Oesophagus: posterior mediastinal relations: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Oesophagus: posterior mediastinal relations

Sample item

A 35-year-old woman with long-standing rheumatic mitral stenosis has mild dysphagia for solids. A barium swallow shows a smooth indentation of the anterior wall of the lower thoracic oesophagus with normal mucosa. Which structure is responsible?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Enlarged left atrium

The left atrium forms most of the base of the heart and lies directly in front of the lower thoracic oesophagus, separated by the pericardium. Gross left atrial enlargement in mitral stenosis can indent the oesophagus and cause dysphagia. The aortic arch and left main bronchus indent it higher, at the normal constrictions.

Option by option

  • A. Diaphragmatic crura

    The crura form the oesophageal hiatus and do not cause an anterior smooth indentation.

  • B. Left main bronchus

    The left main bronchus indents the oesophagus at its normal constriction at the level of T5, above the left atrium.

  • C. Aortic arch

    The aortic arch makes a normal indentation higher up, at the left side of the upper oesophagus.

  • D. Enlarged left atrium (correct)

    Correct. The enlarged left atrium lies in front of the lower oesophagus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Anatomy questions

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Enlarged left atrium. The left atrium forms most of the base of the heart and lies directly in front of the lower thoracic oesophagus, separated by the pericardium.

Why is "Diaphragmatic crura" not the answer?

The crura form the oesophageal hiatus and do not cause an anterior smooth indentation.

Why is "Left main bronchus" not the answer?

The left main bronchus indents the oesophagus at its normal constriction at the level of T5, above the left atrium.

Why is "Aortic arch" not the answer?

The aortic arch makes a normal indentation higher up, at the left side of the upper oesophagus.

What concept does this question test?

It tests Oesophagus: posterior mediastinal relations in Anatomy. Gross left atrial enlargement in mitral stenosis can indent the oesophagus and cause dysphagia. The aortic arch and left main bronchus indent it higher, at the normal constrictions.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Oesophagus: posterior mediastinal relations?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.