Gastrointestinal surgery: epiphrenic diverticulum: practice question

A General Surgery 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 Surgery · Gastrointestinal surgery: epiphrenic diverticulum

Sample item

A 62-year-old man has dysphagia and regurgitation. Barium swallow shows a 5 cm pouch arising from the lower oesophagus a few centimetres above the diaphragm. What is the most important associated finding to look for before planning surgery?

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

The answer and the reasoning

B. An oesophageal motility disorder

Epiphrenic diverticula are pulsion diverticula that usually accompany a motility disorder such as achalasia or diffuse spasm. Manometry is therefore needed, and surgery combines diverticulectomy with a myotomy to treat the underlying disorder and reduce the risk of leak.

Option by option

  • A. Plummer-Vinson web

    A post-cricoid web is a feature of Plummer-Vinson syndrome and is unrelated to a distal pouch.

  • B. An oesophageal motility disorder (correct)

    Correct. Distal pulsion pouches are driven by raised intraluminal pressure from a motility disorder.

  • C. Mediastinal tuberculous nodes

    Traction from tuberculous nodes causes mid-oesophageal traction diverticula.

  • D. A cricopharyngeal bar

    A cricopharyngeal bar is associated with pharyngeal (Zenker) pouches in the neck.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is B, An oesophageal motility disorder. Epiphrenic diverticula are pulsion diverticula that usually accompany a motility disorder such as achalasia or diffuse spasm.

Why is "Plummer-Vinson web" not the answer?

A post-cricoid web is a feature of Plummer-Vinson syndrome and is unrelated to a distal pouch.

Why is "Mediastinal tuberculous nodes" not the answer?

Traction from tuberculous nodes causes mid-oesophageal traction diverticula.

Why is "A cricopharyngeal bar" not the answer?

A cricopharyngeal bar is associated with pharyngeal (Zenker) pouches in the neck.

What concept does this question test?

It tests Gastrointestinal surgery: epiphrenic diverticulum in General Surgery. Manometry is therefore needed, and surgery combines diverticulectomy with a myotomy to treat the underlying disorder and reduce the risk of leak.

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 Gastrointestinal surgery: epiphrenic diverticulum?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.