Oesophagus: Zenker 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 · Oesophagus: Zenker diverticulum

Sample item

An elderly man has halitosis, regurgitation of undigested food eaten the day before and a gurgling swelling in the left neck. Where does this pouch arise?

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

The answer and the reasoning

D. Between thyropharyngeus and cricopharyngeus (Killian dehiscence)

A Zenker diverticulum is a false pulsion pouch of mucosa herniating through Killian dehiscence, a weak area between the oblique and transverse fibres of the inferior constrictor. Cricopharyngeal dysfunction raises the pressure that drives the herniation. Treatment is cricopharyngeal myotomy with diverticulectomy or stapling, and blind passage of a nasogastric tube risks perforating the sac.

Option by option

  • A. Immediately above the lower oesophageal sphincter

    A pouch just above the LES is an epiphrenic diverticulum.

  • B. Mid-oesophagus opposite the carina

    Mid-oesophageal diverticula are traction type, often from mediastinal TB nodes.

  • C. Gastric cardia

    The gastric cardia is not the origin of a cervical swelling.

  • D. Between thyropharyngeus and cricopharyngeus (Killian dehiscence) (correct)

    Correct. Killian dehiscence is the site of a Zenker pouch.

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 D, Between thyropharyngeus and cricopharyngeus (Killian dehiscence). A Zenker diverticulum is a false pulsion pouch of mucosa herniating through Killian dehiscence, a weak area between the oblique and transverse fibres of the inferior constrictor.

Why is "Immediately above the lower oesophageal sphincter" not the answer?

A pouch just above the LES is an epiphrenic diverticulum.

Why is "Mid-oesophagus opposite the carina" not the answer?

Mid-oesophageal diverticula are traction type, often from mediastinal TB nodes.

Why is "Gastric cardia" not the answer?

The gastric cardia is not the origin of a cervical swelling.

What concept does this question test?

It tests Oesophagus: Zenker diverticulum in General Surgery. Cricopharyngeal dysfunction raises the pressure that drives the herniation. Treatment is cricopharyngeal myotomy with diverticulectomy or stapling, and blind passage of a nasogastric tube risks perforating the sac.

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: Zenker 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.