain
D	Regurgitation

Question 20 Explanation:

Dysphagia, chest pain, regurgitation and weight loss are the main symptoms of achalasia. Presence of gastroesophageal reflux goes against achalasia

Question 21

Chest x-ray in achalasia may show all except ?

A	Absence of the gastric air bubble
B	Tubular mediastinal mass beside the aorta
C	Air-fluid level in mediastinum in upright position
D	Atelectasis

Question 21 Explanation:

A chest x-ray shows absence of the gastric air bubble and sometimes a tubular mediastinal mass beside the aorta. An air-fluid level in the mediastinum in the upright position represents retained food in the esophagus. Barium swallow shows esophageal dilation, and in advanced cases the esophagus may become sigmoid. On fluoroscopy with barium swallow, normal peristalsis is lost in the lower two-thirds of the esophagus. The terminal part of the esophagus shows a persistent beaklike narrowing representing the nonrelaxing LES.

Question 22

In CCK test, paradoxical contraction of LES is found in ?

A	Achalasia
B	Gastric carcinoma
C	Scleroderma
D	Diffuse esophageal spasm

Question 22 Explanation:

In achalasia, Cholecystokinin (CCK) paradoxically causes contraction of LES (CCK test) because neurally transmitted inhibitory effect of CCK is absent & direct excitatory effect of CCK remains unopposed

Question 23

In achalasia, which is the treatment of choice ?

A	Pneumatic dilatation
B	Esophageal resection with gastric pull-up
C	Laparoscopic Heller myotomy of LES
D	Open surgical myotomy of LES

Question 23 Explanation:

Laparoscopic Heller myotomy is currently the procedure of choic

Question 24

Secondary achalasia may be caused by all except ?

A	Ulcerative colitis
B	Chagas’ disease
C	Eosinophilic gastroenteritis
D	Neurodegenerative disorders

Question 25

Which of the following is not a hypertensive motor disorder of esophagus ?

A	Diffuse esophageal spasm (DES)
B	Nutcracker esophagus
C	Hypercontracting LES
D	Hypertensive LES

Question 25 Explanation:

The hypertensive disorders of esophagus include nutcracker esophagus, hypercontracting LES and hypertensive LES. DES is characterized by nonperistaltic contractions.

Question 26

Esophageal contractions are normally peristaltic but hypertensive in ?

A	Nutcracker esophagus
B	Hypercontracting LES
C	Hypertensive LES
D	All of the above

Question 26 Explanation:

In nutcracker esophagus, esophageal contractions are normally peristaltic but hypertensive. In hypercontracting LES, normal sphincter relaxation is followed by hypertensive contraction. In hypertensive LES, basal LES pressure is elevated, but sphincter relaxation and contraction are normal

Question 27

“Corkscrew” esophagus is typical of ?

A	Diffuse esophageal spasm (DES)
B	Achalasia
C	Carcinoma esophagus
D	GERD

Question 28

Which of the following contributes to the development of gastroesophageal reflux disease (GERD) ?

A	Transient LES relaxations
B	LES hypotension
C	Anatomic distortion of esophagogastric junction
D	All of the above

Question 29

Which of the following may have a protective effect in GERD patients ?

A	Zollinger-Ellison syndrome
B	Chronic H. pylori gastritis
C	Hiatus hernia
D	Scleroderma

Question 29 Explanation:

Chronic H. pylori gastritis may have a protective effect in GERD by inducing atrophic gastritis with concomitant hypoacidity

Question 30

Which out of the following conditions has associations with GERD ?

A	Pulmonary fibrosis
B	Chronic sinusitis
C	Cardiac arrhythmias
D	All of the above

Question 30 Explanation:

Extraesophageal syndromes that have established association to GERD include chronic cough, laryngitis, asthma & dental erosions. Other conditions like pharyngitis, chronic bronchitis, pulmonary fibrosis, chronic sinusitis, cardiac arrhythmias, sleep apnea, and recurrent aspiration pneumonia have proposed associations with GERD.

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See all quizzes of Diseases of the Esophagus at here:

Diseases of the Esophagus- Part 1| Diseases of the Esophagus- Part 2| Diseases of the Esophagus- Part 3

1.Multiple esophageal mucosal rings are characteristic of ?
A. Eosinophilic esophagitis

B. Radiation esophagitis
C. Corrosive esophagitis
D. Candida Esophagitis

2. Risk of development of esophageal adenocarcinoma in
Barrett’s metaplasia is increased by ?
A. 5 fold
B. 10 fold
C. 15 fold
D. 20 fold

3. Esophageal mucosal biopsies should be taken at least ?
A. 2 cm above the LES
B. 5 cm above the LES
C. 7 cm above the LES
D. 9 cm above the LES

3. Which of the following about Bernstein test is false ?
A. Infusion of 0.1 N HCl & saline in esophagus
B. Useful in diagnosing Barrett’s esophagus that is not
endoscopically obvious
C. In symptomatic esophagitis, infusion of acid, but not of saline,
reproduces symptoms of heartburn
D. Infusion of acid in normal individuals produces no symptom

4. Which of the following statements about Barrett’s esophagus is false ?
A. Barrett’s esophagus is an acquired condition
B. Metaplasia occurs from esophageal columnar to
squamous epithelium
C. Complication of severe reflux esophagitis
D. Risk factor for esophageal adenocarcinoma

5. Which of the following groups is at greatest risk of Barrett’s
metaplasia progressing to adenocarcinoma ?
A. Obese black males in fifth decade of life
B. Obese white males in fifth decade of life
C. Obese black males in sixth decade of life
D. Obese white males in sixth decade of life

6. Methods for mucosal ablation in Barrett’s esophagus include
all except ?
A. Electrocautery
B. Mucosal stripping
C. Argon-plasma-beam fulguration
D. Chemical fulguration
7. Methods for mucosal ablation in Barrett’s esophagus include
all except ?
A. Laser photothermal coagulation
B. Heater-probe ablation
C. Hyperbaric oxygen ablation
D. Cryotherapy
8. Photosensitizing agent used in photodynamic therapy for
Barrett’s esophagus is ?
A. Trigen sodium
B. Porfimer sodium
C. Sugran sodium
D. Mofetil sodium
9. Which of the following foods is “refluxogenic” ?
A. Peppermint
B. Tomato-based foods
C. Alcohol
D. All of the above

10. Absorption of which of the following may be compromised on
indefinite treatment with PPIs ?
A. Vitamin B12
B. Calcium
C. Iron
D. All of the above
11. Characteristic endoscopic finding of Eosinophilic Esophagitis is ?
A. Multiple esophageal rings
B. Linear furrows
C. Punctate exudates
D. All of the above

12. For diagnosis of eosinophilic esophagitis, eosinophils in
esophagal mucosa per high-power field should be ?
A. 5 or more

B. 10 or more
C. 15 or more
D. 20 or more

13. Preferred treatment of eosinophilic esophagitis is ?
A. H
2 receptor blocking agents
B. Nifedipine
C. Swallowed fluticasone propionate
D. Isosorbide dinitrate

14. Odynophagia is a characteristic symptom of ?
A. Pill-induced esophagitis
B. Reflux esophagitis
C. Esophageal perforation
D. Infectious esophagitis

15 Which of the following is characteristic of Candida esophagitis ?
A. Bleeding
B. White plaques with friability
C. Perforation
D. Stricture

16. Candida esophagitis can be treated with ?
A. Fluconazole
B. Itraconazole
C. Amphotericin B
D. Any of the above
17. “Volcano-like” oesophageal ulcerations are seen in ?
A. Candidiasis
B. HSV
C. CMV
D. Corrosive poisoning

18. Herpes simplex virus (HSV) esophagitis is treated with ?
A. Acyclovir
B. Foscarnet
C. Famciclovir
D. All of the above

19. Which of the following infections occur only in immunocompromised patients ?
A. Herpes simplex virus (HSV) esophagitis
B. Varicella-zoster virus (VZV) esophagitis
C. Cytomegalovirus (CMV) esophagitis
D. Candida esophagitis

20. Serpiginous ulcers in an otherwise normal esophageal mucosa
is a feature of ?
A. Herpes simplex virus (HSV) esophagitis
B. Varicella-zoster virus (VZV) esophagitis
C. Cytomegalovirus (CMV) esophagitis
D. Candida Esophagitis

21. Ganciclovir is the treatment of choice for ?
A. Herpes simplex virus (HSV) esophagitis
B. Varicella-zoster virus (VZV) esophagitis
C. Cytomegalovirus (CMV) esophagitis
D. Candida Esophagitis

22. Boerhaave’s syndrome refers to ?
A. Esophagial damage due to instrumentation
B. Esophagial damage due to vomiting or retching
C. Esophagial damage due to external trauma
D. None of the above

23. Instrumental perforation usually occurs in ?
A. Upper esophagus
B. Mid esophagus
C. Lower esophagus
D. Any of the above
.
24. Mallory-Weiss Syndrome can be caused by ?
A. Vomiting
B. Retching
C. Vigorous coughing
D. All of the above

25. Which of the following is false about Mallory-Weiss Syndrome ?
A. Usually involves esophageal mucosa
B. Upper gastrointestinal bleeding
C. In most patients bleeding ceases spontaneously
D. Respond to vasopressin therapy

26. Treatment with which of the following can reduce esophagitis during radiation treatment ?
A. Cimetidine
B. Indomethacin
C. Allopurinol
D. Sucralfate

27. Patients with alkaline esophagitis are treated with ?
A. Cholestyramine
B. Aluminum hydroxide
C. Sucralfate
D. All of the above

28. Pill-induced esophagitis can be caused by all except ?
A. Alendronate
B. Ferrous sulfate
C. Doxycycline
D. Medroxyprogesterone

29. Esophageal lesion in systemic sclerosis consist of ?
A. Atrophy of smooth muscle
B. Weakness in lower two-thirds of esophagus
C. Incompetence of LES
D. All of the above

30. “Strawberry gums” is a pathognomonic sign of ?
A. Wegener’s granulomatosis
B. Acute myelomonocytic leukemia
C. Down’s syndrome
D. Diabetes mellitus

Diseases of the Esophagus

[MCQ] Diseases of the Esophagus- Part 3

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Diseases of the Esophagus- Part 2

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