Gastroenterology and hepatology: diffuse oesophageal spasm manometry: practice question

A General Medicine 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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General Medicine · Gastroenterology and hepatology: diffuse oesophageal spasm manometry

Sample item

A 50-year-old woman has intermittent chest pain and dysphagia for both solids and liquids, often triggered by cold drinks. A barium swallow shows a corkscrew appearance, and coronary angiography is normal. Which manometric finding is characteristic?

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

The answer and the reasoning

C. Intermittent premature contractions with normal peristalsis in between

Distal oesophageal spasm shows premature simultaneous contractions in a proportion of swallows, while some normal peristalsis is preserved. The barium appearance is corkscrew or rosary-bead. Calcium channel blockers, nitrates and peppermint oil may help.

Option by option

  • A. Normal propagation with very high-amplitude distal contractions

    Preserved propagation with very high-amplitude contractions describes hypercontractile (jackhammer) oesophagus.

  • B. Absent peristalsis with a very low lower oesophageal sphincter pressure

    Absent peristalsis with a low sphincter pressure is typical of the oesophagus in systemic sclerosis.

  • C. Intermittent premature contractions with normal peristalsis in between (correct)

    Correct. Premature contractions interspersed with normal peristalsis define distal spasm.

  • D. Absent peristalsis with incomplete relaxation of the lower oesophageal sphincter

    Absent peristalsis with poor sphincter relaxation is achalasia, which gives a bird's beak.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Intermittent premature contractions with normal peristalsis in between. Distal oesophageal spasm shows premature simultaneous contractions in a proportion of swallows, while some normal peristalsis is preserved.

Why is "Normal propagation with very high-amplitude distal contractions" not the answer?

Preserved propagation with very high-amplitude contractions describes hypercontractile (jackhammer) oesophagus.

Why is "Absent peristalsis with a very low lower oesophageal sphincter pressu…" not the answer?

Absent peristalsis with a low sphincter pressure is typical of the oesophagus in systemic sclerosis.

Why is "Absent peristalsis with incomplete relaxation of the lower oesophagea…" not the answer?

Absent peristalsis with poor sphincter relaxation is achalasia, which gives a bird's beak.

What concept does this question test?

It tests Gastroenterology and hepatology: diffuse oesophageal spasm manometry in General Medicine. The barium appearance is corkscrew or rosary-bead. Calcium channel blockers, nitrates and peppermint oil may help.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Gastroenterology and hepatology: diffuse oesophageal spasm manometry?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.