Gastrointestinal surgery: pseudoachalasia: 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: pseudoachalasia

Sample item

A 68-year-old man has had three months of progressive dysphagia and an 8 kg weight loss. Barium swallow shows a smooth bird-beak tapering at the lower oesophagus. What is the best next step?

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

The answer and the reasoning

C. Upper endoscopy with biopsy and cross-sectional imaging of the gastro-oesophageal junction

Short history, age over 60 and marked weight loss suggest pseudoachalasia from a tumour at the cardia mimicking achalasia. Malignancy must be excluded before any treatment for achalasia.

Option by option

  • A. Pneumatic balloon dilatation

    Dilatation risks perforation through an unrecognised tumour.

  • B. Laparoscopic Heller myotomy

    Myotomy is definitive for true achalasia only after malignancy is excluded.

  • C. Upper endoscopy with biopsy and cross-sectional imaging of the gastro-oesophageal junction (correct)

    Correct. Cancer at the junction must be excluded first in an older patient with rapid weight loss.

  • D. Botulinum toxin injection into the sphincter

    Botulinum toxin treats achalasia and would delay the diagnosis of cancer.

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 C, Upper endoscopy with biopsy and cross-sectional imaging of the gastro-oesophageal junction. Short history, age over 60 and marked weight loss suggest pseudoachalasia from a tumour at the cardia mimicking achalasia.

Why is "Pneumatic balloon dilatation" not the answer?

Dilatation risks perforation through an unrecognised tumour.

Why is "Laparoscopic Heller myotomy" not the answer?

Myotomy is definitive for true achalasia only after malignancy is excluded.

Why is "Botulinum toxin injection into the sphincter" not the answer?

Botulinum toxin treats achalasia and would delay the diagnosis of cancer.

What concept does this question test?

It tests Gastrointestinal surgery: pseudoachalasia in General Surgery. Malignancy must be excluded before any treatment for achalasia.

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: pseudoachalasia?

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.